The interventions for resilience of breast cancer patients: a systematic review and meta-analysis

The interventions for resilience of breast cancer patients: a systematic review and meta-analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The interventions for resilience of breast cancer patients: a systematic review and meta-analysis Zhi Wang, Qiu-yue Liu, Yu-Lei Zhao, Xin-Yi Xu, Yan Chen, Wen-Juan Cao, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-396869/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Breast cancer has now overtaken lung cancer as the world’s mostly commonly-diagnosed cancer. With the increasing prevalence of breast cancer, the psychological problems of breast cancer patients have also received more and more attention from scholars. The aim of our study was to synthesis the available research evidence on the effectiveness of interventions designed to promote or enhance the resilience of breast cancer patients. Methods We performed a systematic and comprehensive search of 12 databases from inception to February 4,2021: Web of Science, PubMed, Embase, MEDLINE, Scopus, Cochrane Library, CINAHL, PsycINFO, Chinese National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBM), WanFang and VIP. We conducted a comprehensive qualification screening of the retrieved records and analysed all the included data using Review Manager Version 5.3 and STATA/SE Version 15.1. Results A total of 23 RCTs involving 2,002 women with stage I-Ⅳ breast cancer met the eligibility criteria and 15 of them were included in the meta-analysis. The results showed that the effectiveness of resilience training program (SMD = 0.89; 95% CI 0.54, 1.24; p < 0.00001), health education delivered via mobile devices (SMD = 1.84; 95% CI 0.86, 2.82; p = 0.0002) and peer support (SMD = 2.62; 95% CI 0.61, 4.63; p = 0.01) in the experimental groups was better than that of the control groups. Furthermore, there were seven other kind of interventions which might contribute to improve resilience but with very few evidences available. Conclusion Our findings suggest that resilience training program, health education delivered via mobile devices and peer support are more effective than that of the routine nursing care in improving the resilience of breast cancer patients. In addition, this study cannot draw definitive conclusions regarding the effectiveness of other seven kind of interventions because the sample size in the included is small and cannot be conducted in the meta-analysis. More studies are needed in the future to clarify the effectiveness of these interventions. Health Policy Breast cancer Resilience Intervention Systematic Review Meta-Analysis Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Breast cancer is the leading cause of cancer death in women worldwide [ 1 ]. It has now overtaken lung cancer as the world’s most commonly-diagnosed cancer, according to statistics released by the International Agency for Research on Cancer (IARC) in December 2020 [ 2 ]. In 2018, there were an estimated 2.1 million new cases of breast cancer and 627,000 deaths from breast cancer worldwide [ 3 ]. Breast cancer patients faced with high level of pressure in psychological and social respects. Also, both patients and their family undertook heavy economic and psychological burdens due to the painful and long process of disease diagnosis, treatment and rehabilitation. Breast cancer has adverse effects on patients' self-image, behavior, attitude towards life and quality of life [ 4 ]. Studies indicated that up to 50% of breast cancer patients suffered from significant psychosocial distress [ 5 ], and more than one-third of which developed anxiety (33.6%) and/or depression (58.6%) [ 6 ]. However, breast cancer still has a high chance of cure if diagnosed early and treated appropriately [ 2 ]. With the change of the social medicine model, the psychological problems of breast cancer patients have also received more and more attention from scholars. Not everyone copes adversities in the negative way, many breast cancer patients may also develop resilience and produce positive psychological changes in the face of illness [ 7 , 8 ]. Resilience, which is also known as psychological resilience, was proposed by American psychologist Anthony in the 1970s, and the American Psychological Society defines resilience as a process of ‘bouncing back’ from difficult experiences and ‘adapting well in the face of adversity, trauma, tragedy, threats or significant sources of stress’ [ 9 ]. In healthcare area, resilience were defined as ''the capacity to adapt to challenges and changes at different system levels, to maintain high quality care'' [ 10 ]. Resilience is a dynamic developmental process that promotes a successful adaptation to cancer-related adversity [ 8 , 11 ]. Studies showed that psychological distress was the variable that most frequently linked to reductions in resilience, and there is a bidirectional relationship between them [ 8 , 12 , 13 ]. A survey study showed that breast cancer patients with poor resilience may have poor body images and suffer more severe adverse effects of systemic therapy, such as arm symptoms and breast symptoms, and hair loss [ 13 ]. Resilience is related to many factors such as sociodemographic, clinical, psychosocial and physiological aspects in women with breast cancer [ 8 ]. Resilience it not solely a quality within individuals; it also can be enhanced by the external support from others [ 14 ]. The evidence showed that the resilience of breast cancer patients is at a moderate or lower level currently [ 15 – 17 ]. Thus, resilience-promoting interventions should be obtained to improve breast cancer patients' psychological well-being. Various psychosocial interventions to enhance resilience were found recently, such as mindfulness meditation, yoga exercises, a healthy diet, peer support, group meetings and group counseling [ 12 ]. However, there is no clearly evidence to summarize the specific effect of intervention measures for resilience of breast cancer patients, and overview of the quantitative studies on the interventions still lacks. In this study, we conducted a systematic review and meta-analysis using data from randomized controlled trials (RCTs). The aim of our study was to synthesis the available research evidence on the effectiveness of interventions designed to promote or enhance the resilience of breast cancer patients. Methods This review was adhered to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines [18] (see Additional file 1). Inclusion and exclusion criteria We included published studies meeting the following criteria: (1) Participants: Women with breast cancer; (2) Intervention: Interventions which aim to improve psychological resilience; (3) Control: Routine/Basic nursing care, wait-list or no intervention; (4) Outcomes: Psychological resilience score; and (5) Study design: RCTs. Studies were excluded if they met the following criteria: (1) Studies in which full-text were not available; (3) Studies which reported unextractable or unrelated raw data; (4) Studies were not published in English or Chinese; and (5) Studies where types were reviews/ editorials/ books/ theses/ case reports/ news etc. Search strategy We performed a systematic and comprehensive search of 12 databases from inception to February 4,2021: Web of Science, PubMed, Embase, MEDLINE, Scopus, Cochrane Library, CINAHL, PsycINFO, Chinese National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBM), WanFang and VIP. Keywords or medical subject headings used in the search were as following: ["resilience" OR " mental resilience" OR " psychological resilience" OR "Mental Elasticity"] AND ["breast cancer" OR " breast carcinoma" OR "mammary cancer" OR "Breast Neoplasm" OR "Breast Tumor"] AND ["randomized controlled trial*" OR " randomized clinical trial*" OR "RCT" OR "randomized"]. In addition, the references in the articles were manually tracked for relevant studies. All articles were managed by EndNote X9 software. Two reviewers searched the databases and screened of the literature searches independently based on the agreed-on criteria. Any disagreements were resolved by discussion or referred to a senior reviewer. Detailed search strategies were listed in Additional file 2. Data extraction and synthesis All relevant published data from the studies were extracted and recorded on a standardized data extraction form using Microsoft Excel. The extraction included author, year, origin, sample size, age, stage of cancer, study object, intervention description and outcome measurement. All the data were extracted by two authors independently and checked by a third reviewer. Quality assessment Two investigators evaluated the risk of bias of each article independently using the RoB 2.0, which is the latest tool, developed by the Cochrane Handbook for Systematic Reviews of Interventions (Version 6, 2019) [19]. RoB 2.0 includes five domains and there are a series of "signalling questions" for each domain [19, 20]. The authors should reach a judgement after these questions were answered and assign one of three levels ("low risk of bias", "some concerns", "high risk of bias") to each domain. The overall judgement for the articles were mapped from the results within domains. Any disagreements or uncertainty was resolved through discussion or consulted a senior reviewer. Statistical analysis The meta-analysis was performed by using the Cochrane Collaboration Review Manager Version 5.3 and STATA/SE Version 15.1 (StataCorp, College Station, TX, USA). ALL the outcome data were presented as the mean ± standard deviation (SD) and were expressed as mean difference (MD), standard mean difference (SMD), weighted mean difference (WMD) and 95% confidence interval (CI) because they were all continuous variables. Tests for heterogeneity were assessed statistically by using the standard chi-squared test (χ 2 , or Cochran’s Q test) and the I 2 statistic, with p ≤ 0.10 or I 2 > 50% indicating significant heterogeneity. A random-effects model was selected to pool the effect of the interventions on resilience of breast cancer patients because of the heterogeneity of interventions used and timing of outcome measurements [21]. Subgroup analysis was performed to identify the sources of heterogeneity and assess the effects of covariates on the pooled estimates[22, 23]. Egger’s linear regression test was performed to detect the publication bias [24]. For the data of which could not undertake meta-analyses, we synthesized the results and presented the evidence in a narrative form. Results Search results Initially, a total of 337 publications were identified from the 12 databases. Then, 101 duplicate records were excluded by automation tools and 24 duplicate records were excluded by a human. 212 records were screened based on title and abstract. 87 studies were sought for retrieval and 82 reports were assessed for eligibility. Following full texts screening, 59 studies were excluded. Finally, 23 studies met the eligibility criteria, of which 16 studies were included in the meta-analysis. We searched studies via other methods, but did not find any additional studies that met the inclusion criteria. The flowchart details the literature selection process using the PRISMA 2020 flow diagram [18] (Fig. 1). Study characteristics The characteristics of the included studies are shown in Table 1. A total of 23 RCTs involving 2,002 women with stage I-Ⅳ breast cancer met the eligibility criteria and 16 of them were included in the meta-analysis. Data accrue mainly from China (n = 20), Taiwan (n = 1), United States of America (n = 1) and Spain (n = 1). The publication date of the included studies ranges from 2011 to 2020. The intervention time lasted from 1 week to 6 months. The 25-item Connor-Davidson Resilience Scale (CD-RISC-25) was the primary outcome measurement for most studies (n = 20) [25-44], and there were only 3 studies [45-47] used the Resilience Scale for Adults (RSA). Further details of the studies’ interventions were summarized in Table 2. The 16 studies for meta-analysis were divided into three groups: resilience training program (n = 8) [25-28, 38, 43, 45, 46], health education delivered via mobile devices (n = 5) [34, 36, 37, 42, 44] and peer support (n = 3) [31-33] based on the intervention measures. For the remaining 7 studies [29, 30, 35, 39-41, 47] that cannot be classified or meta-analyzed, we presented in a narrative form only. Risk of bias assessment Summary of quality assessments of all included RCT studies is shown in Fig. 2. With regard to the judgement of all the domains and signalling questions, twelve studies (78.3%) were judged to have low risk of bias, four studies (21.7%) were judged to raise some concerns, and none (0%) were judged to have high risk of bias for their outcomes. In general, the quality of the included studies was from moderate to high quality. Synthesis of results Resilience training program Eight studies [25-28, 38, 43, 45, 46], with a total of 649 breast cancer women, reported data on the resilience training program. There was substantial heterogeneity among the studies (χ 2 = 65.83, p = 0.000, I 2 = 89.4%) according to the heterogeneity test. Therefore, we performed sensitivity analysis and found that Zhou K’s study [26] substantially influence the results. The heterogeneity has decreased significantly (χ 2 = 19.25, p = 0.004, I 2 = 69%) after removing the study. Therefore, the random effects model was utilized for the meta-analysis. The results showed that the resilience training program intervention was more effective than routine nursing care intervention in improving the resilience of breast cancer patients (SMD = 0.89; 95% CI 0.54, 1.24; p < 0.00001) (Fig. 3a). Health education delivered via mobile devices Five studies [34, 36, 37, 42, 44] provided information on the intervention of health education delivered via a mobile device, and these studies included 495 breast cancer women. There was substantial heterogeneity (χ 2 = 80.74, p < 0.00001, I 2 = 95%) according to the results of the heterogeneity test for these studies. Therefore, we used the random effects model to analyze these data, which confirmed that the intervention of health education delivered via a mobile device was more effective than routine nursing care in improving the resilience of breast cancer patients (SMD = 1.84; 95% CI 0.86, 2.82; p = 0.0002) (Fig. 3b). Peer support Three studies [31-33], with a total of 240 breast cancer women, reported data on the peer support. The results showed that the heterogeneity between the two groups was very significant (χ 2 = 127.50, p < 0.00001, I 2 = 98%), and we utilized a random effects model for the meta-analysis. The results showed that peer support was more effective than routine nursing care in improving the resilience of breast cancer patients (SMD = 2.62; 95% CI 0.61, 4.63; p = 0.01) (Fig. 3c). Other kind of interventions Seven studies [29, 30, 35, 39-41, 47], with a total of 617 breast cancer women, reported seven other kind of interventions which may contribute to improve resilience: 1) trinity nursing intervention, 2) nursing of family affection and psychological counseling, 3) synchronous stage cognitive therapy of family members combined with psychological intervention, 4) supportive psychological nursing, 5) psychological phased change nursing intervention, 6) admission and commitment therapy, and 7) collaboration care model. However, meta-analysis was abandoned and the evidence was presented in a narrative form because there was significant heterogeneity within the implemented interventions and the data cannot be classified and integrated. Further details about the summary of all the included studies’ interventions of all the included studies are shown in Table 2. Subgroup analysis Two subgroup analyses were undertaken based on the intervention time of resilience training program. The p -value for interaction was 0.85, which suggests that there was no interaction, in other words, the intervention time was not a source of heterogeneity. The results for the intervention times showed that the difference was not significant among the three subgroups: the intervention time was less than 12 weeks (SMD = 1.00; 95%CI 0.26, 1.74), the intervention time was 12 weeks (SMD = 1.19; 95%CI 0.10, 2.28), and the intervention time was more than 12 weeks (SMD = 0.88; 95%CI 0.57, 1.19). Overall, the results of the subgroup analysis showed that the resilience training program was more effective than the routine nursing care intervention, indicating the results of resilience training program had no change (Fig. 4). Publication bias We used Egger's linear regression test to detect the publication bias caused by the influencing factors quantitatively. The results for the resilience training program (95% CI -11.37, 9.41; p = 0.825) and the intervention of health education delivered via a mobile device (95% CI -10.38, 33.46; p = 0.192) showed that there was no significant publication bias among the included studies. However, the p -value for peer support (95% CI 3.81, 29.78; p = 0.039) was less than 0.05 and the results reversed significantly after the data were analysed by the trim and fill method, which indicated that there was significant publication bias. Discussion This systematic review and meta-analysis estimated the effect of the interventions for resilience of breast cancer patients. These interventions included resilience training program, health education delivered via mobile devices, peer support, and seven other kind of interventions. The effectiveness of the interventions included in the meta-analysis was examined through the assessment of resilience score. The measurement of the outcome for most studies were CD-RISC-25 and RSA. Resilience training program is helpful to improving the psychological resilience of breast cancer patients. In recent years, more and more researches suggest that resilience training may play a pivotal role in the realm of public health and prevention [ 48 ], and it also has a great number of wider benefits such as enhanced psychosocial functioning and improved performance [ 49 ]. There was considerable variation in the type of resilience training program provided in this study, although most involved Acceptance and Commitment Therapy (ACT), Cognitive Behavioral Therapy (CBT), Mindfulness-Based techniques [ 9 , 48 ]. Our meta-analysis showed that the resilience training program was more effective than the routine nursing care intervention (SMD = 0.89; 95% CI 0.54, 1.24; p < 0.00001). This result is consistent with the study of resilience training programmes and interventions in adults, reflecting a moderate positive effect (SMD = 0.44; 95% CI 0.23, 0.64) in favor of the resilience training program group [ 9 ]. It may be because psychological resilience training program helps patients control their emotions, cope with setbacks and adapt to adversity. The influence of psychological training on future functions depends heavily on the type of measurement results and the setting of the training [ 50 ]. Therefore, further researches about the effect of the resilience training should be conducted for a more definitive conclusion due to the difference in content, delivery and length. Health education delivered via mobile devices is a new and effective healthcare method [ 51 ], and the included