The control arm will receive the NCI booklet, "Taking Time: Support for People with Cancer," which provides basic strategies for symptom (e.g., pain, fatigue, stress) management, coping with negative emotions, and communication and will continue their usual medical care of advanced cancer.

Fatigue will be assessed using the PROMIS Computer Adaptive Test for Fatigue. Questions ask participants to rate their fatigue during the past 7 days. The T-score ranges from 0 to 100, where higher T-scores indicate greater fatigue. Scores are converted to standardized t-scores with a mean of 50 and standard deviation of 10. T-scores of 55 to <60 indicate mild levels of fatigue, ≥60 to <70 indicates moderate levels of fatigue, and ≥70 indicate severe levels of fatigue.

Depressive Symptoms will be assessed using the PROMIS Computer Adaptive Test for Depression. Questions ask participants to respond to questions during the past 7 days. Scores are converted to standardized T-scores with a mean of 50 and standard deviation of 10. Higher T-scores indicate higher levels of depression. T-scores of 55 to <60 indicate mild levels of depression, ≥60 to <70 indicates moderate levels of depression, and ≥70 indicate severe levels of depression.

The Self-Efficacy for Managing Chronic Disease Scale is a 6-item scale. Participants rate their confidence in keeping pain, fatigue, emotional distress, and other symptoms from interfering with things they want to do on a scale from 1 "not at all confident" to 10 "totally confident." The score for the scale is the mean of the six items, with higher number indicating higher self-efficacy.

7-Item: The Acceptance and Action Questionnaire-II assesses acceptance, experiential avoidance and psychological flexibility. Question scale ranges from 1, never true, to 7, always true. The total score ranges from 7 to 49, where a higher score indicates greater psychological inflexibility.

The FACIT assesses the spiritual wellbeing of participants with 12-item questionnaire. Responses for each item are on a scale from 0 = "not at all" to 4 = "very much." Three subscale scores (Meaning, Peace, Faith) are calculated by summing specific items. Each subscale has 4 items, with total scores ranging from 0 to 16, with higher scores indicating greater well-being for each subscale (Meaning, Peace, or Faith). A total score is calculated as the sum of the three subscores, with total scores ranging from 0 to 48. Higher scores represent greater spiritual wellbeing.

The PROMIS Computer Adaptive Test for Anxiety will be used to assess anxiety symptoms in the last week. Scores are converted to standardized T-scores with a mean of 50 and standard deviation of 10. Higher T-scores indicate higher levels of anxiety. T-scores of 55 to <60 indicate mild levels of anxiety, ≥60 to <70 indicates moderate levels of anxiety, and ≥70 indicate severe levels of anxiety.

The SSTS-R is a 13-item measure. The first 12-items ask participants to rate their satisfaction with the therapy received (6-items) or the therapist delivering the intervention (6-items) on a five-point scale ranging from 1 "strongly disagree" to 5 "strongly disagree." Each of the subscales (Satisfaction With Therapy and Satisfaction With Therapist) range from 6 to 30, with higher scores indicating greater satisfaction. The 13th item (Global Improvement) asks, "How much did the intervention help with your symptoms?" with 5 answer choices ranging from 1 "made things a lot worse" to 5 "made things a lot better," where higher scores indicate a better outcome.

The Bulls Eye Values Survey assists participants with clarifying their values and will be used to examine participants' personal values, values attainment, and persistence towards values in the face of barriers. Part 1 asks the person to record values for 4 domains (work/education, relationships, personal growth/health, and leisure). Then, participants are asked to think of their values in each domain as "bull's eye" (the middle of the dart board). A 1 is equal to a hit in the bull's eye, which means that they are living completely in keeping with their value for that area of living. An 8 is equal to far from the bull's eye, which means that their life is way off the mark in terms of how they are living their life. Part 2 asks the person to identify obstacles to those values and rate from 1, "doesn't prevent me at all", to 7, "prevents me completely".

Participants' use of intervention strategies will be assessed using a measure developed specific to components of the proposed intervention. Participants will be asked about how frequently treatment strategies discussed in session have been used outside of session since the previous session or last assessment depending on the timing of the questionnaire. A scale ranging from 0 "not at all" to 4 "6 or more days per week" is used.

The Valuing Questionnaire is a 10-item self-report questionnaire with a scale 0 = "not true at all" to 6 "completely true." Two subscale scores are calculated, Progress and Obstruction, which typically have a negative correlation. Higher scores on the Progress subscale represent a closer alignment between one's internal values and one's actions. Higher scores on the Obstruction subscale represent more interference with living consistently with one's values. The range for both subscales is 0 to 30.

