JMIR Publications

ABSTRACT

Background:

Patients with cancer and their families often experience significant distress and deterioration in their quality of life. Psychosocial interventions were examined to address patients' and families' psychosocial needs. Digital technology is increasingly utilized to deliver psychosocial interventions to cancer patients and their families.

Objective:

A systematic review and meta-analysis were conducted to review the characteristics and effectiveness of the digital health intervention on psychosocial outcomes in adult patients with cancer and their family members.

Methods:

Databases (PubMed, Cochrane Library, Web of Science, Embase, CINAHL, PsycINFO, ProQuest Dissertations and Theses Global, ClinicalTrails.gov) were searched for randomized controlled trials (RCTs) or quasi-experimental studies that tested the effects of a digital intervention on psychosocial outcomes. The Joanna Briggs Institute critical appraisal checklist for RCTs and quasi-experimental studies was used to assess quality. Standardized mean differences (i.e., Hedges’ g) were calculated to compare intervention effectiveness. Subgroup analysis was planned to examine the effect of delivery mode, duration of the intervention, type of control, and dosage on outcomes using a random-effects modeling approach.

Results:

Sixty-five studies involving a total of 10,361 patients (per study, M = 159, SD = 166, range = 9-803]; and 1,045 caregiver/partners (per study, M = 16, SD = 54, range = 9–244) were included in the systematic review. Of these, 32 studies were included in a meta-analysis of the effects of digital health interventions on quality of life, anxiety, depression, distress, and self-efficacy. Overall, the RCT studies' general quality was mixed (range of applicable scores = 0.38-0.91; M=0.61, SD=0.12). Quasi-experimental studies were generally of moderate to high quality (range of applicable scores=0.63-0.89; M=0.75, SD=0.08). Psychoeducation and cognitive-behavioral strategies were commonly used. More than half (n=38, 58.5%) did not identify a conceptual or theoretical framework. Most interventions were delivered via Internet (n=40, 61.5%). The median number of intervention sessions was six (range=1-56). Frequency of the intervention was highly variable, with self-paced (n=26, 40%) being most common. The median duration was eight weeks. The meta-analysis results showed that digital psychosocial interventions were effective in improving patients’ quality of life with a small effect size (g=0.05, 95% CI [-0.10, 0.12]; I2=48.2%, p=.00). Moderate effect sizes were found on anxiety and depression in patients measured by Hospital Anxiety and Depression Scale total scores (g=-0.72, 95% CI [-1.89, 0.46]; I2=97.59%, p=.00).

Conclusions:

This study demonstrated the effectiveness of digital health interventions on quality of life, anxiety, and depression in patients. Future large, high-quality research with a clear description of the methodology to enhance the ability to perform meta-analysis is needed. Moreover, this study provides preliminary evidence to support the integration of existing digital health psychosocial interventions in clinical practice.