Internet-Based Cognitive Behavioral Therapy Interventions for Caregivers of Patients With Cancer: Scoping Review.

Abstract

Background: Cancer imposes significant physical and emotional distress not only on patients, but also on their caregivers. In recent years, there has been a growing focus on the mental and physical well-being of caregivers. Among various psychological interventions, cognitive behavioral therapy (CBT) is widely recognized as one of the most effective approaches. However, traditional CBT is often limited by time and geographical constraints, resulting in delayed or inefficient support for caregivers. Internet-based cognitive behavioral therapy (ICBT) presents a valuable alternative for alleviating the caregiving burden and the negative emotions experienced by caregivers.

Objectives: This study aimed to provide a scoping review of ICBT interventions for caregivers of patients with cancer, examining intervention content, outcome measures, and effectiveness and to offer insights and references for the development and clinical applications of ICBT programs tailored to caregivers of patients with cancer in China.

Methods: Relevant literature was systematically searched in PubMed, Web of Science, Cochrane Library, CINAHL, Embase, China National Knowledge Infrastructure (CNKI), Wanfang Data, and VIP Chinese Journal Database. The search timeframe was from database inception to June 6, 2024. Inclusion criteria encompassed intervention studies that implemented cognitive behavioral therapy for caregivers of patients with cancer via the internet, WeChat (Tencent), or mobile electronic devices. This category includes both randomized and nonrandomized controlled trials.

Results: A total of 12 studies met the criteria and were included in the review. The intervention content included the following components: treatment initiation and brief introduction (5/12, 41%), cognitive education and restructuring (7/12, 58%), emotional expression and coping (6/12, 50%), cognitive restructuring and reinforcement (4/12, 33%), behavioral training and activation (9/12, 75%), problem-solving techniques (4/12, 33%), communication (5/12, 41%), and completion of treatment with follow-up consolidation (3/12, 25%). The intervention duration typically ranged from 6 to 8 weeks. Outcome indicators encompassed feasibility and acceptability, anxiety, depression, caregiver burden, and quality of life. ICBT demonstrated positive effects for caregivers of patients with cancer. Most intervention programs were feasible and acceptable, with 2 out of 5 feasibility studies reporting recruitment rates below 50%. Attrition rates across studies ranged from 3% to 16%, and caregivers expressed satisfaction with the information, quality, and skills provided. ICBT exhibits a moderate effect in diminishing negative emotions among caregivers and alleviating caregiver stress. However, its impact on improving quality of life is not statistically significant, underscoring the need for long-term follow-up.

Conclusions: The implementation of ICBT for caregivers of patients with cancer has demonstrated beneficial outcomes, attributed to its practicality and flexibility, which contribute to its greater acceptance among caregivers. Nevertheless, there is significant heterogeneity in intervention format, duration, and outcome indicators. It is necessary to develop optimal intervention strategies and secure online platforms based on the cultural background in China to improve the quality of life of caregivers.