Therapeutic alliance in a stepped digital psychosocial intervention for breast cancer patients: findings from a multicentre randomised controlled trial
ICOnnecta't Digital Health Program, Catalan Institute of Oncology, Hospitalet del Llobregat, Spain; Psychooncology and Digital Health Group, The Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet del Llobregat, Spain; and Department of Clinical Psychology and Psychobiology, Universitat de Barcelona, Spain
Joan Carles Medina
ICOnnecta't Digital Health Program, Catalan Institute of Oncology, Hospitalet del Llobregat, Spain; Psychooncology and Digital Health Group, The Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet del Llobregat, Spain; and Department of Psychology and Education Sciences, Universitat Oberta de Catalunya, Spain
Arnau Souto-Sampera
ICOnnecta't Digital Health Program, Catalan Institute of Oncology, Hospitalet del Llobregat, Spain; Psychooncology and Digital Health Group, The Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet del Llobregat, Spain; and Department of Clinical Psychology and Psychobiology, Universitat de Barcelona, Spain
Alejandra Arizu-Onassis
ICOnnecta't Digital Health Program, Catalan Institute of Oncology, Hospitalet del Llobregat, Spain; Psychooncology and Digital Health Group, The Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet del Llobregat, Spain; and Department of Clinical Psychology and Psychobiology, Universitat de Barcelona, Spain
Eva Juan-Linares
Psychooncology and Digital Health Group, The Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet del Llobregat, Spain; and Psycho-oncology Unit, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
Maria Serra-Blasco
ICOnnecta't Digital Health Program, Catalan Institute of Oncology, Hospitalet del Llobregat, Spain; Psychooncology and Digital Health Group, The Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet del Llobregat, Spain; and Carlos III Health Institute, Mental Health Networking Biomedical Research Centre (CIBERSAM), Madrid, Spain
Laura Ciria-Suárez
ICOnnecta't Digital Health Program, Catalan Institute of Oncology, Hospitalet del Llobregat, Spain; and Psychooncology and Digital Health Group, The Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet del Llobregat, Spain
Guillem Feixas
Department of Clinical Psychology and Psychobiology, Universitat de Barcelona, Spain; and Institute of Neuroscience, Universitat de Barcelona, Spain
Cristian Ochoa-Arnedo
ICOnnecta't Digital Health Program, Catalan Institute of Oncology, Hospitalet del Llobregat, Spain; Psychooncology and Digital Health Group, The Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet del Llobregat, Spain; and Department of Clinical Psychology and Psychobiology, Universitat de Barcelona, Spain
Background Action mechanisms of therapeutic alliance in stepped and digital interventions remain unclear. Aims (a) To compare the development of therapeutic alliance between psychosocial treatment as usual (PTAU) and a stepped digital intervention designed to prevent distress in cancer patients; (b) to analyse the level of agreement between patients’ and therapists’ therapeutic alliance ratings; and (c) to explore variables associated with therapeutic alliance in the digital intervention. Method A multicentre randomised controlled trial with 184 newly diagnosed breast cancer women was conducted. Patients were assigned to digital intervention or PTAU. Therapeutic alliance was assessed at 3, 6 and 12 months after inclusion using the working alliance inventory for patients and therapists. Age, usability (system usability scale), satisfaction (visual analogue scale), type and amount of patient–therapist communication were analysed as associated variables. Results Patients and therapists established high therapeutic alliance in the digital intervention, although significantly lower compared with PTAU. The development of patients’ therapeutic alliance did not differ between interventions, unlike that of the therapists. No agreement was found between patients’ and therapists’ therapeutic alliance ratings. Patients’ therapeutic alliance was associated with usability and satisfaction with app, whereas therapists’ therapeutic alliance was associated with satisfaction with monitoring platform. Conclusions A stepped digital intervention for cancer patients could develop and maintain strong therapeutic alliance. Neither the type nor amount of communication affected patients’ therapeutic alliance, suggesting that flexible and available digital communication fosters a sense of care and connection. The association between usability and satisfaction with digital tools highlights their importance as key therapeutic alliance components in digital settings.