studies about it were all conducted in China. WeChat is a free communication application, which is the most widely and extensively used mobile social networking App in China. Mobile health (mHealth) or WeChat-based intervention programs have become a popular health service model in China [ 26 ]. Our meta-analysis showed that the intervention of health education delivered via mobile devices was more effective than the routine nursing care intervention (SMD = 1.84; 95% CI 0.86, 2.82; p = 0.0002). This result is consistent with a study of people living with schizophrenia (PLS), which reported that WeChat-based intervention was related to a series of positive health outcomes, including decreased symptoms and depression, as well as improved functioning, recovery, quality of life and mental well-being [ 52 ]. It may be because that the online delivery of resilience training has the potential of delivering effective training in a more flexible, personalized, and cost-effective way [ 53 ]. This new method can hold great promise for mental health care by extending the reach of services and supplementing existing models of care [ 54 ]. Therefore, health education delivered via mobile devices is worthy of clinical promotion for breast cancer patients. Peer support was more effective than routine nursing care in improving the resilience of breast cancer patients. Peer support refers to the approach whereby individuals with the same disease or condition meet in order to exchange information, share experiences, and provide emotional/appraisal/informational assistance [ 55 , 56 ]. The results of this study showed that peer support was more effective than routine nursing care in improving the resilience of breast cancer patients (SMD = 2.62; 95% CI 0.61, 4.63; p = 0.01), which was similar to the results of a systematic review [ 56 ]. However, this conclusion should be treated with caution because only three trials [ 31 – 33 ], were included. In addition, the small sample size and publication bias may also lead to false negative results. Peer support was underutilised amongst women with breast cancer in recent years [ 57 , 58 ]. Future studies with better design/execution and larger sample size are needed to investigate the effectiveness of peer support on breast cancer patients. There were seven other kind of interventions included which may be favorably associated with the breast cancer women’s resilience [ 29 , 30 , 35 , 39 – 41 , 47 ]. However, at present, these studies on resilience interventions for breast cancer patients had many limitations such as scattered research content and low quality of some researches, all of which bring difficulties to data integration. These studies were not included in the meta-analysis due to the inability to classify and integrate the data, soour study cannot draw definitive conclusions regarding the effectiveness of them. Thus, there is no clearly evidence to summarize the effect of these intervention measures for resilience of breast cancer patients. Further studies are needed to clarify the effectiveness of these interventions, respectively. Although the existing interventions seem to be effective for promoting resilience of breast cancer patients, the current evidences are still in the preliminary research stage and the quality of them were not high. Recently, more and more studies have shown that in addition to social and psychological factors, biological mechanisms such as the amygdala, hippocampus, ventral striatum and frontal-associated regions of the brain are related to resilience strength [ 11 , 59 ]. An improved understanding of the biological mechanisms-based intervention could reveal novel therapeutic targets and help clarifying which psychosocial interventions can improve the psychological elasticity of breast cancer patients [ 60 ]. Therefore, we should formulate a staged, personalized and reasonable intervention plan from physiological, psychological social dimensions and influencing factors in the future. One of the advantages of this study is that we performed a systematic and comprehensive search of 12 databases. Another major strength of our review and meta-analysis is that all the included studies are RCTs. We used the latest tool RoB 2.0 to assess the risk of bias, and the quality of the included studies was moderate to high quality. This review was adhered to the PRISMA 2020 checklist and PRISMA 2020 flow diagram, which are the latest versions of PRISMA. There were several limitations in our study. First, we considered RCTs published in English and Chinese only. Second, the included studies were exclusively conducted in the USA, Spain or China, which limit generalizability across other countries. Third, the small sample size (ranges from 20 to 175) might have decreased the reliability and could cause bias. Furthermore, this study performed meta-analysis on two interventions only due to data limitations and more RCTs are needed for data integration and analysis of other interventions. Conclusions It has been found in this study that the resilience training program, health education delivered via mobile devices and peer support are more effective than that of the routine nursing care. However, the heterogeneities between the studies were obvious and the sample sizes were not large. In addition, this study cannot draw definitive conclusions regarding the effectiveness of other seven kind of interventions included in the systematic review because the sample size of these studies is small and cannot be conducted in the meta-analysis as there is only one study included regarding each kind of intervention. More studies are needed in the future to clarify the effectiveness of these interventions. Declarations Funding information This research was supported by Health research project from Health Commission of Sichuan Province (19PJ121) and Special Scientific Research Fund of Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital (2021ZX08). The funding bodies had no role in study design, data collection and analysis, decision to publish or writing the manuscript. Conflicts of interest/Competing interests All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. Availability of data and material The data sets analyzed during the current study will be available upon reasonable request of the corresponding author. Code availability Not applicable. Authors' contributions Study concept and design: Zhi Wang, Qiu-Yue Liu, Xiao-Rong Mao and Li-Hua Min; Strategy searching: Zhi Wang and Qiu-Yue Liu; Selection of studies: Yu-Lei Zhao, Xin-Yi Xu and Yan Chen; Quality assessment: Zhi Wang and Qiu-Yue Liu; Data extraction and organization: Wen-Juan Cao, Yan Chen and Cai-Hong Li; Data checking: Li-Hua Min and Yan Chen; Data analysis and chart production: Zhi Wang, Qiu-Yue Liu and Xiao-Rong Mao; Drafting the manuscript: Zhi Wang, Qiu-Yue Liu, Yu-Lei Zhao and Xin-Yi Xu. Revision and appraisal of the manuscript: Xiao-Rong Mao and Li-Hua Min; Proofreading the manuscript: Wen-Juan Cao and Cai-Hong Li. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Ethics approval Not applicable. Consent to participate Not applicable. Consent for publication Not applicable. References Wild CP, Weiderpass E, Stewart BW (2020) World Cancer Report: Cancer Research for Cancer Prevention. Lyon, France: International Agency for Research on Cancer. Available from: https://publications.iarc.fr/586 . Licence: CC BY-NC-ND 3.0 IGO. p382-383. Accessed 19 February 2021 World Health Organization (2021) Breast cancer now most common form of cancer: WHO taking action. Available from: https://www.who.int/news/item/03-02-2021-breast-cancer-now-most-common-form-of-cancer-who-taking-action . Accessed 18 February 2021 Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. Cancer J Clin 68(6):394–424. https://doi.org/10.3322/caac.21492 Sebri V, Triberti S, Pravettoni G (2020) Injured Self: Autobiographical Memory, Self-Concept, and Mental Health Risk in Breast Cancer Survivors. Front Psychol 11. https://doi.org/10.3389/fpsyg.2020.607514 Ng CG, Mohamed S, Kaur K, Sulaiman AH, Zainal NZ, Taib NA et al (2017) Perceived distress and its association with depression and anxiety in breast cancer patients. PLoS ONE 12(3):e0172975. https://doi.org/10.1371/journal. pone.0172975 Naik H, Leung B, Laskin J, McDonald M, Srikanthan A, Wu J, Bates A, Ho C (2020) Emotional distress and psychosocial needs in patients with breast cancer in British Columbia: younger versus older adults. Breast cancer research treatment 179(2):471–477. https://doi.org/10.1007/s10549-019-05468-6 Guil R, Ruiz-González P, Merchán-Clavellino A, Morales-Sánchez L, Zayas A, Gómez-Molinero R (2020) Breast Cancer and Resilience: The Controversial Role of Perceived Emotional Intelligence. Front Psychol 11:3604. https://doi.org/10.3389/fpsyg.2020.595713 Aizpurua-Perez I, Perez-Tejada J (2020) Resilience in women with breast cancer: A systematic review. European Journal of Oncology Nursing 101854. https://doi.org/10.1016/j.ejon.2020.101854 Joyce S, Shand F, Tighe J, Laurent SJ, Bryant RA, Harvey SB (2018) Road to resilience: a systematic review and meta-analysis of resilience training programmes and interventions. BMJ open 8(6). http://dx.doi.org/10.1136/bmjopen-2017-017858 Wiig S, Aase K, Billett S, Canfield C, Røise O, Njå O, Guise L, Haraldseid-Driftland C, Ree E, Anderson JE, Macrae C, RiH-team (2020) Defining the boundaries and operational concepts of resilience in the resilience in healthcare research program. BMC Health Serv Res 20:1–9. https://doi.org/10.1186/s12913-020-05224-3 Holz NE, Tost H, Meyer-Lindenberg A (2020) Resilience and the brain: a key role for regulatory circuits linked to social stress and support. Molecular psychiatry 25(2):379–396. https://doi.org/10.1038/s41380-019-0551-9 Ristevska-Dimitrovska G, Stefanovski P, Smichkoska S, Raleva M, Dejanova B (2015) Depression and resilience in breast cancer patients. Open Access Macedonian Journal of Medical Sciences 3(4):661. https://doi.org/10.3889/oamjms.2015.119 Ristevska-Dimitrovska G, Filov I, Rajchanovska D, Stefanovski P, Dejanova B (2015) Resilience and quality of life in breast cancer patients. Open access Macedonian journal of medical sciences 3(4):727. https://doi.org/10.3889/oamjms.2015.128 Ungar M, Theron L (2020) Resilience and mental health: How multisystemic processes contribute to positive outcomes. The Lancet Psychiatry 7(5):441–448. https://doi.org/10.1016/S2215-0366(19)30434-1 Wu ZJ, Liu Y, Li XL, Li XH (2016) Resilience and associated factors among mainland Chinese women newly diagnosed with breast cancer. PLoS One 11(12):e0167976. https://doi.org/10.1371/journal.pone.0167976 Fradelos EC, Papathanasiou IV, Veneti A, Daglas A, Christodoulou E, Zyga S, Kourakos M (2017) Psychological distress and resilience in women diagnosed with breast cancer in Greece. Asian Pacific journal of cancer prevention APJCP 18(9):2545. https://doi.org/10.22034/apjcp.2017.18.9.2545 Alizadeh S, Khanahmadi S, Vedadhir A, Barjasteh S (2018) The relationship between resilience with self-compassion, social support and sense of belonging in women with breast cancer. Asian Pacific journal of cancer prevention APJCP 19(9):2469. https://doi.org/10.22034/apjcp.2018.19.9.2469 Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372:n71. https://doi.org/10.1136/bmj.n71 Higgins JPT, Savović J, Page MJ, Elbers RG, Sterne JAC (2019) Chap. 8: Assessing risk of bias in a randomized trial. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). Cochrane Handbook for Systematic Reviews of Interventions version 6.0 (updated July 2019). Cochrane. Available from: https://training.cochrane.org/handbook/current/chapter-06 . Accessed 10 February 2021 Yang ZR, Sun F, Zhan SY (2017) Risk on bias assessment: (2) Revised Cochrane risk of bias tool for individually randomized, parallel group trials (RoB2. 0). Chinese Journal of Epidemiology 38(9):1285–1291. https://doi.org/10.3760/cma.j.issn.0254-6450.2017.09.028 Koenig C, Schneider C, Morgan JE, Ammann RA, Sung L, Phillips B (2019) Interventions aiming to reduce time to antibiotics (TTA) in patients with fever and neutropenia during chemotherapy for cancer (FN), a systematic review. Supportive care in cancer 28:2369–2380. https://doi.org/10.1007/s00520-019-05056-w Thongprayoon C, Khoury NJ, Bathini T, Bathini T, Aeddula NR, Boonpheng B, Leeaphorn N, Ungprasert P, Bruminhent J, Lertjitbanjong P, Watthanasuntorn K, Chesdachai S, Mao MA, Cheungpasitporn W (2019) BK polyomavirus genotypes in renal transplant recipients in the United States: A meta-analysis. Journal of Evidence‐Based Medicine 12(4):291–299. https://doi.org/10.1111/jebm.12366 Zhang SH (2016) Subgroup analysis and sensitive analysis should be set up reasonably in meta-analysis. Chinese Journal of Contemporary Neurology Neurosurgery 16(1):1. https://doi.org/10.3969/j.issn.1672-6731.2016.01.001 Zwetsloot PP, Van Der Naald M, Sena ES, Howels DW, IntHout J, De Groot AH, Chamuleau JAJ, Macleod S, Wever MR KE (2017) Standardized mean differences cause funnel plot distortion in publication bias assessments. eLife 6:e24260. https://doi.org/10.7554/eLife.24260.001 Wu PH, Chen SW, Huang WT, Chang SC, Hsu MC (2018) Effects of a psychoeducational intervention in patients with breast cancer undergoing chemotherapy. Journal of Nursing Research 26(4):266–279. https://doi.org/10.1097/jnr.0000000000000252 Zhou KN, Li J, Li XM (2019) Effects of cyclic adjustment training delivered via a mobile device on psychological resilience, depression, and anxiety in Chinese post-surgical breast cancer patients. Breast cancer research treatment 178(1):95–103. https://doi.org/10.1007/s10549-019-05368-9 Cerezo MV, Ortiz-Tallo M, Cardenal V, De La Torre-Luque A (2014) Positive psychology group intervention for breast cancer patients: a randomised trial. Psychol Rep 115(1):44–64. https://doi.org/10.2466/15.20.PR0.115c17z7 Loprinzi CE, Prasad K, Schroeder DR, Sood A (2011) Stress Management and Resilience Training (SMART) program to decrease stress and enhance resilience among breast cancer survivors: a pilot randomized clinical trial. Clin Breast Cancer 11(6):364–368. https://doi.org/10.1016/j.clbc.2011.06.008 Luo H, Lin J, Zhao XF (2019) Influence of Family Psychological Counselling on Postoperative Psychological Pressure and Quality of Life of Patients with Modified Radical Mastectomy for Breast Cancer. Journal of Qilu Nursing 25(22):44–47. https://doi.org/10.3969/j.issn.1006-7256.2019.22.014 Lu J, Shi TY, Liu QG, Yin AC, Song CL, Li H, Li YJ (2015) Effect of the collaboration care model on posttraumatic growth and resilience in patients with breast cancer. Chinese Journal of Practical Nursing 31(18):1353–1356. https://doi.org/10.3760/cma.j.issn.1672-7088.2015.18.008 Liu CC, Sun X, Zhao LP, Xu LL (2019) Effect of peer support on psychological resilience of breast cancer patients undergoing post -operative chemotherapy. Chinese Evidence-based Nursing 5(4):309–313. https://doi.org/10.12102/j.issn.2095-8668.2019.04.004 Xie XL (2019) The influence of peer support education on the psychological resilience of breast cancer patients. Healthmust-Readmagazine 25:283 Chen ZY (2018) Research on the Influence of Peer Support Education on the Psychological Resilience Level of Breast Cancer Patients. Jilin Medical Journal 39(3):580–582. https://doi.org/10.3969/j.issn.1004-0412.2018.03.083 Shen YY, Sheng LL, Yan M (2020) The impact of continuous care intervention based on WeChat platform on breast cancer patients. Journal of Qilu Nursing 26(09):61–63. https://doi.org/10.3969/j.issn.1006-7256.2020.09.018 Li HB, Qing X, Wang XQ, Zhang SP, Liu Q (2019) Effects of synchronous stage cognitive therapy of family members combined with psychological intervention on family function, hope level, sense of coherence and quality of life in patients with breast cancer. 27(11):1729–1733. China Journal of Health Psychology https://doi.org/10.13342/j.cnki.cjhp.2019.11.032 Zhou L, Kong HW (2019) Effect of continuous nursing intervention based on WeChat platform on post-operative psychological elasticity and shame of breast cancer patients. Chinese Journal of General Practice 17(10):1773–1776. https://doi.org/10.16766/j.cnki.issn.1674-4152.001052 Wang XY, Wang XJ (2020) Effect of WeChat-based symptom assessment and self-intervention on adverse reactions, mental state and quality of life in patients with breast cancer during chemotherapy. Chinese Journal of General Practice 18(01):94–97. https://doi.org/10.16766/j.cnki.issn.1674-4152.001177 Zhao WW, Zhang AH (2015) Study on influence of mental awareness training on psychological resilience of patients with breast cancer. Chinese Nursing Research 29(26):3286–3288. https://doi.org/10.3969/j.issn.1009-6493.2015.26.029 Liu AH (2018) The Effect of Psychological Phased Change Nursing on Rehabilitation of Breast Cancer Patients After Operation. China Continuing Medical Education 10(36):180–182. https://doi.org/10.3969/j.issn.1674-9308.2018.36.076 Ou LC, Guo XP, Meng YZ (2017) Effect of admission and commitment therapy on psychological resilience and disease awareness in patients with breast cancer surgery. Modern Clinical Nursing 16(02):14–18. https://doi.org/10.3969/j.issn.1671-8283.2017.02.004 Hou LJ, Zhang LQ (2019) The influence of supportive psychological nursing combined with rapid rehabilitation surgery theory on the psychological resilience score and compliance of patients with modified radical mastectomy. Journal of Clinical Research 36(12):2495–2496. https://doi.org/10.3969/j.issn.1671-7171.2019.12.075 Yuan P (2017) Influence of aerobic exercise combined with continuity of care on post-traumatic growth and psychological resilience of breast cancer patients. Chinese Nursing Research 31(21):2617–2619. https://doi.org/10.3969/j.issn.1009-6493.2017.21.016 Cui Y, Wang XH, Liu YX (2020) Effect of mindfulness decompression training on psychological flexibility, self-efficacy and quality of life in postoperative patients with breast cancer. International Journal of Nursing 39(21):3847–3851. https://doi.org/10.3760/cma.j.cn221370-20190718-01181 Shen XM (2020) Influence of "in-hospital-out-hospital" continuous nursing model on the psychological resilience of chemotherapy patients after radical mastectomy. Chinese Baby (2):176 Xu MR, Wei XH, Wu GL, Dai LJ (2015) The effect of resilience training on the mental health of breast cancer patients. Modern Journal of Integrated Traditional Chinese western medicine 24(08):896–898. https://doi.org/10.3969/j.issn.1008-8849.2015.08.040 Zhao XF, Chen MS, Yang HW, Rong W (2016) Effect of psychological flexibility training on the mental status of patients with breast cancer after simplified radical mastectomy. Journal of International Psychiatry 43(02):350–353. https://doi.org/10.13479/j.cnki.jip.2016.02.048 Wang LM (2020) Effect of Trinity Nursing Intervention on Psychological Elasticity and Family Adaptability of Patients with Breast Cancer Radiotherapy. Journal of Clinic Nursing's Practicality 5(49):9 Joyce S, Shand F, Bryant RA, Lal TJ, Harvey SB (2018) Mindfulness-Based Resilience Training in the Workplace: Pilot Study of the Internet-Based Resilience@Work (RAW) Mindfulness Program. J Med Internet Res 20(9):e10326. https://doi.org/10.2196/10326 Robertson IT, Cooper CL, Sarkar M, Curran T (2015) Resilience training in the workplace from 2003 to 2014: A systematic review. Journal of occupational organizational psychology 