Systematic review of psychosocial interventions for adult cancer patients and their family caregivers in Sub-Saharan Africa

Figures & data

Figure 1. Preferred reporting items for systematic reviews and meta-analysis (PRISMA) flow chart of study identification and selection.

Table 1. Characteristics of study and participants (n = 6).

First author, year, and country research conducted	Study aim	Theoretical basis	Design	Sample size	Cancer type and stage	Mean age (years)	Gender
Gabriel 2019 Nigeria	Evaluate the effectiveness of a psychosocial intervention programme on the QOL and caregiver burden of the primary caregivers of women with breast cancer	Lazarus and Folkman's transactional model of stress and coping	Quasi-experimental	108 CG (I = 54; C = 54)	Breast cancer	63.0% being below 40 years	CG: 55.6% Female
Morse 2021 Tanzania	Design and develop a web and mobile app to support outpatient symptom assessment and care coordination and control, with a focus on pain	WHO palliative care pillars (policy, education, drug availability, and implementation)	Quasi-experimental pilot study	Usability testing: 7 PT and CG; Pilot test: 10 PT	Mixed cancer, Advanced stage	Usability testing PT: range 34–64 years	Usability testing PT: 86% Female
Ngoma 2021 Tanzania	Assess the effectiveness of a smartphone- or Web-based app, mPalliative Care Link, to extend specialist access via shared data and communication with local health workers	WHO palliative care pillars (policy, education, drug availability, and implementation)	Quasi-experimental	98 PT	Mixed cancer, stage II-IV	36–65 years: 78%	72% Female
Onyechi 2016 Nigeria	Examine the effects of rational emotive hospice care therapy on problematic assumptions, death anxiety, and psychological distress in cancer patients and their caregivers.	N/A	RCT	32 PT 52 CG	Breast, cervical, and prostate cancer	PT: 48 CG: 55	PT: 88% Female CG: 85% Female
Onyedibe 2021 Nigeria	Investigate the effect of eight weeks of a group psychoeducation intervention on cognitive emotion regulation	N/A	RCT	28 PT	Breast cancer, stages I to III, and had completed chemotherapy	I: 45.5 C: 49.5	100% Female
Weru 2020 Kenya	Assess the effect of dignity therapy on QOL	N/A	RCT	144 PT (I = 72; C = 72)	Mixed cancer, advanced stage	I: 50.5 C:52.5	PT: 70% Female

Note. PT = Patient; CG = Caregiver; RCT = Randomised controlled trial; QOL = Quality of life; I = Intervention group; C: Control group; N/A = Not available.

Table 2. Interventions characteristics and effect (n = 6).

Study	Intervention details			Control group	QOL outcome measurement	Findings
	Component	Mode, format, duration, dosage	Interventionist
Gabriel 2019 Nigeria	A psychosocial intervention: Providing information about breast cancer, dealing with emotional aspects of caring, adjustment to caregiving, communication strategies, self-care, practical care information	In-person 6 weeks 6 sessions (90 min)	Nurses	Usual care	Caregiver Quality of Life Index Cancer (CQOLC)	Greater improvement in overall QOL (p = 0.020) in the intervention group as compared to the control group.
Morse 2021 Tanzania	Symptom management and communication: Facilitating real-time symptom reporting for direct communication between patients or caregivers and their clinical care team members, and specialist care coordination to support prompt and effective community-based symptom control	App (Computer or mobile) 4 months	Multidisciplinary study team Palliative care specialists, health services researchers, software engineers and designers, and a user experience specialist	Usual care and phone-contact to collect palliative care outcome	Perception of usability for task: ranged from a low degree of ease and acceptability (3 out of 4) to a very high degree of ease and acceptability (1 out of 4)	Usability: Respondents found it easy to use, with an average usability score of 2 and below for any given task. Several respondents remarked that their ease of use and acceptability would improve with increased experience using the app.
Ngoma 2021 Tanzania	Symptom management and communication: Facilitating real-time symptom reporting for direct communication between patients or caregivers and their clinical care team members, and specialist care coordination to support prompt and effective community-based symptom control	App (Computer or mobile) 4 months	Multidisciplinary study team Palliative care specialists, health services researchers, software engineers and designers, and a user experience specialist	Usual care and phone-contact to collect palliative care outcome	The African Palliative Outcome Scale	Symptom severity was significantly lower in the phone-contact group (p < 0.0001), and symptom severity decreased over time in both groups (p = 0.0001); however, between-group change in overall symptoms over time did not vary significantly (p = 0.34).
Onyechi 2016 Nigeria	Rational emotive hospice care therapy: Using a family-centered approach to disputing problematic assumptions, motivation, decision-making, cognitive restructuring, confrontation, therapeutic alliance, acceptance, socratic dialogue, reframing, metaphors, therapeutic approaches (e.g. relaxation techniques), multigenerational family therapy, solution-focused brief therapy, imagery work, and Gestalt therapy	In-person 14 weeks 10 sessions (45 min) and 4 follow-up sessions	Oncology nurses	Usual care and conventional counselling	Problematic assumptions Questionnaire; Death Anxiety Questionnaire; Kessler Psychological Distress Scale	Less problematic assumptions (p = .000), lower death anxiety (p = .000), and lower psychological distress (p = .000) in the intervention group over time as compared to the control group
Onyedibe 2021 Nigeria	Group psychoeducation: Providing information about cancer and treatment; psychosocial factors in cancer; coping strategies; and nutrition	In-person 8 weeks 8 session (90 min)	Clinical psychologists and a doctor	Usual care and psychoeducational material	Cognitive Emotion Regulatory Questionnaires	Significant decrease in maladaptive cognitive regulation (self-blame, rumination and catastrophizing) in the intervention group over time
Weru 2020 Kenya	Dignity therapy: Using 10 core questions to address the most important accomplishments, lessons in life, hopes and dreams for loved ones, and etc	In-person One session (30-60 min)	Counselors	Usual care	Edmonton symptom scale (ESAS).	No group difference in quality of life.

Note. N/A = Not available

Table 3. Quality of articles summary utilising the mixed methods appraisal tool (MMAT) version 2018.

Category of study designs	Number of articles	Methodological quality criteria	Responses
			Yes	No	Could not determine
Randomised controlled trials	3	Is randomisation appropriately performed?	2	0	1
		Are the groups comparable at baseline?	3	0	0
		Are there complete outcome data?	3	0	0
		Are outcome assessors blinded to the intervention provided?	1	1	1
		Did the participants adhere to the assigned intervention?	0	0	3
Quasi-experimental	3	Are the participants representative of the target population?	3	0	0
		Are measurements appropriate regarding both the outcome and intervention (or exposure)?	2	1	0
		Are there complete outcome data?	2	1	0
		Are the confounders accounted for in the design and analysis?	1	2	0
		During the study period, was the intervention administered (or did exposure occur) as intended?	0	0	3