Feasibility, acceptability, and experienced benefits of kind acts and gratitude letter interventions among collectivist and individualist culture cancer patients and caregivers: A pilot study.

This was a pilot, and the trial yielded only 2 to 6 patients per cell, so it cannot show that the activities improve well-being. Interviews were optional, and only 13 were conducted, so the interview sample may not represent all participants. Only 1 individualist gratitude interview was available, and 1 interview could not be analyzed because of a recording error. The consent rate was 19%, and many contacted people could not be reached, so recruitment may not reflect other settings. The sample was mostly breast and prostate cancer, and collectivist patients were mostly Latino, so results may not apply to other cancers or cultures. The study was done at a top-ranked cancer hospital with many college-educated participants, so lower socioeconomic groups may be underrepresented. Culture was classified by ethnicity, and sex may have confounded cultural effects.

No competing interests were declared.

Do not read the reported benefits as proof that kind acts or gratitude letters improve cancer patients' well-being. The trial was a pilot, cells had 2 to 6 patients, and the paper says well-being effect sizes would be meaningless.