Psicosomática y Psiquiatría (Mar 2022)
Digital therapeutic alliance in psycho-oncology: an overview
Abstract
ABSTRACT Introduction: After the declaration of the COVID-19 pandemic, health services have had to adapt to be delivered by eHealth tools. Cancer population has extensively experienced this disruption due to non-urgent in-person visits being deferred to avoid disease aggravations caused by the spread of the virus. Despite the extensive literature assessing the efficacy of telepsychology in cancer, clinical effectiveness remains unclear. Since Therapeutic Alliance in digital settings appears to be established by mechanisms different than those of in-person interventions, Digital Therapeutic Alliance could work as a particular predictor, moderator, or mediator variable of telepsychology effectiveness. The aim of this narrative overview is to present a broad summary that describes the use of eHealth in psycho-oncology, to later focus on exploring the state of knowledge regarding the establishment of Digital Therapeutic Alliance in this particular setting. Method: The search was conducted from July to September 2021 in four electronic databases. There were three search layers: “telepsychology”, “psycho-oncology” and “therapeutic alliance”. Special attention was paid to reviews and those articles contradicting the regular findings. Results: The research on Digital Therapeutic Alliance in psycho-oncology is limited. The overview has extrapolated the results of general mental health interventions to cancer patients since the characteristics of patients and their diagnoses do not seem to differ when considering previous reviews on the subject. Conclusion and future perspectives: The relational dimension between the therapist and the patient is essential in telepsychology for the development of the therapeutic process and for the intervention outcomes. The literature about Digital Therapeutic Alliance presents uneven and inconclusive results, and the professional’s perspective is poorly developed. It is essential to know how this Alliance is established and which are its barriers and facilitators, both in patients and professionals, and in the different digital formats. With that knowledge, the mechanisms of change and the specific moderators between Alliance and intervention outcomes could be identified. Considering the currently limited access to conventional psychosocial care and leveraging the rapid advances in digital cancer care due to the COVID- 19 pandemic, integrating future findings on Digital Therapeutic Alliance to comprehensive cancer treatments will support the development of more accessible and effective telepsychological interventions.
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