Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Nov 10, 2025
Date Accepted: Jul 1, 2026
Compliance with ecological momentary assessment among cancer patients: a systematic review and meta-analysis
ABSTRACT
Background:
Cancer patients often experience substantial fluctuations in psychological states during disease management. Traditional research tools are limited in capturing these dynamic changes in real time, constraining clinicians’ understanding of patients’ true conditions. Ecological Momentary Assessment (EMA) enables high-frequency, real-time data collection, providing patient-reported data with greater ecological validity. However, the effectiveness of EMA studies critically depends on patient compliance, and reported compliance rates vary widely, with a lack of systematic quantitative synthesis.
Objective:
To systematically review and quantitatively analyze compliance to EMA among cancer patients and to explore the impact of EMA design characteristics on compliance.
Methods:
PubMed, Embase, Web of Science, Cochrane Library, CINAHL, CNKI, and Wanfang databases were searched for literature published up to May 8, 2025. Observational studies reporting EMA compliance metrics were included. A random-effects model was used to pool single-group proportions (compliance defined as answered prompts/total sent), and subgroup and sensitivity analyses were conducted to explore sources of heterogeneity.
Results:
Twenty-seven studies involving 13,776 participants were included. The pooled compliance rate was 84% (95% CI: 0.78–0.89) with substantial heterogeneity (I² = 99.7%, P < 0.001). Subgroup analyses indicated that assessment window, sampling frequency, and device type were significantly associated with compliance (assessment window, χ² = 15.00, P= 0.002; sampling frequency, χ² = 8.62, P = 0.013; device type, χ² = 16.52, P < 0.001). Studies with an assessment window >3 hours achieved the highest compliance (92%, 95% CI: 0.86–0.95), whereas studies with more than 6 prompts per day had the lowest compliance (58.6%, 95% CI: 0.37–0.77).
Conclusions:
Overall compliance to EMA among cancer patients is moderate to high (84%), demonstrating the feasibility of EMA for oncological research and clinical monitoring. Study design, particularly the assessment window, prompt frequency, and device selection, affects compliance. Future studies should focus on optimizing EMA design to reduce patient burden and adopt standardized compliance reporting to improve comparability. Clinical Trial: PROSPERO CRD420251047109; https://www.crd.york.ac.uk/PROSPERO/recorddashboard
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