{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T16:31:24Z","timestamp":1791822684821,"version":"4.3.4"},"reference-count":64,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Cancer"],"abstract":"Abstract<\/jats:title>\n \n \n Background<\/jats:bold>\n <\/jats:title>\n Breast cancer and its treatment can negatively affect women\u2019s quality of life (QoL), including physical, psychological, and social well-being. Digital health interventions have been increasingly used to provide supportive care, but their effectiveness on QoL and related psychosocial outcomes remains unclear.<\/jats:p>\n <\/jats:sec>\n \n \n Objective<\/jats:bold>\n <\/jats:title>\n This review aimed to evaluate the effectiveness of digital health interventions on QoL in women with breast cancer and to assess their effects on anxiety, depression, and self-efficacy.<\/jats:p>\n <\/jats:sec>\n \n \n Methods<\/jats:bold>\n <\/jats:title>\n This systematic review was registered in PROSPERO (CRD420250578307) and conducted following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 statement. PsycINFO, Web of Science, Scopus, LILACS, and SciELO were searched in September 2025. Eligible studies were randomized controlled trials (RCTs) or controlled quasi-experimental studies with preintervention and postintervention assessments that evaluated digital health interventions in women with breast cancer during or up to 1 year after active treatment and reported QoL outcomes. Two reviewers independently screened all records (interrater agreement >90%) and extracted data using a standardized template, with independent verification by a second reviewer. Risk of bias was assessed using the Cochrane Risk of Bias tool (RoB 2) for RCTs and the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool for the quasi-experimental study; findings were synthesized narratively following the Synthesis Without Meta-analysis (SWiM) guideline.<\/jats:p>\n <\/jats:sec>\n \n \n Results<\/jats:bold>\n <\/jats:title>\n A total of 408 records were identified, and 15 studies were included: 14 RCTs and 1 quasi-experimental study. Sample sizes ranged from 35 to 394 participants. Ten studies evaluated internet-based approaches such as websites or apps; 3 used text messaging (eg, WhatsApp [WhatsApp LLC] or WeChat [Tencent Technology, Shenzhen Company Limited]), 1 used virtual reality, and 1 used an email listserve. The direction of effect favored the digital intervention for QoL in 8 of the 15 studies. Self-efficacy was assessed in 5 studies and favored the intervention in only 1, with the effect not maintained at follow-up. Anxiety, depression, or emotional distress were assessed in 13 studies, with a favorable direction of effect in 5. Retention rates ranged from 68.6% to 100%. Among the 14 RCTs, 3 were judged at high overall risk of bias, and 11 raised some concerns; none was at low risk. The quasi-experimental study had a serious overall risk of bias. Certainty of evidence was low for QoL and emotional outcomes and very low for self-efficacy.<\/jats:p>\n <\/jats:sec>\n \n \n Conclusions<\/jats:bold>\n <\/jats:title>\n Digital health interventions may provide modest, short-term improvements in some dimensions of QoL in women with breast cancer. Favorable effects appeared more often in interventions with active therapeutic components or professional support; however, this pattern was based on indirect comparisons across heterogeneous studies. Effects on self-efficacy and mental health were inconsistent, and acceptability was insufficiently evaluated. Although promising, current evidence does not support strong or generalizable conclusions.