Participants in this early stage of the study helped us to develop and refine the program that we subsequently used for the randomized controlled trial. These participants were patients who provided feedback on the program.

Participants in this early stage of the study helped us to develop and refine the program that we subsequently used for the randomized controlled trial. These participants were caregivers who provided feedback on the program.

Participants in this early stage of the study helped us to develop and refine the program that we subsequently used for the randomized controlled trial. These participants were patients who tested the first iteration of the program and provided feedback.

Total of all reporting groups

Treatment feasibility will be assessed by measuring the session attendance percentage for each participant receiving the intervention.

Outcome only applicable to the SMILE Intervention arm.

Number of participants who enrolled in the randomized controlled trial phase of the study after being found eligible.

This measure is for individuals who were eligible for the randomized controlled trial. Only patients who were screened for eligibility to participate in the randomized controlled trial are included in this outcome measure.

The Brief Pain Inventory is a 9-item, self-report measure assessing pain severity and interference from pain across important life domains (e.g., general activity, work, relations with others). Participants rate their pain on a scale from 0 "no pain" to 10 "pain as bad as you can imagine." Pain severity is calculated as the average of four items assessing participants' worst, least, current, and average (in the last week) pain on a scale from 0 "no pain" to 10 "worst pain."

SMILE Intervention: One participant lost to follow-up, one participant with missing data; Education Control Arm: One participant lost to follow-up, one participant with missing data, and one participant died prior to completion of the A2 assessment.

The Brief Pain Inventory is a 9-item, self-report measure assessing pain severity and interference from pain across important life domains (e.g., general activity, work, relations with others). Pain interference is computed as the average of seven items, which ask about the interference of pain across different life domains (e.g., general activity, mood, relations with other people) in the past week on a scale from 0 "Does not interfere" to 10 "Completely interferes." Higher scores indicate higher levels of pain interference.

SMILE Intervention: One participant lost to follow-up; Education Control Arm: One participant lost to follow-up and one participant died prior to completion of the A2 assessment.

Fatigue will be assessed using the PROMIS Computer Adaptive Test for Fatigue. Questions ask participants to rate their fatigue during the past 7 days. The T-score ranges from 0 to 100, where higher T-scores indicate greater fatigue. Scores are converted to standardized t-scores with a mean of 50 and standard deviation of 10. T-scores of 55 to <60 indicate mild levels of fatigue, ≥60 to <70 indicates moderate levels of fatigue, and ≥70 indicate severe levels of fatigue.

SMILE Intervention: One participant lost to follow-up; Education Control Arm: One participant lost to follow-up one participant died prior to completion of the A2 assessment.

Depressive Symptoms will be assessed using the PROMIS Computer Adaptive Test for Depression. Questions ask participants to respond to questions during the past 7 days. Scores are converted to standardized T-scores with a mean of 50 and standard deviation of 10. Higher T-scores indicate higher levels of depression. T-scores of 55 to <60 indicate mild levels of depression, ≥60 to <70 indicates moderate levels of depression, and ≥70 indicate severe levels of depression.

SMILE Intervention: One participant lost to follow-up; Education Control Arm: One participant lost to follow-up one participant died prior to completion of the A2 assessment.

The Self-Efficacy for Managing Chronic Disease Scale is a 6-item scale. Participants rate their confidence in keeping pain, fatigue, emotional distress, and other symptoms from interfering with things they want to do on a scale from 1 "not at all confident" to 10 "totally confident." The score for the scale is the mean of the six items, with higher number indicating higher self-efficacy.

SMILE Intervention: One participant lost to follow-up; Education Control Arm: One participant lost to follow-up one participant died prior to completion of the A2 assessment.

7-Item: The Acceptance and Action Questionnaire-II assesses acceptance, experiential avoidance and psychological flexibility. Question scale ranges from 1, never true, to 7, always true. The total score ranges from 7 to 49, where a higher score indicates greater psychological inflexibility.

SMILE Intervention: One participant lost to follow-up and two participants with missing data on at least one item of the subscale; Education Control Arm: One participant lost to follow-up and one participant died prior to completion of the A2 assessment.

