Effects of a Phase-Based PRISM Intervention on Psychological Resilience and Treatment Adherence in Children Undergoing Radiotherapy for Cancer: A Randomized Controlled Trial

<title>Abstract</title> <p> <bold>Objective</bold> To investigate the effects of a phase-based psychological intervention based on the Promoting Resilience in Stress Management (PRISM) model on psychological resilience and treatment adherence among children undergoing radiotherapy for cancer. <bold>Methods</bold> A total of 40 pediatric oncology patients receiving radiotherapy at the Department of Radiation Oncology, Sun Yat-sen University Cancer Center, between November 2025 and April 2026 were enrolled and randomly assigned to either an intervention group (n = 20) or a control group (n = 20) using a random number table method. The control group received routine radiotherapy education and standard preparation, whereas the intervention group additionally received a phase-based PRISM intervention consisting of four modules: stress management, goal setting, cognitive reframing, and meaning-making. Psychological resilience, emotional status, behavioral problems, and treatment adherence were assessed at baseline and weekly during radiotherapy using the Connor–Davidson Resilience Scale (CD-RISC), Depression Anxiety Stress Scale-21 (DASS-21), Conners Children's Behavior Scale, and Frankl Compliance Scale, respectively. Positioning time was also recorded throughout treatment. <bold>Results</bold> No significant differences were observed between the two groups in baseline demographic characteristics or outcome measures (all P &gt; 0.05). Repeated-measures analyses demonstrated that psychological resilience scores increased significantly over time in the intervention group, with a more favorable trajectory than that observed in the control group (P &lt; 0.05). At the completion of radiotherapy, depression scores were significantly lower in the intervention group than in the control group (P &lt; 0.05), while anxiety and stress scores showed downward trends. Children in the intervention group demonstrated significantly better Frankl compliance ratings and a higher proportion of good or excellent treatment adherence than those in the control group (P &lt; 0.05). Positioning time decreased progressively in both groups during radiotherapy. Although a larger numerical reduction was observed in the intervention group, the between-group difference did not reach statistical significance. Behavioral problem scores showed improvement within the intervention group; however, between-group differences were not statistically significant. <bold>Conclusions</bold> A phase-based psychological intervention based on the PRISM model can enhance psychological resilience among children undergoing radiotherapy for cancer and may improve treatment adherence. Psychological resilience may represent an important factor underlying treatment adaptation. These findings suggest that the PRISM intervention has promising clinical value and may serve as an effective supportive care strategy in pediatric radiation oncology. </p>