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/96858","type":"journal-article","created":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T17:25:09Z","timestamp":1783704309000},"page":"e96858-e96858","source":"Crossref","is-referenced-by-count":2,"title":["Digital Health Interventions and Psychosocial Outcomes in Women With Breast Cancer: Systematic Review"],"prefix":"10.2196","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8097-3985","authenticated-orcid":false,"given":"Roc\u00edo","family":"Z\u00fa\u00f1iga-Tapia","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8407-7336","authenticated-orcid":false,"given":"Merc\u00e8","family":"Boixad\u00f3s","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0319-861X","authenticated-orcid":false,"given":"Eul\u00e0lia","family":"Hern\u00e1ndez Encuentra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,8,21]]},"reference":[{"key":"R1","unstructured":"Breast cancer. World Health Organization. 2024. URL: https:\/\/www.who.int\/es\/news-room\/fact-sheets\/detail\/breast-cancer [Accessed 25-07-2026]"},{"issue":"3","key":"R2","doi-asserted-by":"publisher","first-page":"229","DOI":"10.3322\/caac.21834","article-title":"Global Cancer Statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries","volume":"74","author":"Bray","journal-title":"CA Cancer J Clin"},{"key":"R3","unstructured":"Breast cancer cases projected to rise by nearly 40 per cent by 2050, WHO warns. United Nations. 2025. URL: https:\/\/news.un.org\/en\/story\/2025\/02\/1160391 [Accessed 25-07-2026]"},{"issue":"1","key":"R4","doi-asserted-by":"publisher","DOI":"10.1186\/s12888-020-02760-4","article-title":"Psychological and physical effects of breast cancer diagnosis and treatment on young Ghanaian women: a qualitative study","volume":"20","author":"Iddrisu","journal-title":"BMC Psychiatry"},{"issue":"5","key":"R5","doi-asserted-by":"publisher","first-page":"141","DOI":"10.6004\/jnccn.2024.7353","article-title":"Trajectory of global mental health and global physical health in breast cancer survivorship","volume":"23","author":"Pritzl","journal-title":"J Natl Compr Canc Netw"},{"issue":"1","key":"R6","doi-asserted-by":"publisher","DOI":"10.1186\/s12885-025-14538-6","article-title":"Sleep disturbance, cancer-related fatigue, and depression as determinants of quality of life among breast cancer patients undergoing chemotherapy: a cross-sectional study","volume":"25","author":"Hendy","journal-title":"BMC Cancer"},{"key":"R7","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2025.1440966","article-title":"Research trends on lymphedema after mastectomy for breast cancer patients from 2000 to 2023: a scientometric analysis","volume":"15","author":"Chen","journal-title":"Front Oncol"},{"issue":"4","key":"R8","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-025-09352-6","article-title":"Sexual dysfunction in women with breast cancer: a systematic review","volume":"33","author":"Rodrigues-Machado","journal-title":"Support Care Cancer"},{"issue":"1","key":"R9","doi-asserted-by":"publisher","DOI":"10.1186\/s12885-025-14667-y","article-title":"The influence of cancer treatments on long-term psychological outcomes and quality of life in breast cancer patients","volume":"25","author":"Yang","journal-title":"BMC Cancer"},{"key":"R10","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2025.1521555","article-title":"Association between fear of cancer recurrence and emotional distress in breast cancer: a latent profile and moderation analysis","volume":"16","author":"Jiang","journal-title":"Front Psychiatry"},{"issue":"1","key":"R11","doi-asserted-by":"publisher","DOI":"10.1186\/s12905-025-03791-3","article-title":"Resilience and renewal: the personal impact of physical activity in breast cancer survivors","volume":"25","author":"Lirola","journal-title":"BMC Womens Health"},{"issue":"6","key":"R12","doi-asserted-by":"publisher","DOI":"10.3390\/medicina61061086","article-title":"Mind over malignancy: a systematic review and meta-analysis of psychological distress, coping, and therapeutic interventions in oncology","volume":"61","author":"Paslaru","journal-title":"Medicina (Kaunas)"},{"issue":"9","key":"R13","doi-asserted-by":"publisher","first-page":"1781","DOI":"10.1002\/pon.5148","article-title":"Interventions