The FACIT assesses the spiritual wellbeing of participants with 12-item questionnaire. Responses for each item are on a scale from 0 = "not at all" to 4 = "very much." Three subscale scores (Meaning, Peace, Faith) are calculated by summing specific items. Each subscale has 4 items, with total scores ranging from 0 to 16, with higher scores indicating greater well-being for each subscale (Meaning, Peace, or Faith). A total score is calculated as the sum of the three subscores, with total scores ranging from 0 to 48. Higher scores represent greater spiritual wellbeing.

SMILE Intervention: One participant lost to follow-up; Education Control Arm: One participant lost to follow-up and one participant died prior to completion of the A2 assessment.

The PROMIS Computer Adaptive Test for Anxiety will be used to assess anxiety symptoms in the last week. Scores are converted to standardized T-scores with a mean of 50 and standard deviation of 10. Higher T-scores indicate higher levels of anxiety. T-scores of 55 to <60 indicate mild levels of anxiety, ≥60 to <70 indicates moderate levels of anxiety, and ≥70 indicate severe levels of anxiety.

SMILE Intervention: One participant lost to follow-up; Education Control Arm: One participant lost to follow-up and one participant died prior to completion of the A2 assessment.

The SSTS-R is a 13-item measure. The first 12-items ask participants to rate their satisfaction with the therapy received (6-items) or the therapist delivering the intervention (6-items) on a five-point scale ranging from 1 "strongly disagree" to 5 "strongly disagree." Each of the subscales (Satisfaction With Therapy and Satisfaction With Therapist) range from 6 to 30, with higher scores indicating greater satisfaction. The 13th item (Global Improvement) asks, "How much did the intervention help with your symptoms?" with 5 answer choices ranging from 1 "made things a lot worse" to 5 "made things a lot better," where higher scores indicate a better outcome.

Only participants receiving one intervention session had data analyzed. One of these participants had missing data on this item.

The Bulls Eye Values Survey assists participants with clarifying their values and will be used to examine participants' personal values, values attainment, and persistence towards values in the face of barriers. Part 1 asks the person to record values for 4 domains (work/education, relationships, personal growth/health, and leisure). Then, participants are asked to think of their values in each domain as "bull's eye" (the middle of the dart board). A 1 is equal to a hit in the bull's eye, which means that they are living completely in keeping with their value for that area of living. An 8 is equal to far from the bull's eye, which means that their life is way off the mark in terms of how they are living their life. Part 2 asks the person to identify obstacles to those values and rate from 1, "doesn't prevent me at all", to 7, "prevents me completely".

SMILE Intervention arm: Work/education, relationships, personal growth/health, leisure: One participant lost to follow-up and two participants had missing data.

SMILE Intervention arm: Obstacles: One participant lost to follow-up and four participants had missing data.

Education Control Arm: One participant lost to follow-up, one participant died prior to completion of the A2 assessment, and one participant had missing data.

Participants' use of intervention strategies will be assessed using a measure developed specific to components of the proposed intervention. Participants will be asked about how frequently treatment strategies discussed in session have been used outside of session since the previous session or last assessment depending on the timing of the questionnaire. A scale ranging from 0 "not at all" to 4 "6 or more days per week" is used.

This measure was only provided to participants who received the SMILE Intervention and analyzed among participants receiving at least one AYA SMILE session (n=20) were included in the analysis.

The Valuing Questionnaire is a 10-item self-report questionnaire with a scale 0 = "not true at all" to 6 "completely true." Two subscale scores are calculated, Progress and Obstruction, which typically have a negative correlation. Higher scores on the Progress subscale represent a closer alignment between one's internal values and one's actions. Higher scores on the Obstruction subscale represent more interference with living consistently with one's values. The range for both subscales is 0 to 30.

SMILE Intervention: Progress - 1 participant lost to follow-up and 2 participants with missing data at least one item of the subscale; Obstruction - 1 participant lost to follow-up and 1 participant with missing data on at least one item of the subscale

Education Control Arm: Progress - 1 participant lost to follow-up and 1 participant died prior to completion of the A2 assessment; Obstruction - 1 participant lost to follow-up and 1 participant died prior to completion of the A2 assessment.

The control arm will receive the NCI booklet, "Taking Time: Support for People with Cancer" and otherwise continue their usual care.

Participants in this early stage of the study helped us to develop and refine the program that we subsequently used for the randomized controlled trial. These participants were patients who provided feedback on the program.

Participants in this early stage of the study helped us to develop and refine the program that we subsequently used for the randomized controlled trial. These participants were caregivers who provided feedback on the program.

Participants in this early stage of the study helped us to develop and refine the program that we subsequently used for the randomized controlled trial. These participants were patients who tested the first iteration of the program and provided feedback.