{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T04:02:01Z","timestamp":1789012921247,"version":"build-2803163510"},"reference-count":67,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T00:00:00Z","timestamp":1779840000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T00:00:00Z","timestamp":1779840000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Psycho-Oncology"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To evaluate the effectiveness of psychosocial interventions in reducing demoralization among cancer patients through a systematic review and meta\u2010analysis, and to inform evidence\u2010based psycho\u2010oncological practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Ten electronic databases were systematically searched. Two reviewers independently conducted the study selection, data extraction, and risk\u2010of\u2010bias assessment using RoB 2 for randomized controlled trials and ROBINS\u2010I for quasi\u2010experimental studies. The certainty of evidence was evaluated via the GRADE framework. Meta\u2010analyses were performed with random effects models. Heterogeneity was assessed via the\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      statistic and Cochran's Q test. Subgroup and leave\u2010one\u2010out sensitivity analyses were used to examine robustness. When meta\u2010analysis was not feasible, findings were synthesized narratively, with effect sizes calculated as Cohen's\n                      <jats:italic>d<\/jats:italic>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Psychosocial interventions significantly reduced overall demoralization (SMD\u00a0=\u00a0\u22120.82, 95% CI \u22121.54 to \u22120.10,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.03). Although heterogeneity was substantial (\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0=\u00a092%), sensitivity analyses reduced heterogeneity(\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      \u00a0=\u00a057%) while preserving a significant effect (SMD\u00a0=\u00a0\u22120.36,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.03). Significant improvements were observed across demoralization domains, including loss of meaning, dysphoria, disheartenment, helplessness, and sense of failure, with stable effects in several subdomains after sensitivity analyses. Subgroup analyses indicated greater benefits for narrative\u2010based interventions, third\u2010wave behavioral therapies, and nurse\u2010led programs, particularly in single\u2010cancer\u2010type interventions. Psychosocial interventions also significantly reduced anxiety (SMD\u00a0=\u00a0\u22121.42,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.007) and depressive symptoms (SMD\u00a0=\u00a0\u22121.48,\n                      <jats:italic>p<\/jats:italic>\n                      \u00a0=\u00a00.001), with the results remaining robust.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Psychosocial interventions effectively reduce demoralization and psychological distress in cancer patients, with greater effects observed in patients with the same cancer diagnosis. Third\u2010wave behavioral therapies show particular promise. Nurse\u2010led interventions are feasible but require greater standardization. Future research should focus on large, rigorous trials and develop individualized, mechanism\u2010guided digital interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/pon.70501","type":"journal-article","created":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T17:43:59Z","timestamp":1779903839000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Effectiveness of Psychosocial Interventions for Demoralization in Patients with Cancer: A Systematic Review and Meta\u2010Analysis"],"prefix":"10.1002","volume":"35","author":[{"given":"Yijia","family":"Xu","sequence":"first","affiliation":[{"name":"School of Nursing Fujian Medical University  Fuzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhixuan","family":"Kang","sequence":"additional","affiliation":[{"name":"School of Nursing Fujian Medical University  Fuzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhishan","family":"Zeng","sequence":"additional","affiliation":[{"name":"School of Nursing Fujian Medical University  Fuzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2010-8188","authenticated-orcid":false,"given":"Rachel H. A.","family":"Arbing","sequence":"additional","affiliation":[{"name":"Joe C. Wen School of Nursing University of California Los Angeles  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2342-045X","authenticated-orcid":false,"given":"Wei\u2010Ti","family":"Chen","sequence":"additional","affiliation":[{"name":"Joe C. Wen School of Nursing University of California Los Angeles  Los Angeles California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xi","family":"Ke","sequence":"additional","affiliation":[{"name":"Nursing Department Clinical Oncology School of Fujian Medical University &amp; Fujian Cancer Hospital  Fuzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0197-8687","authenticated-orcid":false,"given":"Feifei","family":"Huang","sequence":"additional","affiliation":[{"name":"School of Nursing Fujian Medical University  Fuzhou China"},{"name":"Nursing Humanities Research Center Fujian Provincial University Research Base for Humanities and Social Sciences  Fuzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,27]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.3322\/caac.21834"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471\u2010244X\u201012\u201070"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291714001597"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1176\/ajp.131.3.271"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1440\u20101614.2002.01086.x"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/10499091231154887"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1478951519000191"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1478951520001388"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.30749"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/JNR.0000000000000421"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/pon.5802"},{"key":"e_1_2_12_13_1","volume-title":"Psychosocial Interventions for Mental and Substance Use Disorders: A Framework for Establishing Evidence\u2010Based Standards","author":"Institute of Medicine","year":"2015"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2023.102371"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1080\/0284186X.2023.2203329"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1192\/j.eurpsy.2025.10126"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1080\/00952990.2024.2350056"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11912\u2010020\u20100870\u20107"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1080\/15433710903126521"},{"key":"e_1_2_12_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejon.2024.102505"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1177\/0269881119897615"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2020.100538"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.anr.2020.04.003"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1097\/NCC.0000000000000740"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00520\u2010023\u201008189\u20101"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1478951521001486"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00520\u2010020\u201005322\u20102"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12529\u2010024\u201010262\u2010w"},{"key":"e_1_2_12_29_1","doi-asserted-by":"publisher","DOI":"10.1097\/NMD.0000000000001615"},{"key":"e_1_2_12_30_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.n71"},{"key":"e_1_2_12_31_1","volume-title":"Cochrane Handbook for Systematic Reviews of Interventions","author":"Higgins J. 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