AI‐Enhanced Versus Clinician‐Guided Expressive Writing for Improving Psychological Well‐Being in Cancer Survivors: A Randomized Controlled Trial

AIMS: Digital tools offer scalable support for cancer survivors' psychological well-being, however, direct efficacy comparisons between artificial intelligence (AI)-Enhanced and clinician-guided digital interventions are scarce. This study evaluated an AI-Enhanced expressive writing intervention against clinician-guided digital support and usual care for cancer survivors. METHODS: In this randomized controlled trial, 120 cancer survivors (111 completers) were randomized (1:1:1) to AI-Enhanced, clinician-guided, or usual care groups for a 4-week expressive writing intervention. Outcomes, including depression, anxiety, fear of progression (FoP), and resilience, were assessed at baseline, post-intervention, and 1-month follow-up between September 2024 and April 2025. Data were analyzed using repeated-measures ANOVAs and thematic analysis of semi-structured interviews. RESULTS: Both AI and clinician-guided interventions significantly reduced depression (AI: d = 0.92; Clinician: d = 0.98) and anxiety (AI: d = 0.59; Clinician: d = 0.66) versus usual care, with comparable efficacy. However, clinician-guided support demonstrated greater efficacy in reducing FoP (d = 0.62 vs. AI). Resilience improved over time across all groups, with no significant inter-group differences. Qualitatively, AI offered reduced stigma and accessibility, while the clinician-guided approach provided valued empathetic connection. CONCLUSION: AI-Enhanced expressive writing is a viable, scalable tool for reducing depression and anxiety in cancer survivors. Yet, the greater efficacy of clinician-guided digital support for complex issues like FoP highlights the value of human-mediated empathy. This advocates for hybrid models in psychological care that integrate AI's scalability with the relational depth of clinical expertise to enhance survivor well-being. TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR2400089455).