Interventions for enhancing resilience in breast cancer patients: a realist review

Breast cancer is a growing global health issue. The treatment of breast cancer has a significant impact on women's health. Various efficacious interventions are available to enhance resilience. However, it remains unclear what mechanisms are triggered or if specific contexts favor the activation of different mechanisms. This review aims to comprehend how the different interventions lead to changes in resilience in breast cancer patients.

This study followed a realist review approach with an iterative design. First, the research scope was defined and an initial conceptual model was developed. Relevant evidence was then searched and collated from nine databases. Studies on interventions to improve resilience in patients with breast cancer were included. The included studies were appraised using the RAMESES standards for relevance and rigor. Data on study characteristics, contexts, interventions, and outcomes were extracted, and context-mechanism-outcome (C-M-O) configurations were identified, classified, and qualitatively synthesized across interventions.

A total of 65 articles were included. The intervention on resilience was administered to patients with breast cancer of all tumor stages. Key outcomes were grouped: resilience, quality of life, treatment compliance, nursing satisfaction, etc. The mechanisms identified underpinning change outcomes related to interventions (e.g., cognitive intervention) on resilience encompassed the sub-themes of external factors (e.g., social support, collective endeavor, supervision, feedback), self-response and resources (e.g., positive psychological resources, emotional connection), individual changes (e.g., mood change, cognitive change, active coping).

The success of interventions for breast cancer patients depends on the quality of interactions of mechanisms. Taking into account contextual factors and the interaction process of individuals (e.g., positive psychological) and the environment (e.g., collective endeavor) promotes resilience's occurrence, development, and effect can increase the likelihood of successful interventions. To better improve the resilience of breast cancer patients, intervention schemes targeted at activating these mechanisms should be formulated.