88(3):533–562. https://doi.org/10.1111/joop.12120 Forbes S, Fikretoglu D (2018) Building resilience: The conceptual basis and research evidence for resilience training programs. Review of General Psychology 22(4):452–468. https://doi.org/10.1037/gpr0000152 Zhang XT, Wen D, Liang J, Lei JB (2017) How the public uses social media wechat to obtain health information in china: a survey study. BMC Med Inf Decis Mak 17(2):71–79. https://doi.org/10.1186/s12911-017-0470-0 Yu Y, Li YL, Li TX, Xi SJ, Xiao X, Xiao SY, Tebes JK (2020) New Path to Recovery and Well-Being: Cross-Sectional Study on WeChat Use and Endorsement of WeChat-Based mHealth Among People Living With Schizophrenia in China. Journal of Medical Internet Research 22(9):e18663. https://doi.org/10.2196/18663 Smith B, Shatté A, Perlman A, Siers M, Lynch WD (2018) Improvements in resilience, stress, and somatic symptoms following online resilience training: A dose–response effect. Journal of occupational environmental medicine 60(1):1. https://doi.org/10.1097/JOM.0000000000001142 Firth J, Cotter J, Torous J, Bucci S, Firth JA, Yung AR (2016) Mobile phone ownership and endorsement of “mHealth” among people with psychosis: a meta-analysis of cross-sectional studies. Schizophr Bull 42(2):448–455. https://doi.org/10.1093/schbul/sbv132 Huang RR, Yan CL, Tian YM, Lei BM, Yang DQ, Liu D, Lei J (2020) Effectiveness of peer support intervention on perinatal depression: A systematic review and meta-analysis. J Affect Disord. https://doi.org/10.1016/j.jad.2020.06.048 Hu JM, Wang X, Guo SN, Chen FF, Wu YY, Ji FJ, Fang XD (2019) Peer support interventions for breast cancer patients: a systematic review. Breast cancer research treatment 174(2):325–341. https://doi.org/10.1007/s10549-018-5033-2 Legg M, Occhipinti S, Youl P, Dunn J, Chambers SK (2017) Needy or resilient? How women with breast cancer think about peer support. Psycho-Oncology 26(12):2307–2310. https://doi.org/10.1002/pon.4401 Legg M, Hyde MK, Occhipinti S, Youl PH, Dunn J, Chambers SK (2019) A prospective and population-based inquiry on the use and acceptability of peer support for women newly diagnosed with breast cancer. Support Care Cancer 27(2):677–685. https://doi.org/10.1007/s00520-018-4358-z Hsieh S, Yao ZF, Yang MH (2021) Multimodal Imaging Analysis Reveals Frontal-Associated Networks in Relation to Individual Resilience Strength. Int J Environ Res Public Health 18(3):1123. https://doi.org/10.3390/ijerph18031123 Borgi M, Collacchi B, Ortona E, Cirulli F (2020) Stress and coping in women with breast cancer: unravelling the mechanisms to improve resilience. Neurosci Biobehav Rev 119:406–421. https://doi.org/10.1016/j.neubiorev.2020.10.011 Tables Table 1 Characteristics of the studies included Author (year) Origin Sample size( n ) Age in years (Mean ± SD) Cancer Stage Outcome measurement E C E C Shen (2020) [44] Shanghai, China 37 36 NR NR NR CD-RISC-25 Shen et al. (2020) [34] Jiangsu, China 40 40 50.23 ± 14.35 50.87 ± 14.41 I-III CD-RISC-25 Wang (2020) [47] Guangdong, China 42 42 45.5 ± 7.0 44.5 ± 6.5 NR RSA Wang et al. (2020) [37] Zhejiang, China 73 73 52.79 ± 4.58 51.45 ± 4.32 I-IV CD-RISC-25 Cui et al. (2020) [43] Henan, China 40 40 45.48 ± 6.09 45.56 ± 6.17 I-III CD-RISC-25 Zhou K et al. (2019) [26] Shanxi, China 66 66 44.62 ± 7.89 44.37 ± 7.32 I-III CD-RISC-25 Zhou L et al. (2019) [36] Zhejiang, China 30 30 48.87 ± 14.41 48.76. ± 12.25 I-III CD-RISC-25 Luo et al. (2019) [29] Guangdong, China 40 40 33.48 ± 5.69 33.56 ± 5.23 I-III CD-RISC-25 Li et al. (2019) [35] Sichuan, China 65 65 43.25 ± 4.31 42.38 ± 3.52 I-II CD-RISC-25 Hou et al. (2019) [41] Neimenggu, China 52 52 42.04 ± 6.45 41.76 ± 6.38 I-IV CD-RISC-25 Xie (2019) [32] Sichuan, China 38 38 NR NR NR CD-RISC-25 Liu et al. (2019) [31] Hunan, China 38 38 45.92 ± 8.27 46.53 ± 8.37 NR CD-RISC-25 Chen (2018) [33] Guangdong, China 45 44 NR NR I-III CD-RISC-25 Wu et al. (2018) [25] Southern, Taiwan 20 20 51.2 ± 9.18 51.2 ± 10.71 I-IV CD-RISC-25 Liu (2018) [39] Jiangsu, China 38 38 48.92 ± 6.40 49.41 ± 6.18 I-II CD-RISC-25 Yuan (2017) [42] Hubei, China 68 68 49.6 ± 9.4 50.5 ± 10.3 I-IV CD-RISC-25 Ou et al. (2017) [40] Guangxi, China 41 39 39.8 ± 4.3 40.5 ± 4.8 NR CD-RISC-25 Zhao et al. (2016) [46] Sichuan, China 37 37 51.39 ± 8.73 51.92 ± 8.05 NR RSA Lu et al. (2015) [30] Liaoning, China 32 31 50.47 ± 9.51 NR NR CD-RISC-25 Zhao et al. (2015) [38] Shandong, China 36 38 42.47 ± 8.51 42.63 ± 7.40 I-III CD-RISC-25 Xu et al. (2015) [45] Hubei, China 30 24 NR NR NR RSA Cerezo et al. (2014) [27] Minnesota, United States 87 88 50.71 ± 9.44 49.35 ± 9.85 I-III CD-RISC-25 Loprinzi et al. (2011) [28] Malaga, Spain 12 8 61 ± NR 61 ± NR I-III CD-RISC-25 E: experimental group, C: control group, SD: standard deviation, NR: Not Reported, h: hour, d: day, w: week, m: month Table 2 The summary of studies’ interventions Approaches of the intervention Author (year) Delivery of the intervention Follow-up point Theory Content of the intervention Resilience training program Cui et al. (2020) [43] Nurse 6w Mindfulness decompression Experimental Group: Mindfulness decompression training combined with routine nursing care. Mindfulness decompression training includes mindful body scanning training, mindfulness meditation training, mindfulness walking training, mindfulness breathing training and mindfulness yoga training. Control Group: Routine nursing care. Zhou K et al. (2019) [26] Nurse 4w, 8w and 12w Roy Adaptation Model (RAM) Experimental Group: Cyclic adjustment training (CAT) delivered via a device combined with routine nursing care. The CAT using WeChat included 4 steps: Confront, pre-introspect, adjust and re-introspect. Control Group: Routine nursing care. The control group patients received only routine nursing care, including health instruction, vital signs and post-surgery complications monitoring, and post-surgery and drainage tube care. Wu et al. (2018) [25] Nurse 2w Stress and Coping Model Experimental Group: Psychoeducational interventions (PEIs). The PEI included interaction between healthcare professionals and patients, use of a self-directed videotape, educational information and materials, and an educational manual. Control Group: The traditional pamphlet education. Participants in the control group were exposed only to the traditional pamphlet education approach (consultation from nurses and information sheets) in the outpatient department. Zhao et al. (2016) [46] Nurse 12w Kumpfer's Psychological Resilience Framework Theory Experimental Group: Psychological flexibility training combined with routine nursing care. Based on Kumpfer's related psychological resilience framework theory, each patient in the observation group was given a set of DVDs for learning breathing meditation and relaxation. Use methods such as case analysis, discussion, sharing, and theme games for patients in the observation group, and use 5 major links (warm-up, interaction, cohesion, sharing, and end) as a fixed activity program for each training. Psychological training takes place every Tuesday, 1.5 hours each time. Control Group: Routine nursing care. The control group was given routine care for 12 weeks, including maintaining a comfortable ward environment, monitoring patient vital signs, ward rounds, diet and medication guidance, etc. Zhao et al. (2015) [38] Doctor and nurse 8w Mental awareness Experimental Group: Mental awareness training combined with routine nursing care. Nurses teach the patients the basic principles and methods of mental awareness in the first to third weeks, the body awareness in the fourth to sixth weeks, and the meditation exercises in the seventh to eighth weeks. Once a week, 40 to 50 minutes each time, meditation music is played during each intervention, so that the patients can adopt the most comfortable posture. Control Group: Routine nursing care. Xu et al. (2015) [45] Nurse 12w Kumpfer's Psychological Resilience Framework Theory Experimental Group: Mental flexibility(resilience) training combined with routine nursing care. Based on Kumpfer's related psychological resilience framework theory, each patient in the observation group was given a set of DVDs for learning breathing meditation and relaxation. Use methods such as case analysis, discussion, sharing, and theme games for patients in the observation group, and use 5 major links (warm-up, interaction, cohesion, sharing, and end) as a fixed activity program for each training. Psychological training takes place every Tuesday, 1.5 hours each time. Control Group: Routine nursing care. Cerezo et al. (2014) [27] Psychologists 14w Positive psychology Experimental Group: A psychological group intervention based on positive psychology. The psychological intervention was applied during 14 two-hour sessions (3 modules: Self-knowledge, Positive psychology-related skills, and Positive psychology-related skills), once per week, to groups of 10 to 15 women. Control Group: Wait-list Group. The waitlist group was administered the psychological intervention for the same amount of time as the experimental group, which was followed by a post-test assessment. Loprinzi et al. (2011) [28] Physician 12w SMART program Experimental Group: Stress Management and Resilience Training (SMART) program. The study intervention consisted of 3 parts: The program consisted of two 90-minute group training sessions (paced breathing meditation), a brief individual session (practice deep diaphragmatic breathing at 5 breaths per minute for 5 or 15 minutes, once or twice a day), and 3 follow-up telephone calls (30-60 minutes). Control Group: Wait-list Group. Intervention for the wait-list control arm was delayed by 12 weeks compared with the active arm. The participants completed the written baseline surveys during an initial meeting and at the end of the 12-week intervention. Health education delivered via mobile devices Shen (2020) [44] Nurse NR NR Experimental Group: "In-hospital and out-hospital" continued nursing combined with routine nursing care and discharge guidance. In-hospital nursing mode: Distribute health knowledge manuals, face-to-face education, broadcast education videos, and situational drills to teach patients and their families related health knowledge. Out-of-hospital continued nursing: After the patient is discharged from the hospital, a health record is established for the patient, and full-time nurses conduct popular science knowledge and health information education using phone and WeChat, and regularly organize patient symposiums and small lectures. Control Group: Routine nursing care and discharge guidance. Shen et al. (2020) [34] Doctor and nurse 1m, 3m and 6m NR Experimental Group: Continuous care based on WeChat platform combined with routine nursing care. The intervention includes registering a dedicated WeChat official account and WeChat group chat, establishing a continuous nursing team. Meantime, nurses conduct health education and problem guidance and carry out prize-winning contests to promote patients' knowledge. Control Group: Routine nursing care. Wang et al. (2020) [37] Doctor and nurse 6m NR Experimental Group: WeChat-based symptom assessment and self-intervention combined with routine outpatient guidance. Based on the WeChat platform, the experimental group established a remote service group to give patients relevant guidance. Control Group: Routine outpatient guidance. Nurses provide relevant guidance on the precautions of chemotherapy after chemotherapy, and conduct telephone follow-up at half a month and one month after chemotherapy. Zhou L et al. (2019) [36] Doctor and nurse 1m, 3m and 6m NR Experimental Group: Continuous nursing intervention based on WeChat platform combined with routine outpatient guidance. The intervention includes registering a dedicated WeChat official account and WeChat group chat, establishing a continuous nursing team. After discharge from the hospital, the experimental group received continuation care from the continuous nursing team. Control Group: Routine outpatient guidance. The control group used telephone follow-up for continuous care at 1 week, 1 month, 3 months and 6 months After discharge from the hospital. Yuan (2017) [42] Nurse 1w and 6m NR Experimental Group: Aerobic exercise combined with continuity of care on post. Nurses conduct in-depth interviews psychological interventions, post-operative health education and rehabilitation exercise guidance with patients and their families. The follow-up intervention is conducted using QQ or WeChat platforms every Friday and the follow-up time is 6 months. Control Group: Routine nursing care. Peer support Xie (2019) [32] Nurse NR NR Experimental Group: Peer support education combined with routine nursing care. Nursing staff screen the peer support educators and divide them into different groups, each with 3 members. The peers provide positive emotional support and strengthen communication with the patient and their family members, and provide at least 6 hours of support education per week. Control Group: Routine nursing care. Liu et al. (2019) [31] Doctor and nurse NR NR Experimental Group: Peer support combined with routine health education. Intervention measures include face-to-face guidance (postoperative functional exercise guidance, diet guidance, medication guidance, infection prevention and upper limb edema guidance, psychological adjustment guidance), telephone supervision (companion volunteers are responsible for telephone supervision of the same group of patients for disease self-management, the frequency is every Once a week, each talk time> 10 minutes) has been group activities (volunteers organize at least one group activity in each patient's inpatient chemotherapy cycle to summarize self-management experience and lessons). Control Group: Routine health education on chemotherapy after breast cancer operation. Chen (2018) [33] Doctor, nurse and psychologist NR NR Experimental Group: Peer support combined with routine nursing education. Companion volunteers provide health education and positive emotional guidance to patients based on personal experience or other patients' successful anti-cancer experience, and complete at least 3 peer support education before the patient's surgery, early postoperative period, and before discharge from the hospital. Depending on the patient's personal psychological cognition and family status, the number of interventions can be flexibly increased by 1-3 times. Control Group: Routine nursing education. Other kind of special interventions Wang (2020) [47] Doctor and nurse NR NR Experimental Group: Trinity nursing intervention combined with routine nursing care. It includes psychological intervention and the establishment of a family nursing team, and cooperate with patients to complete psychological and physical management and guidance. Control Group: Routine nursing care. Luo et al. (2019) [29] Nurse 1m NR Experimental Group: Nursing of family affection and psychological counseling combined with routine perioperative care. When the patient is conscious and stable, the family members are required to accompany the patient for about 8 hours a day, and participate in simple nursing interventions according to the patient's own wishes, so as to encourage the family members to build a good bridge between the nurse and the patient and satisfy the patient a sense of need for family support. Control Group: Routine perioperative care. Li et al. (2019) [35] Nurse NR NR Experimental Group: Synchronous stage cognitive therapy of family members combined with psychological intervention. The CAT using WeChat included 4 steps, cognitive intervention and rehabilitation guidance were given to patients and their families one day before admission, one day before surgery, three days after surgery, and one day before discharge. Control Group: Routine and psychological intervention. Hou et al. (2019) [41] Nurse 1w Fast-track surgery (FTS) theory Experimental Group: Supportive psychological nursing combined with nursing intervention based on Fast-track surgery (FTS) theory. Supportive psychological care includes four aspects: understanding mental state, cognitive intervention, information support and family support. Control Group: Nursing intervention based on FTS theory. Liu (2018) [39] Doctor and nurse NR NR Experimental Group: Peer support combined with routine health education. Intervention measures include face-to-face guidance (postoperative functional exercise guidance, diet guidance, medication guidance, infection prevention and upper limb edema guidance, psychological adjustment guidance), telephone supervision (companion volunteers are responsible for telephone supervision of the same group of patients for disease self-management, the frequency is every Once a week, each talk time> 10 minutes) has been group activities (volunteers organize at least one group activity in each patient's inpatient chemotherapy cycle to summarize self-management experience and lessons). Control Group: Routine health education on chemotherapy after breast cancer operation. Ou et al. (2017) [40] Nurse 2w NR Experimental Group: Admission and commitment therapy combined with routine nursing care. The intervention content includes acceptance, cognitive isolation, experience of the present, self-awareness, clarification of values, and committed actions. The intervention time is 2 weeks from the second day after the patient's operation. A total of 5 to 6 times, 30 to 40 minutes each time, once every 2 days. Control Group: Routine nursing care. Lu et al. (2015) [30] Nurse 3m Collaboration-care-mode (CCM) Experimental Group: Collaboration care model combined with routine nursing care. Intervention started after diagnosis and lasted 3 months, the measures include establishing a good nurse-patient relationship, guiding patients to cope with bad emotions, lifestyle guidance (functional exercise, functional exercise, diet), and disease-related knowledge guidance. Control Group: Routine nursing care. NR: Not Reported, h: hour, d: day, w: week, m: month Supplementary Files Additionalfile1PRISMA2020checklist.docx Additional file 1. PRISMA 2020 checklist. Additionalfile2Searchstrategies.docx Additional file 2. Search strategies. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-396869","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":24568539,"identity":"6b2a5503-0e96-49bf-a691-29cf53f7a69f","order_by":0,"name":"Zhi Wang","email":"","orcid":"","institution":"University of Electronic Science and Technology of China","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Zhi","middleName":"","lastName":"Wang","suffix":""},{"id":24568540,"identity":"24923fe0-4479-4de4-ae8e-95d981e3b631","order_by":1,"name":"Qiu-yue Liu","email":"","orcid":"","institution":"North Sichuan Medical College","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Qiu-yue","middleName":"","lastName":"Liu","suffix":""},{"id":24568541,"identity":"2fddc3a2-42d9-4c4d-8b4a-40573e96ad39","order_by":2,"name":"Yu-Lei Zhao","email":"","orcid":"","institution":"University of Electronic Science and Technology of China","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yu-Lei","middleName":"","lastName":"Zhao","suffix":""},{"id":24568542,"identity":"98e3ad38-72ad-48e5-bdd5-97935dd73d35","order_by":3,"name":"Xin-Yi Xu","email":"","orcid":"","institution":"University of Electronic Science and Technology of China","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xin-Yi","middleName":"","lastName":"Xu","suffix":""},{"id":24568543,"identity":"f8029837-fa9d-4515-8778-a7912b2f0e98","order_by":4,"name":"Yan Chen","email":"","orcid":"","institution":"Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Yan","middleName":"","lastName":"Chen","suffix":""},{"id":24568544,"identity":"efed8490-6419-415d-b9b9-1d338bf4658e","order_by":5,"name":"Wen-Juan Cao","email":"","orcid":"","institution":"University of Electronic Science and Technology of China","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Wen-Juan","middleName":"","lastName":"Cao","suffix":""},{"id":24568545,"identity":"3694726b-29cd-4cb2-9eff-4181399c72a2","order_by":6,"name":"Cai-Hong Li","email":"","orcid":"","institution":"University of Electronic Science and Technology of China","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Cai-Hong","middleName":"","lastName":"Li","suffix":""},{"id":24568546,"identity":"af6fd9a6-f215-49b2-865a-4a73b891b89c","order_by":7,"name":"Li-Hua Min","email":"","orcid":"","institution":"Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Li-Hua","middleName":"","lastName":"Min","suffix":""},{"id":24568547,"identity":"c6b61593-966d-4cf1-a8cf-e02b38927676","order_by":8,"name":"Xiaorong Mao","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAx0lEQVRIiWNgGAWjYBACxobDBx98qLCp52dvIFILc+OxZMMZZ9ISJHsOEKmFvfmMmTBvy+EEgxkJRGrhbTtjxszbwJxnIPl44w2GGptogloke46VPZy7g63YXDqt2ILhWFpuAyEthjMObzd4e4aHcefsHDMJYGAQ1mJ//4GZBG+bBOOGm2eI1MLYcMRMkrfNIHHDDR6itYADOcFYsgfolwRi/AKNyv9y/OyHN974UGNDWAsyMJBIIEU5RAupOkbBKBgFo2BkAACwVkhS/4GcFAAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0003-4407-2471","institution":"Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Xiaorong","middleName":"","lastName":"Mao","suffix":""}],"badges":[],"createdAt":"2021-04-06 07:00:52","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-396869/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-396869/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":8754288,"identity":"7434ee18-4c64-452b-96ee-fa40e8a5d60a","added_by":"auto","created_at":"2021-05-04 14:10:54","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":109897,"visible":true,"origin":"","legend":"PRISMA 2020 flow diagram of the literature search and study selection. *Records identified through database searching (n = 337): Web of Science (n = 44), PubMed (n = 24), Embase (n = 25), PsycINFO (n = 5), MEDLINE (n=24), Scopus (n = 0), Cochrane Library (n = 44), CINAHL (n = 12), CNKI (n = 21), CBM (n = 25), WanFang (n = 113), VIP (n = 0)","description":"","filename":"Onlinefloatimage7.png","url":"https://assets-eu.researchsquare.com/files/rs-396869/v1/6b873de662b46c4b93b6e02f.png"},{"id":8754784,"identity":"bfb6044e-7f27-47ba-84ae-30f382224def","added_by":"auto","created_at":"2021-05-04 14:13:54","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":222498,"visible":true,"origin":"","legend":"Risk of bias assessment of the RCTs: judgments about the risk of bias item presented in all included studies (a) and for each included study (b)","description":"","filename":"ScreenShot20210503at8.07.42PM.png","url":"https://assets-eu.researchsquare.com/files/rs-396869/v1/b2671b140a9b62bdee49c738.png"},{"id":8754287,"identity":"83c68daa-dcc7-49d2-9888-b8d84f66ce14","added_by":"auto","created_at":"2021-05-04 14:10:54","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":213557,"visible":true,"origin":"","legend":"Forest plots of the effectiveness for the intervention group versus the routine nursing care group. a Forest plot for the effectiveness the resilience training program. b Forest plot for the effectiveness of the intervention of health education delivered via a mobile device. c Forest plot for the effectiveness of peer support.","description":"","filename":"ScreenShot20210503at8.07.54PM.png","url":"https://assets-eu.researchsquare.com/files/rs-396869/v1/841032784c7102de626d04a9.png"},{"id":8754783,"identity":"5e9ee07e-3a4b-42b2-a8cb-19f38f60058c","added_by":"auto","created_at":"2021-05-04 14:13:54","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":125141,"visible":true,"origin":"","legend":"Subgroup analysis of the resilience training’s intervention time for resilience of breast cancer patients","description":"","filename":"ScreenShot20210503at8.08.08PM.png","url":"https://assets-eu.researchsquare.com/files/rs-396869/v1/fe581cc74ea96a683f3ccf2a.png"},{"id":13690355,"identity":"73d4a2ec-8dff-4058-b202-04e73e6d736f","added_by":"auto","created_at":"2021-09-17 12:33:15","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1178347,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-396869/v1/5eed297e-9214-40ac-83d4-503a25859af8.pdf"},{"id":8754290,"identity":"f4a7142c-1d04-42cd-9499-5ed07d33f9d7","added_by":"auto","created_at":"2021-05-04 14:10:54","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":33895,"visible":true,"origin":"","legend":"Additional file 1. PRISMA 2020 checklist.","description":"","filename":"Additionalfile1PRISMA2020checklist.docx","url":"https://assets-eu.researchsquare.com/files/rs-396869/v1/fd37ba4440c54a32ea41ddc1.docx"},{"id":8754286,"identity":"80bf5588-4959-47a2-a197-2afdf5796471","added_by":"auto","created_at":"2021-05-04 14:10:54","extension":"docx","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":16450,"visible":true,"origin":"","legend":"Additional file 2. Search strategies.","description":"","filename":"Additionalfile2Searchstrategies.docx","url":"https://assets-eu.researchsquare.com/files/rs-396869/v1/efd790ff5749688748cbe24f.docx"}],"financialInterests":"","formattedTitle":"\u003cp\u003eThe interventions for resilience of breast cancer patients: a systematic review and meta-analysis\u003c/p\u003e","fulltext":[{"header":"Introduction","content":" \u003cp\u003eBreast cancer is the leading cause of cancer death in women worldwide [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. It has now overtaken lung cancer as the world\u0026rsquo;s most commonly-diagnosed cancer, according to statistics released by the International Agency for Research on Cancer (IARC) in December 2020 [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In 2018, there were an estimated 2.1\u0026nbsp;million new cases of breast cancer and 627,000 deaths from breast cancer worldwide [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Breast cancer patients faced with high level of pressure in psychological and social respects. Also, both patients and their family undertook heavy economic and psychological burdens due to the painful and long process of disease diagnosis, treatment and rehabilitation. Breast cancer has adverse effects on patients' self-image, behavior, attitude towards life and quality of life [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Studies indicated that up to 50% of breast cancer patients suffered from significant psychosocial distress [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], and more than one-third of which developed anxiety (33.6%) and/or depression (58.6%) [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. However, breast cancer still has a high chance of cure if diagnosed early and treated appropriately [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. With the change of the social medicine model, the psychological problems of breast cancer patients have also received more and more attention from scholars.\u003c/p\u003e \u003cp\u003eNot everyone copes adversities in the negative way, many breast cancer patients may also develop resilience and produce positive psychological changes in the face of illness [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Resilience, which is also known as psychological resilience, was proposed by American psychologist Anthony in the 1970s, and the American Psychological Society defines resilience as a process of \u0026lsquo;bouncing back\u0026rsquo; from difficult experiences and \u0026lsquo;adapting well in the face of adversity, trauma, tragedy, threats or significant sources of stress\u0026rsquo; [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. In healthcare area, resilience were defined as ''the capacity to adapt to challenges and changes at different system levels, to maintain high quality care'' [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Resilience is a dynamic developmental process that promotes a successful adaptation to cancer-related adversity [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Studies showed that psychological distress was the variable that most frequently linked to reductions in resilience, and there is a bidirectional relationship between them [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. A survey study showed that breast cancer patients with poor resilience may have poor body images and suffer more severe adverse effects of systemic therapy, such as arm symptoms and breast symptoms, and hair loss [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Resilience is related to many factors such as sociodemographic, clinical, psychosocial and physiological aspects in women with breast cancer [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Resilience it not solely a quality within individuals; it also can be enhanced by the external support from others [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The evidence showed that the resilience of breast cancer patients is at a moderate or lower level currently [\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Thus, resilience-promoting interventions should be obtained to improve breast cancer patients' psychological well-being.\u003c/p\u003e \u003cp\u003eVarious psychosocial interventions to enhance resilience were found recently, such as mindfulness meditation, yoga exercises, a healthy diet, peer support, group meetings and group counseling [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. However, there is no clearly evidence to summarize the specific effect of intervention measures for resilience of breast cancer patients, and overview of the quantitative studies on the interventions still lacks. In this study, we conducted a systematic review and meta-analysis using data from randomized controlled trials (RCTs). The aim of our study was to synthesis the available research evidence on the effectiveness of interventions designed to promote or enhance the resilience of breast cancer patients.\u003c/p\u003e "},{"header":"Methods","content":"\u003cp\u003eThis review was adhered to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines [18] (see Additional file 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInclusion and exclusion criteria\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe included published studies meeting the following criteria: (1) Participants: Women with breast cancer; (2) Intervention: Interventions which aim to improve psychological resilience; (3) Control: Routine/Basic nursing care, wait-list or no intervention; (4) Outcomes: Psychological resilience score; and (5) Study design: RCTs.\u003c/p\u003e\n\u003cp\u003eStudies were excluded if they met the following criteria: (1) Studies in which full-text were not available; (3) Studies which reported unextractable or unrelated raw data; (4) Studies were not published in English or Chinese; and (5) Studies where types were reviews/ editorials/ books/ theses/ case reports/ news etc.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSearch strategy\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe performed a systematic and comprehensive search of 12 databases from inception to February 4,2021: Web of Science, PubMed, Embase, MEDLINE, Scopus, Cochrane Library, CINAHL, PsycINFO, Chinese National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBM), WanFang and VIP. Keywords or medical subject headings used in the search were as following: [\"resilience\" OR \" mental resilience\" OR \" psychological resilience\" OR \"Mental Elasticity\"] AND [\"breast cancer\" OR \" breast carcinoma\" OR \"mammary cancer\" OR \"Breast Neoplasm\" OR \"Breast Tumor\"] AND [\"randomized controlled trial*\" OR \" randomized clinical trial*\" OR \"RCT\" OR \"randomized\"]. In addition, the references in the articles were manually tracked for relevant studies. All articles were managed by EndNote X9 software. Two reviewers searched the databases and screened of the literature searches independently based on the agreed-on criteria. Any disagreements were resolved by discussion or referred to a senior reviewer. Detailed search strategies were listed in Additional file 2.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData extraction and\u003c/strong\u003e\u003cstrong\u003e synthesis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll relevant published data from the studies were extracted and recorded on a standardized data extraction form using Microsoft Excel. The extraction included author, year, origin, sample size, age, stage of cancer, study object, intervention description and outcome measurement. All the data were extracted by two authors independently and checked by a third reviewer.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQuality assessment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTwo investigators evaluated the risk of bias of each article independently using the RoB 2.0, which is the latest tool, developed by the Cochrane Handbook for Systematic Reviews of Interventions (Version 6, 2019) [19]. RoB 2.0 includes five domains and there are a series of \"signalling questions\" for each domain [19, 20]. The authors should reach a judgement after these questions were answered and assign one of three levels (\"low risk of bias\", \"some concerns\", \"high risk of bias\") to each domain. The overall judgement for the articles were mapped from the results within domains. Any disagreements or uncertainty was resolved through discussion or consulted a senior reviewer.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe meta-analysis was performed by using the Cochrane Collaboration Review Manager Version 5.3 and STATA/SE Version 15.1 (StataCorp, College Station, TX, USA). ALL the outcome data were presented as the mean \u0026plusmn; standard deviation (SD) and were expressed as mean difference (MD), standard mean difference (SMD), weighted mean difference (WMD) and 95% confidence interval (CI) because they were all continuous variables. Tests for heterogeneity were assessed statistically by using the standard chi-squared test (\u0026chi;\u003csup\u003e2\u003c/sup\u003e, or Cochran\u0026rsquo;s Q test) and the I\u003csup\u003e2\u003c/sup\u003e statistic, with \u003cem\u003ep\u003c/em\u003e \u0026le; 0.10 or I\u003csup\u003e2\u003c/sup\u003e \u0026gt; 50% indicating significant heterogeneity. A random-effects model was selected to pool the effect of the interventions on resilience of breast cancer patients because of the heterogeneity of interventions used and timing of outcome measurements [21]. Subgroup analysis was performed to identify the sources of heterogeneity and assess the effects of covariates on the pooled estimates[22, 23]. Egger\u0026rsquo;s linear regression test was performed to detect the publication bias [24]. For the data of which could not undertake meta-analyses, we synthesized the results and presented the evidence in a narrative form.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eSearch results\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInitially, a total of 337 publications were identified from the 12 databases. Then, 101 duplicate records were excluded by automation tools and 24 duplicate records were excluded by a human. 212 records were screened based on title and abstract. 87 studies were sought for retrieval and 82 reports were assessed for eligibility. Following full texts screening, 59 studies were excluded. Finally, 23 studies met the eligibility criteria, of which 16 studies were included in the meta-analysis. We searched studies via other methods, but did not find any additional studies that met the inclusion criteria. The flowchart details the literature selection process using the PRISMA 2020 flow diagram [18] (Fig. 1).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe characteristics of the included studies are shown in Table 1. A total of 23 RCTs involving 2,002 women with stage I-Ⅳ breast cancer met the eligibility criteria and 16 of them were included in the meta-analysis. Data accrue mainly from China (n = 20), Taiwan (n = 1), United States of America (n = 1) and Spain (n = 1). The publication date of the included studies ranges from 2011 to 2020. The intervention time lasted from 1 week to 6 months. The 25-item Connor-Davidson Resilience Scale (CD-RISC-25) was the primary outcome measurement for most studies (n = 20) [25-44], and there were only 3 studies [45-47] used the Resilience Scale for Adults (RSA). Further details of the studies\u0026rsquo; interventions were summarized in Table 2. The 16 studies for meta-analysis were divided into three groups: resilience training program (n = 8) [25-28, 38, 43, 45, 46], health education delivered via mobile devices (n = 5) [34, 36, 37, 42, 44] and peer support (n = 3) [31-33] based on the intervention measures. For the remaining 7 studies [29, 30, 35, 39-41, 47] that cannot be classified or meta-analyzed, we presented in a narrative form only.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRisk of bias assessment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSummary of quality assessments of all included RCT studies is shown in Fig. 2. With regard to the judgement of all the domains and signalling questions, twelve studies (78.3%) were judged to have low risk of bias, four studies (21.7%) were judged to raise some concerns, and none (0%) were judged to have high risk of bias for their outcomes. In general, the quality of the included studies was from moderate to high quality.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSynthesis of results\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResilience training program\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEight studies [25-28, 38, 43, 45, 46], with a total of 649 breast cancer women, reported data on the resilience training program. There was substantial heterogeneity among the studies (\u0026chi;\u003csup\u003e2\u003c/sup\u003e = 65.83, \u003cem\u003ep\u003c/em\u003e = 0.000, I\u003csup\u003e2\u003c/sup\u003e = 89.4%) according to the heterogeneity test. Therefore, we performed sensitivity analysis and found that Zhou K\u0026rsquo;s study [26] substantially influence the results. The heterogeneity has decreased significantly (\u0026chi;\u003csup\u003e2\u003c/sup\u003e = 19.25, \u003cem\u003ep\u003c/em\u003e = 0.004, I\u003csup\u003e2\u003c/sup\u003e = 69%) after removing the study. Therefore, the random effects model was utilized for the meta-analysis. The results showed that the resilience training program intervention was more effective than routine nursing care intervention in improving the resilience of breast cancer patients (SMD = 0.89; 95% CI 0.54, 1.24; \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.00001) (Fig. 3a).