to enhance self-efficacy in cancer patients: a meta-analysis of randomized controlled trials","volume":"28","author":"Merluzzi","journal-title":"Psychooncology"},{"key":"R14","unstructured":"Global strategy on digital health 2020-2027. World Health Organization; 2025. URL: https:\/\/www.who.int\/publications\/i\/item\/9789240116870 [Accessed 07-08-2026]"},{"issue":"5","key":"R15","doi-asserted-by":"publisher","first-page":"e316","DOI":"10.1016\/S2589-7500(23)00049-3","article-title":"Digital health and telehealth in cancer care: a scoping review of reviews","volume":"5","author":"Shaffer","journal-title":"Lancet Digit Health"},{"key":"R16","doi-asserted-by":"publisher","DOI":"10.2196\/46116","article-title":"Digital health psychosocial intervention in adult patients with cancer and their families: systematic review and meta-analysis","volume":"10","author":"Zhang","journal-title":"JMIR Cancer"},{"issue":"10","key":"R17","doi-asserted-by":"publisher","DOI":"10.2196\/24722","article-title":"Supportive care interventions for people with cancer assisted by digital technology: systematic review","volume":"23","author":"Marthick","journal-title":"J Med Internet Res"},{"issue":"4","key":"R18","doi-asserted-by":"publisher","first-page":"151418","DOI":"10.1016\/j.soncn.2023.151418","article-title":"Effectiveness of digital health on the quality of life of long-term breast cancer survivors: a systematic review","volume":"39","author":"Pimentel-Parra","journal-title":"Semin Oncol Nurs"},{"issue":"2","key":"R19","doi-asserted-by":"publisher","DOI":"10.3390\/cancers17020197","article-title":"Harnessing artificial intelligence to enhance global breast cancer care: a scoping review of applications, outcomes, and challenges","volume":"17","author":"Chia","journal-title":"Cancers (Basel)"},{"key":"R20","doi-asserted-by":"crossref","unstructured":"Z\u00fa\u00f1iga-Tapia R Boixad\u00f3s Angl\u00e8s M Hern\u00e1ndez Encuentra E . Effectiveness of digital health interventions on quality of life in woman breast cancer patients: a systematic review. PROSPERO. 2025. URL: https:\/\/www.crd.york.ac.uk\/PROSPERO\/view\/CRD420250578307 [Accessed 25-07-2026]","DOI":"10.2196\/96858"},{"issue":"2","key":"R21","doi-asserted-by":"publisher","first-page":"44","DOI":"10.11565\/arsmed.v51i2.2229","article-title":"Digital health interventions and psychosocial outcomes in women with breast cancer: a systematic review protocol","volume":"51","author":"Z\u00fa\u00f1iga-Tapia","journal-title":"ARS MEDICA Revista de Ciencias M\u00e9dicas"},{"key":"R22","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2021.03.001","article-title":"The PRISMA 2020 statement: an updated guideline for reporting systematic reviews","volume":"134","author":"Page","journal-title":"J Clin Epidemiol"},{"key":"R23","doi-asserted-by":"crossref","unstructured":"Petticrew M Roberts H . Systematic Reviews in the Social Sciences: A Practical Guide. 1st ed. Wiley; 2006. [doi: 10.1002\/9780470754887]","DOI":"10.1002\/9780470754887"},{"key":"R24","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: a revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","journal-title":"BMJ"},{"key":"R25","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i4919","article-title":"ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions","volume":"355","author":"Sterne","journal-title":"BMJ"},{"issue":"4","key":"R26","doi-asserted-by":"publisher","first-page":"401","DOI":"10.1016\/j.jclinepi.2010.07.015","article-title":"GRADE guidelines: 3. Rating the quality of evidence","volume":"64","author":"Balshem","journal-title":"J Clin Epidemiol"},{"issue":"3","key":"R27","doi-asserted-by":"publisher","first-page":"85","DOI":"10.1136\/ebmed-2017-110668","article-title":"Rating the certainty in evidence in the absence of a single estimate of effect","volume":"22","author":"Murad","journal-title":"Evid Based