Therapeutic alliance in a stepped digital psychosocial intervention for breast cancer patients : findings from a multicentre randomised controlled trial
Flix-Valle, Aida (Hospital Universitari de Bellvitge)
Medina, Joan Carles (Hospital Universitari de Bellvitge)
Souto-Sampera, Arnau (Hospital Universitari de Bellvitge)
Arizu-Onassis, Alejandra (Hospital Universitari de Bellvitge)
Juan-Linares, Eva (Institut de Recerca Sant Pau)
Serra-Blasco, Maria (Hospital Universitari de Bellvitge)
Ciria Suarez, Laura (Hospital Universitari de Bellvitge)
Feixas, Guillem (Universitat de Barcelona)
Ochoa-Arnedo, Cristian (Hospital Universitari de Bellvitge)
Universitat Autònoma de Barcelona

Data:	2025
Resum:	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.
Ajuts:	Ministerio de Economía y Competitividad PI15/01278 Instituto de Salud Carlos III PI19/01880 Agència de Gestió d'Ajuts Universitaris i de Recerca 2021/SGR-01003
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra, i la creació d'obres derivades, sempre que no sigui amb finalitats comercials i que es distribueixin sota la mateixa llicència que regula l'obra original. Cal que es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Cancer survivor ; Mhealth ; Psycho-oncology ; Stepped-care ; Therapeutic alliance
Publicat a:	BJPsych Open, Vol. 11 Núm. 1 (27 2025) , p. e23, ISSN 2056-4724

DOI: 10.1192/bjo.2024.844
PMID: 39865983

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