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHealth education delivered via mobile devices\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFive studies [34, 36, 37, 42, 44] provided information on the intervention of health education delivered via a mobile device, and these studies included 495 breast cancer women. There was substantial heterogeneity (\u0026chi;\u003csup\u003e2\u003c/sup\u003e = 80.74, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.00001, I\u003csup\u003e2\u003c/sup\u003e = 95%) according to the results of the heterogeneity test for these studies. Therefore, we used the random effects model to analyze these data, which confirmed that the intervention of health education delivered via a mobile device was more effective than routine nursing care in improving the resilience of breast cancer patients (SMD = 1.84; 95% CI 0.86, 2.82; \u003cem\u003ep\u003c/em\u003e = 0.0002) (Fig. 3b).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePeer support \u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThree studies [31-33], with a total of 240 breast cancer women, reported data on the peer support. The results showed that the heterogeneity between the two groups was very significant (\u0026chi;\u003csup\u003e2\u003c/sup\u003e = 127.50, \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.00001, I\u003csup\u003e2\u003c/sup\u003e = 98%), and we utilized a random effects model for the meta-analysis. The results showed that peer support was more effective than routine nursing care in improving the resilience of breast cancer patients (SMD = 2.62; 95% CI 0.61, 4.63; \u003cem\u003ep\u003c/em\u003e = 0.01) (Fig. 3c).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eOther kind of interventions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSeven studies [29, 30, 35, 39-41, 47], with a total of 617 breast cancer women, reported seven other kind of interventions which may contribute to improve resilience: 1) trinity nursing intervention, 2) nursing of family affection and psychological counseling, 3) synchronous stage cognitive therapy of family members combined with psychological intervention, 4) supportive psychological nursing, 5) psychological phased change nursing intervention, 6) admission and commitment therapy, and 7) collaboration care model. However, meta-analysis was abandoned and the evidence was presented in a narrative form because there was significant heterogeneity within the implemented interventions and the data cannot be classified and integrated. Further details about the summary of all the included studies\u0026rsquo; interventions of all the included studies are shown in Table 2.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubgroup analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTwo subgroup analyses were undertaken based on the intervention time of resilience training program. The \u003cem\u003ep\u003c/em\u003e-value for interaction was 0.85, which suggests that there was no interaction, in other words, the intervention time was not a source of heterogeneity. The results for the intervention times showed that the difference was not significant among the three subgroups: the intervention time was less than 12 weeks (SMD = 1.00; 95%CI 0.26, 1.74), the intervention time was 12 weeks (SMD = 1.19; 95%CI 0.10, 2.28), and the intervention time was more than 12 weeks (SMD = 0.88; 95%CI 0.57, 1.19). Overall, the results of the subgroup analysis showed that the resilience training program was more effective than the routine nursing care intervention, indicating the results of resilience training program had no change (Fig. 4).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePublication bias\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe used Egger's linear regression test to detect the publication bias caused by the influencing factors quantitatively. The results for the resilience training program (95% CI -11.37, 9.41; \u003cem\u003ep\u003c/em\u003e = 0.825) and the intervention of health education delivered via a mobile device (95% CI -10.38, 33.46; \u003cem\u003ep\u003c/em\u003e = 0.192) showed that there was no significant publication bias among the included studies. However, the \u003cem\u003ep\u003c/em\u003e-value for peer support (95% CI 3.81, 29.78; \u003cem\u003ep\u003c/em\u003e = 0.039) was less than 0.05 and the results reversed significantly after the data were analysed by the trim and fill method, which indicated that there was significant publication bias.\u003c/p\u003e"},{"header":"Discussion","content":" \u003cp\u003eThis systematic review and meta-analysis estimated the effect of the interventions for resilience of breast cancer patients. These interventions included resilience training program, health education delivered via mobile devices, peer support, and seven other kind of interventions. The effectiveness of the interventions included in the meta-analysis was examined through the assessment of resilience score. The measurement of the outcome for most studies were CD-RISC-25 and RSA.\u003c/p\u003e \u003cp\u003eResilience training program is helpful to improving the psychological resilience of breast cancer patients. In recent years, more and more researches suggest that resilience training may play a pivotal role in the realm of public health and prevention [\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e], and it also has a great number of wider benefits such as enhanced psychosocial functioning and improved performance [\u003cspan citationid=\"CR49\" class=\"CitationRef\"\u003e49\u003c/span\u003e]. There was considerable variation in the type of resilience training program provided in this study, although most involved Acceptance and Commitment Therapy (ACT), Cognitive Behavioral Therapy (CBT), Mindfulness-Based techniques [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]. Our meta-analysis showed that the resilience training program was more effective than the routine nursing care intervention (SMD\u0026thinsp;=\u0026thinsp;0.89; 95% CI 0.54, 1.24; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.00001). This result is consistent with the study of resilience training programmes and interventions in adults, reflecting a moderate positive effect (SMD\u0026thinsp;=\u0026thinsp;0.44; 95% CI 0.23, 0.64) in favor of the resilience training program group [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. It may be because psychological resilience training program helps patients control their emotions, cope with setbacks and adapt to adversity. The influence of psychological training on future functions depends heavily on the type of measurement results and the setting of the training [\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e]. Therefore, further researches about the effect of the resilience training should be conducted for a more definitive conclusion due to the difference in content, delivery and length.\u003c/p\u003e \u003cp\u003eHealth education delivered via mobile devices is a new and effective healthcare method [\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e], and the included studies about it were all conducted in China. WeChat is a free communication application, which is the most widely and extensively used mobile social networking App in China. Mobile health (mHealth) or WeChat-based intervention programs have become a popular health service model in China [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Our meta-analysis showed that the intervention of health education delivered via mobile devices was more effective than the routine nursing care intervention (SMD\u0026thinsp;=\u0026thinsp;1.84; 95% CI 0.86, 2.82; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.0002). This result is consistent with a study of people living with schizophrenia (PLS), which reported that WeChat-based intervention was related to a series of positive health outcomes, including decreased symptoms and depression, as well as improved functioning, recovery, quality of life and mental well-being [\u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e]. It may be because that the online delivery of resilience training has the potential of delivering effective training in a more flexible, personalized, and cost-effective way [\u003cspan citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e]. This new method can hold great promise for mental health care by extending the reach of services and supplementing existing models of care [\u003cspan citationid=\"CR54\" class=\"CitationRef\"\u003e54\u003c/span\u003e]. Therefore, health education delivered via mobile devices is worthy of clinical promotion for breast cancer patients.\u003c/p\u003e \u003cp\u003ePeer support was more effective than routine nursing care in improving the resilience of breast cancer patients. Peer support refers to the approach whereby individuals with the same disease or condition meet in order to exchange information, share experiences, and provide emotional/appraisal/informational assistance [\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e]. The results of this study showed that peer support was more effective than routine nursing care in improving the resilience of breast cancer patients (SMD\u0026thinsp;=\u0026thinsp;2.62; 95% CI 0.61, 4.63; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.01), which was similar to the results of a systematic review [\u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e]. However, this conclusion should be treated with caution because only three trials [\u003cspan additionalcitationids=\"CR32\" citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e], were included. In addition, the small sample size and publication bias may also lead to false negative results. Peer support was underutilised amongst women with breast cancer in recent years [\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e]. Future studies with better design/execution and larger sample size are needed to investigate the effectiveness of peer support on breast cancer patients.\u003c/p\u003e \u003cp\u003eThere were seven other kind of interventions included which may be favorably associated with the breast cancer women\u0026rsquo;s resilience [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan additionalcitationids=\"CR40\" citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e, \u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e]. However, at present, these studies on resilience interventions for breast cancer patients had many limitations such as scattered research content and low quality of some researches, all of which bring difficulties to data integration. These studies were not included in the meta-analysis due to the inability to classify and integrate the data, soour study cannot draw definitive conclusions regarding the effectiveness of them. Thus, there is no clearly evidence to summarize the effect of these intervention measures for resilience of breast cancer patients. Further studies are needed to clarify the effectiveness of these interventions, respectively.\u003c/p\u003e \u003cp\u003eAlthough the existing interventions seem to be effective for promoting resilience of breast cancer patients, the current evidences are still in the preliminary research stage and the quality of them were not high. Recently, more and more studies have shown that in addition to social and psychological factors, biological mechanisms such as the amygdala, hippocampus, ventral striatum and frontal-associated regions of the brain are related to resilience strength [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e]. An improved understanding of the biological mechanisms-based intervention could reveal novel therapeutic targets and help clarifying which psychosocial interventions can improve the psychological elasticity of breast cancer patients [\u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e]. Therefore, we should formulate a staged, personalized and reasonable intervention plan from physiological, psychological social dimensions and influencing factors in the future.\u003c/p\u003e \u003cp\u003eOne of the advantages of this study is that we performed a systematic and comprehensive search of 12 databases. Another major strength of our review and meta-analysis is that all the included studies are RCTs. We used the latest tool RoB 2.0 to assess the risk of bias, and the quality of the included studies was moderate to high quality. This review was adhered to the PRISMA 2020 checklist and PRISMA 2020 flow diagram, which are the latest versions of PRISMA.\u003c/p\u003e \u003cp\u003eThere were several limitations in our study. First, we considered RCTs published in English and Chinese only. Second, the included studies were exclusively conducted in the USA, Spain or China, which limit generalizability across other countries. Third, the small sample size (ranges from 20 to 175) might have decreased the reliability and could cause bias. Furthermore, this study performed meta-analysis on two interventions only due to data limitations and more RCTs are needed for data integration and analysis of other interventions.\u003c/p\u003e "},{"header":"Conclusions","content":" \u003cp\u003eIt has been found in this study that the resilience training program, health education delivered via mobile devices and peer support are more effective than that of the routine nursing care. However, the heterogeneities between the studies were obvious and the sample sizes were not large. In addition, this study cannot draw definitive conclusions regarding the effectiveness of other seven kind of interventions included in the systematic review because the sample size of these studies is small and cannot be conducted in the meta-analysis as there is only one study included regarding each kind of intervention. More studies are needed in the future to clarify the effectiveness of these interventions.\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eFunding information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research was supported by Health research project from Health Commission of Sichuan Province (19PJ121) and Special Scientific Research Fund of Sichuan Academy of Medical Sciences \u0026amp; Sichuan Provincial People's Hospital (2021ZX08). The funding bodies had no role in study design, data collection and analysis, decision to publish or writing the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest/Competing interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data sets analyzed during the current study will be available upon reasonable request of the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCode availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStudy concept and design: Zhi Wang, Qiu-Yue Liu, Xiao-Rong Mao and Li-Hua Min; Strategy searching: Zhi Wang and Qiu-Yue Liu; Selection of studies: Yu-Lei Zhao, Xin-Yi Xu and Yan Chen; Quality assessment: Zhi Wang and Qiu-Yue Liu; Data extraction and organization: Wen-Juan Cao, Yan Chen and Cai-Hong Li; Data checking: Li-Hua Min and Yan Chen; Data analysis and chart production: Zhi Wang, Qiu-Yue Liu and Xiao-Rong Mao; Drafting the manuscript: Zhi Wang, Qiu-Yue Liu, Yu-Lei Zhao and Xin-Yi Xu. Revision and appraisal of the manuscript: Xiao-Rong Mao and Li-Hua Min; Proofreading the manuscript: Wen-Juan Cao and Cai-Hong Li. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWild CP, Weiderpass E, Stewart BW (2020) World Cancer Report: Cancer Research for Cancer Prevention. Lyon, France: International Agency for Research on Cancer. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://publications.iarc.fr/586\u003c/span\u003e\u003c/span\u003e. Licence: CC BY-NC-ND 3.0 IGO. p382-383. Accessed 19 February 2021\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization (2021) Breast cancer now most common form of cancer: WHO taking action. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/news/item/03-02-2021-breast-cancer-now-most-common-form-of-cancer-who-taking-action\u003c/span\u003e\u003c/span\u003e. Accessed 18 February 2021\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A (2018) Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. Cancer J Clin 68(6):394\u0026ndash;424. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3322/caac.21492\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSebri V, Triberti S, Pravettoni G (2020) Injured Self: Autobiographical Memory, Self-Concept, and Mental Health Risk in Breast Cancer Survivors. Front Psychol 11. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fpsyg.2020.607514\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNg CG, Mohamed S, Kaur K, Sulaiman AH, Zainal NZ, Taib NA et al (2017) Perceived distress and its association with depression and anxiety in breast cancer patients. PLoS ONE 12(3):e0172975. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1371/journal. pone.0172975\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNaik H, Leung B, Laskin J, McDonald M, Srikanthan A, Wu J, Bates A, Ho C (2020) Emotional distress and psychosocial needs in patients with breast cancer in British Columbia: younger versus older adults. Breast cancer research treatment 179(2):471\u0026ndash;477. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s10549-019-05468-6\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuil R, Ruiz-Gonz\u0026aacute;lez P, Merch\u0026aacute;n-Clavellino A, Morales-S\u0026aacute;nchez L, Zayas A, G\u0026oacute;mez-Molinero R (2020) Breast Cancer and Resilience: The Controversial Role of Perceived Emotional Intelligence. Front Psychol 11:3604. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3389/fpsyg.2020.595713\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAizpurua-Perez I, Perez-Tejada J (2020) Resilience in women with breast cancer: A systematic review. European Journal of Oncology Nursing 101854. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.ejon.2020.101854\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJoyce S, Shand F, Tighe J, Laurent SJ, Bryant RA, Harvey SB (2018) Road to resilience: a systematic review and meta-analysis of resilience training programmes and interventions. BMJ open 8(6). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://dx.doi.org/10.1136/bmjopen-2017-017858\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWiig S, Aase K, Billett S, Canfield C, R\u0026oslash;ise O, Nj\u0026aring; O, Guise L, Haraldseid-Driftland C, Ree E, Anderson JE, Macrae C, RiH-team (2020) Defining the boundaries and operational concepts of resilience in the resilience in healthcare research program. BMC Health Serv Res 20:1\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12913-020-05224-3\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHolz NE, Tost H, Meyer-Lindenberg A (2020) Resilience and the brain: a key role for regulatory circuits linked to social stress and support. Molecular psychiatry 25(2):379\u0026ndash;396. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1038/s41380-019-0551-9\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRistevska-Dimitrovska G, Stefanovski P, Smichkoska S, Raleva M, Dejanova B (2015) Depression and resilience in breast cancer patients. Open Access Macedonian Journal of Medical Sciences 3(4):661. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3889/oamjms.2015.119\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRistevska-Dimitrovska G, Filov I, Rajchanovska D, Stefanovski P, Dejanova B (2015) Resilience and quality of life in breast cancer patients. Open access Macedonian journal of medical sciences 3(4):727. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3889/oamjms.2015.128\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUngar M, Theron L (2020) Resilience and mental health: How multisystemic processes contribute to positive outcomes. The Lancet Psychiatry 7(5):441\u0026ndash;448. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/S2215-0366(19)30434-1\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWu ZJ, Liu Y, Li XL, Li XH (2016) Resilience and associated factors among mainland Chinese women newly diagnosed with breast cancer. PLoS One 11(12):e0167976. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1371/journal.pone.0167976\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFradelos EC, Papathanasiou IV, Veneti A, Daglas A, Christodoulou E, Zyga S, Kourakos M (2017) Psychological distress and resilience in women diagnosed with breast cancer in Greece. Asian Pacific journal of cancer prevention APJCP 18(9):2545. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.22034/apjcp.2017.18.9.2545\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlizadeh S, Khanahmadi S, Vedadhir A, Barjasteh S (2018) The relationship between resilience with self-compassion, social support and sense of belonging in women with breast cancer. Asian Pacific journal of cancer prevention APJCP 19(9):2469. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.22034/apjcp.2018.19.9.2469\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePage MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372:n71. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1136/bmj.n71\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHiggins JPT, Savović J, Page MJ, Elbers RG, Sterne JAC (2019) Chap. 8: Assessing risk of bias in a randomized trial. In: Higgins JPT, Thomas J, Chandler J, Cumpston M, Li T, Page MJ, Welch VA (editors). \u003cem\u003eCochrane Handbook for Systematic Reviews of Interventions\u003c/em\u003e version 6.0 (updated July 2019). Cochrane. Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://training.cochrane.org/handbook/current/chapter-06\u003c/span\u003e\u003c/span\u003e. Accessed 10 February 2021\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYang ZR, Sun F, Zhan SY (2017) Risk on bias assessment: (2) Revised Cochrane risk of bias tool for individually randomized, parallel group trials (RoB2. 0). Chinese Journal of Epidemiology 38(9):1285\u0026ndash;1291. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3760/cma.j.issn.0254-6450.2017.09.028\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKoenig C, Schneider C, Morgan JE, Ammann RA, Sung L, Phillips B (2019) Interventions aiming to reduce time to antibiotics (TTA) in patients with fever and neutropenia during chemotherapy for cancer (FN), a systematic review. Supportive care in cancer 28:2369\u0026ndash;2380. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s00520-019-05056-w\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eThongprayoon C, Khoury NJ, Bathini T, Bathini T, Aeddula NR, Boonpheng B, Leeaphorn N, Ungprasert P, Bruminhent J, Lertjitbanjong P, Watthanasuntorn K, Chesdachai S, Mao MA, Cheungpasitporn W (2019) BK polyomavirus genotypes in renal transplant recipients in the United States: A meta-analysis. Journal of Evidence‐Based Medicine 12(4):291\u0026ndash;299. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/jebm.12366\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang SH (2016) Subgroup analysis and sensitive analysis should be set up reasonably in meta-analysis. Chinese Journal of Contemporary Neurology Neurosurgery 16(1):1. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3969/j.issn.1672-6731.2016.01.001\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZwetsloot PP, Van Der Naald M, Sena ES, Howels DW, IntHout J, De Groot AH, Chamuleau JAJ, Macleod S, Wever MR KE (2017) Standardized mean differences cause funnel plot distortion in publication bias assessments. eLife 6:e24260. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.7554/eLife.24260.001\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWu PH, Chen SW, Huang WT, Chang SC, Hsu MC (2018) Effects of a psychoeducational intervention in patients with breast cancer undergoing chemotherapy. Journal of Nursing Research 26(4):266\u0026ndash;279. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/jnr.0000000000000252\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhou KN, Li J, Li XM (2019) Effects of cyclic adjustment training delivered via a mobile device on psychological resilience, depression, and anxiety in Chinese post-surgical breast cancer patients. Breast cancer research treatment 178(1):95\u0026ndash;103. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s10549-019-05368-9\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCerezo MV, Ortiz-Tallo M, Cardenal V, De La Torre-Luque A (2014) Positive psychology group intervention for breast cancer patients: a randomised trial. Psychol Rep 115(1):44\u0026ndash;64. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2466/15.20.PR0.115c17z7\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLoprinzi CE, Prasad K, Schroeder DR, Sood A (2011) Stress Management and Resilience Training (SMART) program to decrease stress and enhance resilience among breast cancer survivors: a pilot randomized clinical trial. Clin Breast Cancer 11(6):364\u0026ndash;368. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.clbc.2011.06.008\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLuo H, Lin J, Zhao XF (2019) Influence of Family Psychological Counselling on Postoperative Psychological Pressure and Quality of Life of Patients with Modified Radical Mastectomy for Breast Cancer. Journal of Qilu Nursing 25(22):44\u0026ndash;47. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3969/j.issn.1006-7256.2019.22.014\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLu J, Shi TY, Liu QG, Yin AC, Song CL, Li H, Li YJ (2015) \u0026iuml;\u0026raquo;\u0026iquest;Effect of the collaboration care model on posttraumatic growth and resilience in patients with breast cancer. Chinese Journal of Practical Nursing 31(18):1353\u0026ndash;1356. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3760/cma.j.issn.1672-7088.2015.18.008\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu CC, Sun X, Zhao LP, Xu LL (2019) Effect of peer support on psychological resilience of breast cancer patients undergoing post -operative chemotherapy. Chinese Evidence-based Nursing 5(4):309\u0026ndash;313. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.12102/j.issn.2095-8668.2019.04.004\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXie XL (2019) The influence of peer support education on the psychological resilience of breast cancer patients. Healthmust-Readmagazine 25:283\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen ZY (2018) Research on the Influence of Peer Support Education on the Psychological Resilience Level of Breast Cancer Patients. Jilin Medical Journal 39(3):580\u0026ndash;582. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3969/j.issn.1004-0412.2018.03.083\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShen YY, Sheng LL, Yan M (2020) The impact of continuous care intervention based on WeChat platform on breast cancer patients. Journal of Qilu Nursing 26(09):61\u0026ndash;63. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3969/j.issn.1006-7256.2020.09.018\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi HB, Qing X, Wang XQ, Zhang SP, Liu Q (2019) Effects of synchronous stage cognitive therapy of family members combined with psychological intervention on family function, hope level, sense of coherence and quality of life in patients with breast cancer. 27(11):1729\u0026ndash;1733. China Journal of Health Psychology \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.13342/j.cnki.cjhp.2019.11.032\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhou L, Kong HW (2019) Effect of continuous nursing intervention based on WeChat platform on post-operative psychological elasticity and shame of breast cancer patients. Chinese Journal of General Practice 17(10):1773\u0026ndash;1776. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.16766/j.cnki.issn.1674-4152.001052\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang XY, Wang XJ (2020) Effect of WeChat-based symptom assessment and self-intervention on adverse reactions, mental state and quality of life in patients with breast cancer during chemotherapy. Chinese Journal of General Practice 18(01):94\u0026ndash;97. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.16766/j.cnki.issn.1674-4152.001177\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhao WW, Zhang AH (2015) Study on influence of mental awareness training on psychological resilience of patients with breast cancer. Chinese Nursing Research 29(26):3286\u0026ndash;3288. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3969/j.issn.1009-6493.2015.26.029\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu AH (2018) The Effect of Psychological Phased Change Nursing on Rehabilitation of Breast Cancer Patients After Operation. China Continuing Medical Education 10(36):180\u0026ndash;182. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3969/j.issn.1674-9308.2018.36.076\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOu LC, Guo XP, Meng YZ (2017) Effect of admission and commitment therapy on psychological resilience and disease awareness in patients with breast cancer surgery. Modern Clinical Nursing 16(02):14\u0026ndash;18. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3969/j.issn.1671-8283.2017.02.004\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHou LJ, Zhang LQ (2019) The influence of supportive psychological nursing combined with rapid rehabilitation surgery theory on the psychological resilience score and compliance of patients with modified radical mastectomy. Journal of Clinical Research 36(12):2495\u0026ndash;2496. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3969/j.issn.1671-7171.2019.12.075\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYuan P (2017) Influence of aerobic exercise combined with continuity of care on post-traumatic growth and psychological resilience of breast cancer patients. Chinese Nursing Research 31(21):2617\u0026ndash;2619. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3969/j.issn.1009-6493.2017.21.016\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCui Y, Wang XH, Liu YX (2020) \u0026iuml;\u0026raquo;\u0026iquest;Effect of mindfulness decompression training on psychological flexibility, self-efficacy \u0026iuml;\u0026raquo;\u0026iquest;and quality of life in postoperative patients with breast cancer. International Journal of Nursing 39(21):3847\u0026ndash;3851. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3760/cma.j.cn221370-20190718-01181\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShen XM (2020) Influence of \"in-hospital-out-hospital\" continuous nursing model on the psychological resilience of chemotherapy patients after radical mastectomy. Chinese Baby (2):176\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eXu MR, Wei XH, Wu GL, Dai LJ (2015) The effect of resilience training on the mental health of breast cancer patients. Modern Journal of Integrated Traditional Chinese western medicine 24(08):896\u0026ndash;898. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3969/j.issn.1008-8849.2015.08.040\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhao XF, Chen MS, Yang HW, Rong W (2016) \u0026iuml;\u0026raquo;\u0026iquest;Effect of psychological flexibility training on the mental status of patients with breast cancer after simplified radical mastectomy. Journal of International Psychiatry 43(02):350\u0026ndash;353. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.13479/j.cnki.jip.2016.02.048\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang LM (2020) Effect of Trinity Nursing Intervention on Psychological Elasticity and Family Adaptability of Patients with Breast Cancer Radiotherapy. Journal of Clinic Nursing's Practicality 5(49):9\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJoyce S, Shand F, Bryant RA, Lal TJ, Harvey SB (2018) Mindfulness-Based Resilience Training in the Workplace: Pilot Study of the Internet-Based Resilience@Work (RAW) Mindfulness Program. J Med Internet Res 20(9):e10326. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2196/10326\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRobertson IT, Cooper CL, Sarkar M, Curran T (2015) Resilience training in the workplace from 2003 to 2014: A systematic review. Journal of occupational organizational psychology 88(3):533\u0026ndash;562. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1111/joop.12120\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eForbes S, Fikretoglu D (2018) Building resilience: The conceptual basis and research evidence for resilience training programs. Review of General Psychology 22(4):452\u0026ndash;468. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1037/gpr0000152\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhang XT, Wen D, Liang J, Lei JB (2017) How the public uses social media wechat to obtain health information in china: a survey study. BMC Med Inf Decis Mak 17(2):71\u0026ndash;79. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s12911-017-0470-0\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eYu Y, Li YL, Li TX, Xi SJ, Xiao X, Xiao SY, Tebes JK (2020) New Path to Recovery and Well-Being: Cross-Sectional Study on WeChat Use and Endorsement of WeChat-Based mHealth Among People Living With Schizophrenia in China. Journal of Medical Internet Research 22(9):e18663. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2196/18663\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSmith B, Shatt\u0026eacute; A, Perlman A, Siers M, Lynch WD (2018) Improvements in resilience, stress, and somatic symptoms following online resilience training: A dose\u0026ndash;response effect. Journal of occupational environmental medicine 60(1):1. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/JOM.0000000000001142\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFirth J, Cotter J, Torous J, Bucci S, Firth JA, Yung AR (2016) Mobile phone ownership and endorsement of \u0026ldquo;mHealth\u0026rdquo; among people with psychosis: a meta-analysis of cross-sectional studies. Schizophr Bull 42(2):448\u0026ndash;455. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1093/schbul/sbv132\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHuang RR, Yan CL, Tian YM, Lei BM, Yang DQ, Liu D, Lei J (2020) Effectiveness of peer support intervention on perinatal depression: A systematic review and meta-analysis. J Affect Disord. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jad.2020.06.048\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHu JM, Wang X, Guo SN, Chen FF, Wu YY, Ji FJ, Fang XD (2019) Peer support interventions for breast cancer patients: a systematic review. Breast cancer research treatment 174(2):325\u0026ndash;341. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s10549-018-5033-2\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLegg M, Occhipinti S, Youl P, Dunn J, Chambers SK (2017) Needy or resilient? How women with breast cancer think about peer support. Psycho-Oncology 26(12):2307\u0026ndash;2310. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1002/pon.4401\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLegg M, Hyde MK, Occhipinti S, Youl PH, Dunn J, Chambers SK (2019) A prospective and population-based inquiry on the use and acceptability of peer support for women newly diagnosed with breast cancer. Support Care Cancer 27(2):677\u0026ndash;685. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s00520-018-4358-z\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHsieh S, Yao ZF, Yang MH (2021) Multimodal Imaging Analysis Reveals Frontal-Associated Networks in Relation to Individual Resilience Strength. Int J Environ Res Public Health 18(3):1123. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.3390/ijerph18031123\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBorgi M, Collacchi B, Ortona E, Cirulli F (2020) Stress and coping in women with breast cancer: unravelling the mechanisms to improve resilience. Neurosci Biobehav Rev 119:406\u0026ndash;421. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.neubiorev.2020.10.011\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1\u003c/strong\u003e Characteristics of the studies included\u003c/p\u003e\n\u003ctable border=\"1\" width=\"769\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd rowspan=\"2\" width=\"180\"\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor (year)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"125\"\u003e\n\u003cp\u003e\u003cstrong\u003eOrigin\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"87\"\u003e\n\u003cp\u003e\u003cstrong\u003eSample size(\u003cem\u003en\u003c/em\u003e)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd colspan=\"2\" width=\"211\"\u003e\n\u003cp\u003e\u003cstrong\u003eAge in years (Mean \u0026plusmn; SD)\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"66\"\u003e\n\u003cp\u003e\u003cstrong\u003eCancer\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStage\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd rowspan=\"2\" width=\"100\"\u003e\n\u003cp\u003e\u003cstrong\u003eOutcome measurement\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"44\"\u003e\n\u003cp\u003e\u003cstrong\u003eE\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"44\"\u003e\n\u003cp\u003e\u003cstrong\u003eC\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"107\"\u003e\n\u003cp\u003e\u003cstrong\u003eE\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e\u003cstrong\u003eC\u003c/strong\u003e\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"180\"\u003e\n\u003cp\u003eShen (2020) [44]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"125\"\u003e\n\u003cp\u003eShanghai, China\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"44\"\u003e\n\u003cp\u003e37\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"44\"\u003e\n\u003cp\u003e36\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"107\"\u003e\n\u003cp\u003eNR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003eNR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003eNR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003eCD-RISC-25\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"180\"\u003e\n\u003cp\u003eShen et al. (2020) [34]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"125\"\u003e\n\u003cp\u003eJiangsu, China\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"44\"\u003e\n\u003cp\u003e40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"44\"\u003e\n\u003cp\u003e40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"107\"\u003e\n\u003cp\u003e50.23 \u0026plusmn; 14.35\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e50.87 \u0026plusmn; 14.41\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003eI-III\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003eCD-RISC-25\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"180\"\u003e\n\u003cp\u003eWang (2020) [47]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"125\"\u003e\n\u003cp\u003eGuangdong, China\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"44\"\u003e\n\u003cp\u003e42\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"44\"\u003e\n\u003cp\u003e42\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"107\"\u003e\n\u003cp\u003e45.5 \u0026plusmn; 