Med"},{"issue":"1","key":"R28","doi-asserted-by":"publisher","DOI":"10.1186\/s13643-016-0384-4","article-title":"Rayyan-a web and mobile app for systematic reviews","volume":"5","author":"Ouzzani","journal-title":"Syst Rev"},{"issue":"4","key":"R29","doi-asserted-by":"publisher","first-page":"587","DOI":"10.1111\/j.1468-2958.2002.tb00826.x","article-title":"Content analysis in mass communication: assessment and reporting of intercoder reliability","volume":"28","author":"Lombard","journal-title":"Human Comm Res"},{"key":"R30","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.l6890","article-title":"Synthesis without meta-analysis (SWiM) in systematic reviews: reporting guideline","volume":"368","author":"Campbell","journal-title":"BMJ"},{"key":"R31","unstructured":"McKenzie JE Brennan SE . Chapter 12: synthesizing and presenting findings using other methods. In: Higgins JP Thomas J Chandler J Cumpston M Li T Page MJ Welch VA , editors. Cochrane Handbook for Systematic Reviews of Interventions Version 6.5. 2024. URL: https:\/\/www.cochrane.org\/authors\/handbooks-and-manuals\/handbook\/current\/chapter-12 [Accessed 03-08-2026]"},{"issue":"4","key":"R32","doi-asserted-by":"publisher","first-page":"441","DOI":"10.1002\/pon.1586","article-title":"A randomized, controlled study of internet peer-to-peer interactions among women newly diagnosed with breast cancer","volume":"19","author":"Salzer","journal-title":"Psychooncology"},{"issue":"7-8","key":"R33","doi-asserted-by":"publisher","first-page":"1016","DOI":"10.1111\/jocn.12007","article-title":"The impact of an empowering Internet-based Breast Cancer Patient Pathway program on breast cancer patients\u2019 clinical outcomes: a randomised controlled trial","volume":"22","author":"Ryh\u00e4nen","journal-title":"J Clin Nurs"},{"issue":"6","key":"R34","doi-asserted-by":"publisher","DOI":"10.1111\/ecc.12897","article-title":"Does access to an information-based, breast cancer specific website help to reduce distress in young women with breast cancer? Results from a randomised trial","volume":"27","author":"White","journal-title":"Eur J Cancer Care (Engl)"},{"issue":"4","key":"R35","doi-asserted-by":"publisher","DOI":"10.2196\/mhealth.9438","article-title":"Mobile Breast Cancer e-Support Program for Chinese women with breast cancer undergoing chemotherapy (Part 2): multicenter randomized controlled trial","volume":"6","author":"Zhu","journal-title":"JMIR Mhealth Uhealth"},{"issue":"11","key":"R36","doi-asserted-by":"publisher","DOI":"10.2196\/40059","article-title":"Effect of a 4-week internet-delivered mindfulness-based cancer recovery intervention on the symptom burden and quality of life of patients with breast cancer: randomized controlled trial","volume":"24","author":"Wang","journal-title":"J Med Internet Res"},{"key":"R37","doi-asserted-by":"publisher","DOI":"10.1155\/2022\/1012813","article-title":"The impact of VR-CALM intervention based on VR on psychological distress and symptom management in breast cancer survivors","volume":"2022","author":"Zhang","journal-title":"J Oncol"},{"issue":"6","key":"R38","doi-asserted-by":"publisher","first-page":"1533","DOI":"10.1007\/s11764-022-01209-9","article-title":"Supporting women\u2019s health outcomes after breast cancer treatment comparing a text message intervention to usual care: the EMPOWER-SMS randomised clinical trial","volume":"17","author":"Singleton","journal-title":"J Cancer Surviv"},{"key":"R39","doi-asserted-by":"publisher","DOI":"10.1177\/20552076241261909","article-title":"Relaxation training via tele-rehabilitation program in patients with breast cancer receiving chemotherapy during COVID-19","volume":"10","author":"Bah\u00e7aci","journal-title":"Digit Health"},{"key":"R40","doi-asserted-by":"publisher","DOI":"10.1177\/15347354241256314","article-title":"Comparison of effects between telerehabilitation and in-person rehabilitation after breast cancer surgery: a randomized