Effectiveness of psychosocial interventions for posttraumatic growth in patients with cancer: A meta-analysis of randomized controlled trials

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Abstract

Purpose

To evaluate the effectiveness of psychosocial interventions for posttraumatic growth in patients with cancer.

Method

A systematic literature search was performed, and relevant studies published prior to January 8, 2020, were retrieved from MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trails, CINAHL, and PsycINFO. Two reviewers independently assessed the eligibility of each study and extracted the data. The Cochrane risk-of-bias tool was utilized to assess the quality of the studies. Review Manager (Version 5.3) was used to analyse the data. The posttraumatic growth scores were calculated using the standard mean difference (SMD) and 95% confidence intervals (CIs).

Results

Fifteen randomized controlled trials published between 2000 and 2019 were included. Most of the studies had a moderate risk of bias due to low methodological quality. The meta-analysis indicated that the PTG scores in the experimental groups were higher than those in the control groups (SMD = 0.42, 95% CI: 0.26–0.57, P < 0.00001). The most effective and commonly used method was mindfulness-based interventions (SMD = 0.55, 95% CI: 0.15–0.95, P = 0.007). Subgroup analysis showed that the effects of psychosocial interventions on breast cancer patients are greater than the effects on other types of cancer patients (SMD = 0.72, 95% CI: 0.44–0.99, P < 0.00001).

Conclusion

Psychosocial interventions for cancer patients are effective in facilitating posttraumatic growth. The most commonly used and effective methods are mindfulness-based interventions. More large well-designed randomized controlled trials are needed to identify the effectiveness of psychosocial interventions for posttraumatic growth in patients with cancer.

Introduction

The term posttraumatic growth (PTG) was first used by Tedeschi and Calhoun, 1996 in 1996; it refers to the positive psychological change experienced as a result of struggling with highly challenging life events (Tedeschi and Calhoun, 2004), including a sense of personal strength, a deeper appreciation for life, closer relationships, new possibilities, and a richer understanding of spiritual matters (Roepke, 2015). PTG emphasizes the capacity for self-restoring and self-renewing following a traumatic experience. Initially, research on PTG focused mainly on college students who experienced traumatic events and then shifted to people who suffered emergencies such as accidental injuries and natural disasters. In recent years, research on PTG has begun to focus on clinical patients, including patients with cancer (Zeng et al., 2018). Cancer is the second leading cause of death globally, and approximately 1 in 6 deaths are due to cancer (World Health Organization). In addition to the large economic burden and physical pain, the diagnosis and treatment of cancer may result in acute and/or adjustment difficulties, maladaptive coping, and reduced social engagement with friends (Brinkman et al., 2018). However, positive changes occur in cancer patients, and patients with higher levels of PTG were reported to have more positive mood, higher psychological adaptation ability, an improved quality of life, and lower levels of negative emotions, such as posttraumatic stress, anxiety and depression (Yu et al., 2014; Sim et al., 2015; Shakespeare-Finch and Lurie-Beck, 2014).

Psychosocial interventions involve various interventions provided to influence or change cognitions, emotions, behaviors, social interactions, or a combination of these to achieve better psychological outcomes and/or fewer problems by using psychological techniques, such as education, coping skills training, psychotherapy, and relaxation (alone or in combination) (Tao et al., 2015; Poort et al., 2017). In recent decades, the number of studies about PTG in cancer patients has increased, and studies have revealed the positive role of psychosocial factors, such as coping strategies and social support, in enhancing PTG in patients with cancer (Tomita et al., 2017). However, research on enhancing the level of PTG is limited; as a result, strategies, especially psychosocial strategies, are needed to help cancer patients facilitate PTG and reduce further psychological distress to improve patients’ psychological well-being and quality of life (Rajandram et al., 2010).

The diagnosis and treatment of cancer are considered as traumatic events, and most studies have investigated cancer-related posttraumatic stress disorder symptoms and other negative emotions (Casellas-Grau et al., 2017). With the development of positive psychology, studies about PTG associated with cancer are increasing but still limited, and most of them have focused on breast cancer patients (Park and Park, 2016). In addition, inconsistencies exist in the results of the previous studies. For instance, Zhang et al. (2017) used a psychosocial intervention called mindfulness-based stress reduction (MBSR) to enhance PTG in breast cancer patients, and the results showed significant improvements in the MBSR group compared with the control group. On the other hand, van der Spek et al. (2017) used supportive group psychotherapy (SGP) to enhance PTG in cancer patients, and the results showed that there were no significant differences between the SGP groups and the control group. To our knowledge, there are few systematic and quantitative assessments of psychosocial interventions for improving PTG in patients with cancer; thus, the objectives of this meta-analysis were to (1) summarize the psychosocial interventions performed in different randomized controlled trials, (2) evaluate the efficacy of these different psychosocial intervention measures and (3) provide clinical practitioners with evidence-based strategies to promote the level of PTG among cancer patients.

Section snippets

Methods

The data used in this review were from previously published articles, and thus, ethical approval and participant consent were not necessary.

Study selection

A total of 380 studies were retrieved from the electronic databases. After the removal of the duplicates (136 studies), an additional 202 studies were excluded on the basis of the title and abstract because they were not interventional studies (119 studies) or because they did not match the eligibility criteria, including the participants were not cancer patients (28 studies), the objectives were unrelated to PTG (36 studies), the article was a conference abstract (15 studies), articles were

Methodological quality of the included studies

Among the included studies, most had a moderate methodological quality. Although all the studies were described as randomized, two studies did not report the random allocation scheme, and six studies did not mention the allocation concealment; a risk of selective bias existed in these studies. In addition, four studies did not describe the blind method of participants and personnel during the intervention, and eleven studies were not blinded. Due to the nature of the psychosocial intervention,

Conclusions

Psychosocial interventions are effective for enhancing PTG in patients with cancer. In this meta-analysis, the most commonly used and most effective method was mindfulness-based intervention, and psychosocial interventions were mainly focused on breast cancer patients. Future studies are needed to examine other types of cancer patients. In addition, it is also necessary to combine quantitative and qualitative research, optimize measurement tools and methods, establish multidisciplinary

Funding

The study is supported by the National Natural Sciences Foundation of China (81803104), the Science and Technology Department of Sichuan Province (20KPZP0220), and Chengdu Science and Technology Bureau (2020-HM04-00007-SN).

Declaration of competing interest

All the authors declare they have no conflict of interest that could inappropriately influence this study.

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    JL, XP, and YS contributed equally to this work.

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