Acceptance and Commitment Therapy (ACT) in End-of-Life Care: A Meta-Analysis of Efficacy and Process of Change

Acceptance and Commitment Therapy (ACT) is an evidence-based, process-oriented psychotherapy that provides palliative care through compassionate, person-centered care for terminal illness. This study evaluates the effects of ACT on quality of life (QoL) and emotional distress and examines the role of process variables (e.g., psychological flexibility).

Systematic review with meta-analysis following searches in PubMed, SCOPUS and PsycInfo for studies measuring QoL, anxiety/depression symptoms, and process variables in ACT interventions. Random-effects meta-analyses and meta-regressions were performed. Risk of bias was assessed.

13 studies were included (1,109 participants; M _age = 61.5; 55.7% women; 6 RCTs). ACT showed significant, moderate effects for QoL, anxiety and depression symptoms versus active controls (SMD = 0.44 to 0.62), sustained at 1-9 months follow-up (SMD = 0.35 to 0.56). Psychological flexibility emerged as the strongest predictor of QoL improvement. Face-to-face interventions demonstrated better results than remote delivery.

These findings support the clinical relevance of ACT as an effective approach for addressing psychological distress and improving QoL in end-of-life care. Key limitations include self-report bias, high heterogeneity, potential overlap between measures, publication bias for QoL, and limited sample sizes in some analyses. High-quality trials are warranted, particularly in non-oncological populations, caregivers, and healthcare professionals.