7.0\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e44.5 \u0026plusmn; 6.5\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003eNR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003eRSA\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"180\"\u003e\n\u003cp\u003eWang et al. (2020) [37]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"125\"\u003e\n\u003cp\u003eZhejiang, China\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"44\"\u003e\n\u003cp\u003e73\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"44\"\u003e\n\u003cp\u003e73\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"107\"\u003e\n\u003cp\u003e52.79 \u0026plusmn; 4.58\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e51.45 \u0026plusmn; 4.32\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003eI-IV\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003eCD-RISC-25\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"180\"\u003e\n\u003cp\u003eCui et al. (2020) [43]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"125\"\u003e\n\u003cp\u003eHenan, China\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"44\"\u003e\n\u003cp\u003e40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"44\"\u003e\n\u003cp\u003e40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"107\"\u003e\n\u003cp\u003e45.48 \u0026plusmn; 6.09\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e45.56 \u0026plusmn; 6.17\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003eI-III\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003eCD-RISC-25\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"180\"\u003e\n\u003cp\u003eZhou K et al. (2019) [26]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"125\"\u003e\n\u003cp\u003eShanxi, China\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"44\"\u003e\n\u003cp\u003e66\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"44\"\u003e\n\u003cp\u003e66\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"107\"\u003e\n\u003cp\u003e44.62 \u0026plusmn; 7.89\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e44.37 \u0026plusmn; 7.32\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003eI-III\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003eCD-RISC-25\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"180\"\u003e\n\u003cp\u003eZhou L et al. (2019) [36]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"125\"\u003e\n\u003cp\u003eZhejiang, China\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"44\"\u003e\n\u003cp\u003e30\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"44\"\u003e\n\u003cp\u003e30\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"107\"\u003e\n\u003cp\u003e48.87 \u0026plusmn; 14.41\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e48.76. \u0026plusmn; 12.25\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003eI-III\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003eCD-RISC-25\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"180\"\u003e\n\u003cp\u003eLuo et al. (2019) [29]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"125\"\u003e\n\u003cp\u003eGuangdong, China\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"44\"\u003e\n\u003cp\u003e40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"44\"\u003e\n\u003cp\u003e40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"107\"\u003e\n\u003cp\u003e33.48 \u0026plusmn; 5.69\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e33.56 \u0026plusmn; 5.23\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003eI-III\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003eCD-RISC-25\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"180\"\u003e\n\u003cp\u003eLi et al. (2019) [35]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"125\"\u003e\n\u003cp\u003eSichuan, China\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"44\"\u003e\n\u003cp\u003e65\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"44\"\u003e\n\u003cp\u003e65\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"107\"\u003e\n\u003cp\u003e43.25 \u0026plusmn; 4.31\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e42.38 \u0026plusmn; 3.52\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003eI-II\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003eCD-RISC-25\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"180\"\u003e\n\u003cp\u003eHou et al. (2019) [41]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"125\"\u003e\n\u003cp\u003eNeimenggu, China\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"44\"\u003e\n\u003cp\u003e52\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"44\"\u003e\n\u003cp\u003e52\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"107\"\u003e\n\u003cp\u003e42.04 \u0026plusmn; 6.45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e41.76 \u0026plusmn; 6.38\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003eI-IV\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003eCD-RISC-25\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"180\"\u003e\n\u003cp\u003eXie (2019) [32]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"125\"\u003e\n\u003cp\u003eSichuan, China\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"44\"\u003e\n\u003cp\u003e38\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"44\"\u003e\n\u003cp\u003e38\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"107\"\u003e\n\u003cp\u003eNR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003eNR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003eNR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003eCD-RISC-25\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"180\"\u003e\n\u003cp\u003eLiu et al. (2019) [31]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"125\"\u003e\n\u003cp\u003eHunan, China\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"44\"\u003e\n\u003cp\u003e38\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"44\"\u003e\n\u003cp\u003e38\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"107\"\u003e\n\u003cp\u003e45.92 \u0026plusmn; 8.27\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e46.53 \u0026plusmn; 8.37\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003eNR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003eCD-RISC-25\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"180\"\u003e\n\u003cp\u003eChen (2018) [33]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"125\"\u003e\n\u003cp\u003eGuangdong, China\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"44\"\u003e\n\u003cp\u003e45\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"44\"\u003e\n\u003cp\u003e44\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"107\"\u003e\n\u003cp\u003eNR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003eNR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003eI-III\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003eCD-RISC-25\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"180\"\u003e\n\u003cp\u003eWu et al. (2018) [25]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"125\"\u003e\n\u003cp\u003eSouthern, Taiwan\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"44\"\u003e\n\u003cp\u003e20\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"44\"\u003e\n\u003cp\u003e20\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"107\"\u003e\n\u003cp\u003e51.2 \u0026plusmn; 9.18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e51.2 \u0026plusmn; 10.71\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003eI-IV\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003eCD-RISC-25\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"180\"\u003e\n\u003cp\u003eLiu (2018) [39]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"125\"\u003e\n\u003cp\u003eJiangsu, China\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"44\"\u003e\n\u003cp\u003e38\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"44\"\u003e\n\u003cp\u003e38\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"107\"\u003e\n\u003cp\u003e48.92 \u0026plusmn; 6.40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e49.41 \u0026plusmn; 6.18\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003eI-II\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003eCD-RISC-25\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"180\"\u003e\n\u003cp\u003eYuan (2017) [42]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"125\"\u003e\n\u003cp\u003eHubei, China\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"44\"\u003e\n\u003cp\u003e68\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"44\"\u003e\n\u003cp\u003e68\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"107\"\u003e\n\u003cp\u003e49.6 \u0026plusmn; 9.4\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e50.5 \u0026plusmn; 10.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003eI-IV\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003eCD-RISC-25\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"180\"\u003e\n\u003cp\u003eOu et al. (2017) [40]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"125\"\u003e\n\u003cp\u003eGuangxi, China\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"44\"\u003e\n\u003cp\u003e41\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"44\"\u003e\n\u003cp\u003e39\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"107\"\u003e\n\u003cp\u003e39.8 \u0026plusmn; 4.3\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e40.5 \u0026plusmn; 4.8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003eNR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003eCD-RISC-25\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"180\"\u003e\n\u003cp\u003eZhao et al. (2016) [46]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"125\"\u003e\n\u003cp\u003eSichuan, China\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"44\"\u003e\n\u003cp\u003e37\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"44\"\u003e\n\u003cp\u003e37\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"107\"\u003e\n\u003cp\u003e51.39 \u0026plusmn; 8.73\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e51.92 \u0026plusmn; 8.05\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003eNR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003eRSA\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"180\"\u003e\n\u003cp\u003eLu et al. (2015) [30]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"125\"\u003e\n\u003cp\u003eLiaoning, China\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"44\"\u003e\n\u003cp\u003e32\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"44\"\u003e\n\u003cp\u003e31\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"107\"\u003e\n\u003cp\u003e50.47 \u0026plusmn; 9.51\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003eNR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003eNR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003eCD-RISC-25\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"180\"\u003e\n\u003cp\u003eZhao et al. (2015) [38]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"125\"\u003e\n\u003cp\u003eShandong, China\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"44\"\u003e\n\u003cp\u003e36\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"44\"\u003e\n\u003cp\u003e38\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"107\"\u003e\n\u003cp\u003e42.47 \u0026plusmn; 8.51\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e42.63 \u0026plusmn; 7.40\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003eI-III\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003eCD-RISC-25\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"180\"\u003e\n\u003cp\u003eXu et al. (2015) [45]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"125\"\u003e\n\u003cp\u003eHubei, China\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"44\"\u003e\n\u003cp\u003e30\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"44\"\u003e\n\u003cp\u003e24\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"107\"\u003e\n\u003cp\u003eNR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003eNR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003eNR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003eRSA\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"180\"\u003e\n\u003cp\u003eCerezo et al. (2014) [27]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"125\"\u003e\n\u003cp\u003eMinnesota, United States\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"44\"\u003e\n\u003cp\u003e87\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"44\"\u003e\n\u003cp\u003e88\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"107\"\u003e\n\u003cp\u003e50.71 \u0026plusmn; 9.44\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e49.35 \u0026plusmn; 9.85\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003eI-III\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003eCD-RISC-25\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd width=\"180\"\u003e\n\u003cp\u003eLoprinzi et al. (2011) [28]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"125\"\u003e\n\u003cp\u003eMalaga, Spain\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"44\"\u003e\n\u003cp\u003e12\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"44\"\u003e\n\u003cp\u003e8\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"107\"\u003e\n\u003cp\u003e61 \u0026plusmn; NR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"104\"\u003e\n\u003cp\u003e61 \u0026plusmn; NR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"66\"\u003e\n\u003cp\u003eI-III\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd width=\"100\"\u003e\n\u003cp\u003eCD-RISC-25\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eE: experimental group, C: control group, SD: standard deviation, NR: Not Reported, h: hour, d: day, w: week, m: month\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2\u003c/strong\u003e The summary of studies\u0026rsquo; interventions\u003c/p\u003e\n\u003ctable style=\"width: 1040px;\" border=\"1\"\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 96px;\"\u003e\n\u003cp\u003eApproaches of the intervention\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 96px;\"\u003e\n\u003cp\u003eAuthor (year)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102px;\"\u003e\n\u003cp\u003eDelivery of the intervention\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 74px;\"\u003e\n\u003cp\u003eFollow-up point\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 103px;\"\u003e\n\u003cp\u003eTheory\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 529px;\"\u003e\n\u003cp\u003eContent of the intervention\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 96px;\"\u003e\n\u003cp\u003eResilience training program\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 96px;\"\u003e\n\u003cp\u003eCui et al. (2020) [43]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102px;\"\u003e\n\u003cp\u003eNurse\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 74px;\"\u003e\n\u003cp\u003e6w\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 103px;\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003c/strong\u003eMindfulness decompression\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 529px;\"\u003e\n\u003cp\u003e\u003cstrong\u003eExperimental Group: \u003c/strong\u003eMindfulness decompression training combined with routine nursing care. Mindfulness decompression training includes mindful body scanning training, mindfulness meditation training, mindfulness walking training, mindfulness breathing training and mindfulness yoga training.\u003cbr /\u003e \u003cstrong\u003eControl Group: \u003c/strong\u003eRoutine nursing care.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 96px;\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 96px;\"\u003e\n\u003cp\u003eZhou K et al. (2019) [26]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102px;\"\u003e\n\u003cp\u003eNurse\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 74px;\"\u003e\n\u003cp\u003e4w, 8w and 12w\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 103px;\"\u003e\n\u003cp\u003e\u003cstrong\u003e\u003c/strong\u003eRoy Adaptation Model (RAM)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 529px;\"\u003e\n\u003cp\u003e\u003cstrong\u003eExperimental Group:\u003c/strong\u003e Cyclic adjustment training (CAT) delivered via a device combined with routine nursing care. The CAT using WeChat included 4 steps: Confront, pre-introspect, adjust and re-introspect.\u003cbr /\u003e \u003cstrong\u003eControl Group:\u003c/strong\u003e Routine nursing care. The control group patients received only routine nursing care, including health instruction, vital signs and post-surgery complications monitoring, and post-surgery and drainage tube care.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 96px;\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 96px;\"\u003e\n\u003cp\u003eWu et al. (2018) [25]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102px;\"\u003e\n\u003cp\u003eNurse\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 74px;\"\u003e\n\u003cp\u003e2w\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 103px;\"\u003e\n\u003cp\u003eStress and Coping Model\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 529px;\"\u003e\n\u003cp\u003e\u003cstrong\u003eExperimental Group: \u003c/strong\u003ePsychoeducational interventions (PEIs). The PEI included interaction between healthcare professionals and patients, use of a self-directed videotape, educational information and materials, and an educational manual. \u003cbr /\u003e \u003cstrong\u003eControl Group: \u003c/strong\u003eThe traditional pamphlet education. Participants in the control group were exposed only to the traditional pamphlet education approach (consultation from nurses and information sheets) in the outpatient department.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 96px;\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 96px;\"\u003e\n\u003cp\u003eZhao et al. (2016) [46]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102px;\"\u003e\n\u003cp\u003eNurse\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 74px;\"\u003e\n\u003cp\u003e12w\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 103px;\"\u003e\n\u003cp\u003eKumpfer's Psychological Resilience Framework Theory\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 529px;\"\u003e\n\u003cp\u003e\u003cstrong\u003eExperimental Group: \u003c/strong\u003ePsychological flexibility training combined with routine nursing care. Based on Kumpfer's related psychological resilience framework theory, each patient in the observation group was given a set of DVDs for learning breathing meditation and relaxation. Use methods such as case analysis, discussion, sharing, and theme games for patients in the observation group, and use 5 major links (warm-up, interaction, cohesion, sharing, and end) as a fixed activity program for each training. Psychological training takes place every Tuesday, 1.5 hours each time.\u003cbr /\u003e \u003cstrong\u003eControl Group: \u003c/strong\u003eRoutine nursing care. The control group was given routine care for 12 weeks, including maintaining a comfortable ward environment, monitoring patient vital signs, ward rounds, diet and medication guidance, etc.