controlled study","volume":"23","author":"de Aviz","journal-title":"Integr Cancer Ther"},{"issue":"6","key":"R41","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.17873","article-title":"Remote monitoring app for endocrine therapy adherence among patients with early-stage breast cancer: a randomized clinical trial","volume":"7","author":"Graetz","journal-title":"JAMA Netw Open"},{"issue":"5","key":"R42","doi-asserted-by":"publisher","first-page":"787","DOI":"10.1007\/s12282-024-01592-4","article-title":"A randomized trial of the impact of symptom monitoring using an electronic patient-reported outcome app on health-related quality of life in postmenopausal breast cancer patients receiving adjuvant endocrine therapy","volume":"31","author":"Okuyama","journal-title":"Breast Cancer"},{"issue":"11","key":"R43","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-024-08924-2","article-title":"Feasibility, acceptability, and preliminary efficacy of a self-directed online psychosocial intervention for women with metastatic breast cancer: Finding My Way-Advanced","volume":"32","author":"Rigg","journal-title":"Support Care Cancer"},{"issue":"3","key":"R44","doi-asserted-by":"publisher","first-page":"207","DOI":"10.4274\/ejbh.galenos.2024.2024-3-9","article-title":"The effect of informative mobile app use on anxiety, distress, and quality of life of women with breast cancer","volume":"20","author":"Salman Sara\u00e7","journal-title":"Eur J Breast Health"},{"key":"R45","doi-asserted-by":"publisher","DOI":"10.2196\/71684","article-title":"Effectiveness of an innovative mobile-based perioperative care program for women undergoing breast cancer surgery (iCareBreast): randomized controlled trial","volume":"27","author":"Pang","journal-title":"J Med Internet Res"},{"issue":"4","key":"R46","doi-asserted-by":"publisher","first-page":"405","DOI":"10.1016\/j.ijnss.2024.08.006","article-title":"Effectiveness of a theory-based tailored mHealth physical activity intervention for women undergoing chemotherapy for breast cancer: a quasi-experimental study","volume":"11","author":"Geng","journal-title":"Int J Nurs Sci"},{"issue":"4","key":"R47","doi-asserted-by":"publisher","first-page":"361","DOI":"10.1001\/jamapsychiatry.2020.4364","article-title":"Internet-based cognitive behavioral therapy for depression: a systematic review and individual patient data network meta-analysis","volume":"78","author":"Karyotaki","journal-title":"JAMA Psychiatry"},{"issue":"1","key":"R48","doi-asserted-by":"publisher","DOI":"10.1002\/pon.6290","article-title":"Guided versus non-guided digital psychological interventions for cancer patients: a systematic review and meta-analysis of engagement and efficacy","volume":"33","author":"Akdemir","journal-title":"Psychooncology"},{"issue":"10","key":"R49","doi-asserted-by":"publisher","first-page":"E327","DOI":"10.1503\/cmaj.230274","article-title":"Therapist-guided remote versus in-person cognitive behavioural therapy: a systematic review and meta-analysis of randomized controlled trials","volume":"196","author":"Zandieh","journal-title":"CMAJ"},{"key":"R50","doi-asserted-by":"publisher","DOI":"10.2196\/55757","article-title":"Digital interventions for self-management of type 2 diabetes mellitus: systematic literature review and meta-analysis","volume":"26","author":"Kerr","journal-title":"J Med Internet Res"},{"issue":"8","key":"R51","doi-asserted-by":"publisher","first-page":"e558","DOI":"10.1016\/S2666-7568(22)00121-0","article-title":"Digital interventions for depression and anxiety in older adults: a systematic review of randomised controlled trials","volume":"3","author":"Riadi","journal-title":"Lancet Healthy Longev"},{"issue":"11","key":"R52","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pdig.0001107","article-title":"App fatigue in mHealth: beyond improving apps, advance equity by meeting people where they are","volume":"4","author":"Ali","journal-title":"PLOS