How Cancer Online Support Groups Work, for Whom, and in What Circumstances: Realist Review

Area of Science:

• Oncology
• Digital Health
• Psychosocial Support

Background:

• Online support groups (OSGs) offer accessible information and support for cancer patients and survivors.
• However, the effectiveness and mechanisms of OSGs remain unclear, with potential for increased distress.

Purpose of the Study:

• To examine the contextual factors, mechanisms, and user characteristics influencing the effectiveness of OSGs for cancer patients and survivors.

Main Methods:

• A realist review of 168 studies (from 16,659 identified) was conducted using RAMESES standards.
• Pawson's realist methodology and the Mixed-Methods Appraisal Tool were employed to analyze evidence.
• Context-mechanism-outcome configurations and a program theory were developed to explain OSG functionality.

Main Results:

• OSGs provide informational, emotional, appraisal, and altruistic support, impacting distress, isolation, empowerment, and self-esteem.
• Outcomes are contingent on user attitudes (trust, usefulness, safety, ease of use), OSG fit with individual needs, and perceived control (anonymity, privacy, autonomy).
• Positive outcomes depend on technology features, group dynamics (norms, moderation, cohesion), and interaction quality, triggering mechanisms like feeling understood and valued.

Conclusions:

• OSGs can enhance supportive care and psychosocial well-being for cancer patients and survivors.
• Optimizing OSG effectiveness requires careful consideration of user needs, trust, privacy, usability, group dynamics, and interaction content.
• Recommendations include assessing fit, building trust, enhancing control and privacy, improving usability, fostering belonging, encouraging engagement, refining content, and adaptive management.