Digit Health"},{"issue":"7","key":"R53","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2022-069966","article-title":"Impact of wearable device-based interventions with feedback for increasing daily walking activity and physical capacities in cardiovascular patients: a systematic review and meta-analysis of randomised controlled trials","volume":"13","author":"Heizmann","journal-title":"BMJ Open"},{"issue":"6","key":"R54","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0237278","article-title":"How predictability affects habituation to novelty","volume":"16","author":"Ueda","journal-title":"PLoS One"},{"issue":"3","key":"R55","doi-asserted-by":"publisher","first-page":"2853","DOI":"10.1007\/s00520-021-06568-0","article-title":"Effectiveness of mobile health-based self-management interventions in breast cancer patients: a meta-analysis","volume":"30","author":"Luo","journal-title":"Support Care Cancer"},{"key":"R56","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijmedinf.2016.04.005","article-title":"The relationship between persuasive technology principles, adherence and effect of web-Based interventions for mental health: a meta-analysis","volume":"96","author":"Wildeboer","journal-title":"Int J Med Inform"},{"issue":"2","key":"R57","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1891\/0889-8391.13.2.158","article-title":"Self-efficacy: the exercise of control","volume":"13","author":"Bandura","journal-title":"J Cogn Psychother"},{"issue":"2","key":"R58","doi-asserted-by":"publisher","first-page":"79","DOI":"10.1089\/cyber.2021.0009","article-title":"Surviving COVID-19: the neuroscience of smart working and distance learning","volume":"24","author":"Riva","journal-title":"Cyberpsychol Behav Soc Netw"},{"key":"R59","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyg.2021.631186","article-title":"Contemplating or acting? Which immersive modes should be favored in virtual reality during physiotherapy for breast cancer rehabilitation","volume":"12","author":"Buche","journal-title":"Front Psychol"},{"key":"R60","doi-asserted-by":"crossref","unstructured":"Mayer RE Fiorella L , editors. The Cambridge Handbook of Multimedia Learning. 3rd ed. Cambridge University Press; 2021. [doi: 10.1017\/9781108894333.003]","DOI":"10.1017\/9781108894333.003"},{"issue":"7","key":"R61","doi-asserted-by":"publisher","first-page":"596","DOI":"10.1002\/da.22641","article-title":"Internet and mobile interventions for depression: opportunities and challenges","volume":"34","author":"Cuijpers","journal-title":"Depress Anxiety"},{"issue":"7","key":"R62","doi-asserted-by":"publisher","DOI":"10.2196\/28168","article-title":"New evidence in the booming field of online mindfulness: an updated meta-analysis of randomized controlled trials","volume":"8","author":"Sommers-Spijkerman","journal-title":"JMIR Ment Health"},{"issue":"4","key":"R63","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1016\/j.invent.2014.08.003","article-title":"The impact of guidance on Internet-based mental health interventions \u2014 a systematic review","volume":"1","author":"Baumeister","journal-title":"Internet Interv"},{"key":"R64","doi-asserted-by":"publisher","DOI":"10.2196\/42864","article-title":"Providing human support for the use of digital mental health interventions: systematic meta-review","volume":"25","author":"Werntz","journal-title":"J Med Internet Res"}],"container-title":["JMIR Cancer"],"original-title":[],"language":"en","deposited":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T18:26:33Z","timestamp":1787336793000},"score":1,"resource":{"primary":{"URL":"https:\/\/cancer.jmir.org\/2026\/1\/e96858"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,21]]},"references-count":64,"URL":"https:\/\/doi.org\/10.2196\/96858","relation":{},"ISSN":["2369-1999"],"issn-type":[{"value":"2369-1999","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,21]]},"article-number":"v12i3e96858"}}