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 96px;\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 96px;\"\u003e\n\u003cp\u003eZhao et al. (2015) [38]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102px;\"\u003e\n\u003cp\u003eDoctor and nurse\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 74px;\"\u003e\n\u003cp\u003e8w\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 103px;\"\u003e\n\u003cp\u003eMental awareness\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 529px;\"\u003e\n\u003cp\u003e\u003cstrong\u003eExperimental Group: \u003c/strong\u003eMental awareness training combined with routine nursing care. Nurses teach the patients the basic principles and methods of mental awareness in the first to third weeks, the body awareness in the fourth to sixth weeks, and the meditation exercises in the seventh to eighth weeks. Once a week, 40 to 50 minutes each time, meditation music is played during each intervention, so that the patients can adopt the most comfortable posture.\u003cbr /\u003e \u003cstrong\u003eControl Group:\u003c/strong\u003e Routine nursing care.\u003cbr /\u003e \u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 96px;\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 96px;\"\u003e\n\u003cp\u003eXu et al. (2015) [45]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102px;\"\u003e\n\u003cp\u003eNurse\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 74px;\"\u003e\n\u003cp\u003e12w\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 103px;\"\u003e\n\u003cp\u003eKumpfer's Psychological Resilience Framework Theory\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 529px;\"\u003e\n\u003cp\u003e\u003cstrong\u003eExperimental Group: \u003c/strong\u003eMental flexibility(resilience) training combined with routine nursing care. Based on Kumpfer's related psychological resilience framework theory, each patient in the observation group was given a set of DVDs for learning breathing meditation and relaxation. Use methods such as case analysis, discussion, sharing, and theme games for patients in the observation group, and use 5 major links (warm-up, interaction, cohesion, sharing, and end) as a fixed activity program for each training. Psychological training takes place every Tuesday, 1.5 hours each time.\u003cbr /\u003e \u003cstrong\u003eControl Group:\u003c/strong\u003e Routine nursing care.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 96px;\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 96px;\"\u003e\n\u003cp\u003eCerezo et al. (2014) [27]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102px;\"\u003e\n\u003cp\u003ePsychologists\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 74px;\"\u003e\n\u003cp\u003e14w\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 103px;\"\u003e\n\u003cp\u003ePositive psychology\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 529px;\"\u003e\n\u003cp\u003e\u003cstrong\u003eExperimental Group: \u003c/strong\u003eA psychological group intervention based on positive psychology. The psychological intervention was applied during 14 two-hour sessions (3 modules: Self-knowledge, Positive psychology-related skills, and Positive psychology-related skills), once per week, to groups of 10 to 15 women.\u003cbr /\u003e \u003cstrong\u003eControl Group: \u003c/strong\u003eWait-list Group. The waitlist group was administered the psychological intervention for the same amount of time as the experimental group, which was followed by a post-test assessment.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 96px;\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 96px;\"\u003e\n\u003cp\u003eLoprinzi et al. (2011) [28]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102px;\"\u003e\n\u003cp\u003ePhysician\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 74px;\"\u003e\n\u003cp\u003e12w\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 103px;\"\u003e\n\u003cp\u003eSMART program\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 529px;\"\u003e\n\u003cp\u003e\u003cstrong\u003eExperimental Group: \u003c/strong\u003eStress Management and Resilience Training (SMART) program. The study intervention consisted of 3 parts: The program consisted of two 90-minute group training sessions (paced breathing meditation), a brief individual session (practice deep diaphragmatic breathing at 5 breaths per minute for 5 or 15 minutes, once or twice a day), and 3 follow-up telephone calls (30-60 minutes).\u003cbr /\u003e \u003cstrong\u003eControl Group: \u003c/strong\u003eWait-list Group. Intervention for the wait-list control arm was delayed by 12 weeks compared with the active arm. The participants completed the written baseline surveys during an initial meeting and at the end of the 12-week intervention.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 96px;\"\u003e\n\u003cp\u003eHealth education delivered via\u003c/p\u003e\n\u003cp\u003emobile devices\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 96px;\"\u003e\n\u003cp\u003eShen (2020) [44]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102px;\"\u003e\n\u003cp\u003eNurse\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 74px;\"\u003e\n\u003cp\u003eNR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 103px;\"\u003e\n\u003cp\u003eNR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 529px;\"\u003e\n\u003cp\u003e\u003cstrong\u003eExperimental Group: \u003c/strong\u003e\"In-hospital and out-hospital\" continued nursing combined with routine nursing care and discharge guidance. In-hospital nursing mode: Distribute health knowledge manuals, face-to-face education, broadcast education videos, and situational drills to teach patients and their families related health knowledge. Out-of-hospital continued nursing: After the patient is discharged from the hospital, a health record is established for the patient, and full-time nurses conduct popular science knowledge and health information education using phone and WeChat, and regularly organize patient symposiums and small lectures.\u003cbr /\u003e \u003cstrong\u003eControl Group:\u003c/strong\u003e Routine nursing care and discharge guidance.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 96px;\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 96px;\"\u003e\n\u003cp\u003eShen et al. (2020) [34]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102px;\"\u003e\n\u003cp\u003eDoctor and nurse\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 74px;\"\u003e\n\u003cp\u003e1m, 3m and 6m\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 103px;\"\u003e\n\u003cp\u003eNR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 529px;\"\u003e\n\u003cp\u003e\u003cstrong\u003eExperimental Group:\u003c/strong\u003e Continuous care based on WeChat platform combined with routine nursing care. The intervention includes registering a dedicated WeChat official account and WeChat group chat, establishing a continuous nursing team. Meantime, nurses conduct health education and problem guidance and carry out prize-winning contests to promote patients' knowledge.\u003cbr /\u003e \u003cstrong\u003eControl Group: \u003c/strong\u003eRoutine nursing care.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 96px;\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 96px;\"\u003e\n\u003cp\u003eWang et al. (2020) [37]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102px;\"\u003e\n\u003cp\u003eDoctor and nurse\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 74px;\"\u003e\n\u003cp\u003e6m\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 103px;\"\u003e\n\u003cp\u003eNR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 529px;\"\u003e\n\u003cp\u003e\u003cstrong\u003eExperimental Group: \u003c/strong\u003eWeChat-based symptom assessment and self-intervention combined with routine outpatient guidance. Based on the WeChat platform, the experimental group established a remote service group to give patients relevant guidance.\u003cbr /\u003e \u003cstrong\u003eControl Group:\u003c/strong\u003e Routine outpatient guidance. Nurses provide relevant guidance on the precautions of chemotherapy after chemotherapy, and conduct telephone follow-up at half a month and one month after chemotherapy.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 96px;\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 96px;\"\u003e\n\u003cp\u003eZhou L et al. (2019) [36]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102px;\"\u003e\n\u003cp\u003eDoctor and nurse\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 74px;\"\u003e\n\u003cp\u003e1m, 3m and 6m\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 103px;\"\u003e\n\u003cp\u003eNR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 529px;\"\u003e\n\u003cp\u003e\u003cstrong\u003eExperimental Group: \u003c/strong\u003eContinuous nursing intervention based on WeChat platform combined with routine outpatient guidance. The intervention includes registering a dedicated WeChat official account and WeChat group chat, establishing a continuous nursing team. After discharge from the hospital, the experimental group received continuation care from the continuous nursing team.\u003cbr /\u003e \u003cstrong\u003eControl Group:\u003c/strong\u003e Routine outpatient guidance. The control group used telephone follow-up for continuous care at 1 week, 1 month, 3 months and 6 months After discharge from the hospital.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 96px;\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 96px;\"\u003e\n\u003cp\u003eYuan (2017) [42]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102px;\"\u003e\n\u003cp\u003eNurse\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 74px;\"\u003e\n\u003cp\u003e1w and 6m\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 103px;\"\u003e\n\u003cp\u003eNR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 529px;\"\u003e\n\u003cp\u003e\u003cstrong\u003eExperimental Group:\u003c/strong\u003e Aerobic exercise combined with continuity of care on post. Nurses conduct in-depth interviews psychological interventions, post-operative health education and rehabilitation exercise guidance with patients and their families. The follow-up intervention is conducted using QQ or WeChat platforms every Friday and the follow-up time is 6 months.\u003cbr /\u003e \u003cstrong\u003eControl Group:\u003c/strong\u003e Routine nursing care.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 96px;\"\u003e\n\u003cp\u003ePeer support\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 96px;\"\u003e\n\u003cp\u003eXie (2019) [32]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102px;\"\u003e\n\u003cp\u003eNurse\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 74px;\"\u003e\n\u003cp\u003eNR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 103px;\"\u003e\n\u003cp\u003eNR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 529px;\"\u003e\n\u003cp\u003e\u003cstrong\u003eExperimental Group: \u003c/strong\u003ePeer support education combined with routine nursing care. Nursing staff screen the peer support educators and divide them into different groups, each with 3 members. The peers provide positive emotional support and strengthen communication with the patient and their family members, and provide at least 6 hours of support education per week. \u003cbr /\u003e \u003cstrong\u003eControl Group:\u003c/strong\u003e Routine nursing care.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 96px;\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 96px;\"\u003e\n\u003cp\u003eLiu et al. (2019) [31]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102px;\"\u003e\n\u003cp\u003eDoctor and nurse\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 74px;\"\u003e\n\u003cp\u003eNR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 103px;\"\u003e\n\u003cp\u003eNR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 529px;\"\u003e\n\u003cp\u003e\u003cstrong\u003eExperimental Group: \u003c/strong\u003ePeer support combined with routine health education. Intervention measures include face-to-face guidance (postoperative functional exercise guidance, diet guidance, medication guidance, infection prevention and upper limb edema guidance, psychological adjustment guidance), telephone supervision (companion volunteers are responsible for telephone supervision of the same group of patients for disease self-management, the frequency is every Once a week, each talk time\u0026gt; 10 minutes) has been group activities (volunteers organize at least one group activity in each patient's inpatient chemotherapy cycle to summarize self-management experience and lessons).\u003cbr /\u003e \u003cstrong\u003eControl Group: \u003c/strong\u003eRoutine health education on chemotherapy after breast cancer operation.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 96px;\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 96px;\"\u003e\n\u003cp\u003eChen (2018) [33]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102px;\"\u003e\n\u003cp\u003eDoctor, nurse and psychologist\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 74px;\"\u003e\n\u003cp\u003eNR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 103px;\"\u003e\n\u003cp\u003eNR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 529px;\"\u003e\n\u003cp\u003e\u003cstrong\u003eExperimental Group:\u003c/strong\u003e Peer support combined with routine nursing education. Companion volunteers provide health education and positive emotional guidance to patients based on personal experience or other patients' successful anti-cancer experience, and complete at least 3 peer support education before the patient's surgery, early postoperative period, and before discharge from the hospital. Depending on the patient's personal psychological cognition and family status, the number of interventions can be flexibly increased by 1-3 times.\u003cbr /\u003e \u003cstrong\u003eControl Group:\u003c/strong\u003e Routine nursing education.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 96px;\"\u003e\n\u003cp\u003eOther kind of special interventions\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 96px;\"\u003e\n\u003cp\u003eWang (2020) [47]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102px;\"\u003e\n\u003cp\u003eDoctor and nurse\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 74px;\"\u003e\n\u003cp\u003eNR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 103px;\"\u003e\n\u003cp\u003eNR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 529px;\"\u003e\n\u003cp\u003e\u003cstrong\u003eExperimental Group: \u003c/strong\u003eTrinity nursing intervention combined with routine nursing care. It includes psychological intervention and the establishment of a family nursing team, and cooperate with patients to complete psychological and physical management and guidance. \u003cbr /\u003e \u003cstrong\u003eControl Group:\u003c/strong\u003e Routine nursing care.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 96px;\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 96px;\"\u003e\n\u003cp\u003eLuo et al. (2019) [29]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102px;\"\u003e\n\u003cp\u003eNurse\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 74px;\"\u003e\n\u003cp\u003e1m\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 103px;\"\u003e\n\u003cp\u003eNR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 529px;\"\u003e\n\u003cp\u003e\u003cstrong\u003eExperimental Group: \u003c/strong\u003eNursing of family affection and psychological counseling combined with routine perioperative care. When the patient is conscious and stable, the family members are required to accompany the patient for about 8 hours a day, and participate in simple nursing interventions according to the patient's own wishes, so as to encourage the family members to build a good bridge between the nurse and the patient and satisfy the patient a sense of need for family support.\u003cbr /\u003e \u003cstrong\u003eControl Group: \u003c/strong\u003eRoutine perioperative care.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 96px;\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 96px;\"\u003e\n\u003cp\u003eLi et al. (2019) [35]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102px;\"\u003e\n\u003cp\u003eNurse\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 74px;\"\u003e\n\u003cp\u003eNR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 103px;\"\u003e\n\u003cp\u003eNR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 529px;\"\u003e\n\u003cp\u003e\u003cstrong\u003eExperimental Group:\u003c/strong\u003e Synchronous stage cognitive therapy of family members combined with psychological intervention.\u0026nbsp; The CAT using WeChat included 4 steps, cognitive intervention and rehabilitation guidance were given to patients and their families one day before admission, one day before surgery, three days after surgery, and one day before discharge.\u003cbr /\u003e \u003cstrong\u003eControl Group:\u003c/strong\u003e Routine and psychological intervention.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 96px;\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 96px;\"\u003e\n\u003cp\u003eHou et al. (2019) [41]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102px;\"\u003e\n\u003cp\u003eNurse\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 74px;\"\u003e\n\u003cp\u003e1w\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 103px;\"\u003e\n\u003cp\u003eFast-track surgery (FTS) theory\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 529px;\"\u003e\n\u003cp\u003e\u003cstrong\u003eExperimental Group: \u003c/strong\u003eSupportive psychological nursing combined with nursing intervention based on Fast-track surgery (FTS) theory. Supportive psychological care includes four aspects: understanding mental state, cognitive intervention, information support and family support.\u003cbr /\u003e \u003cstrong\u003eControl Group:\u003c/strong\u003e Nursing intervention based on FTS theory.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 96px;\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 96px;\"\u003e\n\u003cp\u003eLiu (2018) [39]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102px;\"\u003e\n\u003cp\u003eDoctor and nurse\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 74px;\"\u003e\n\u003cp\u003eNR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 103px;\"\u003e\n\u003cp\u003eNR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 529px;\"\u003e\n\u003cp\u003e\u003cstrong\u003eExperimental Group: \u003c/strong\u003ePeer support combined with routine health education. Intervention measures include face-to-face guidance (postoperative functional exercise guidance, diet guidance, medication guidance, infection prevention and upper limb edema guidance, psychological adjustment guidance), telephone supervision (companion volunteers are responsible for telephone supervision of the same group of patients for disease self-management, the frequency is every Once a week, each talk time\u0026gt; 10 minutes) has been group activities (volunteers organize at least one group activity in each patient's inpatient chemotherapy cycle to summarize self-management experience and lessons).\u003cbr /\u003e \u003cstrong\u003eControl Group: \u003c/strong\u003eRoutine health education on chemotherapy after breast cancer operation.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 96px;\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 96px;\"\u003e\n\u003cp\u003eOu et al. (2017) [40]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102px;\"\u003e\n\u003cp\u003eNurse\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 74px;\"\u003e\n\u003cp\u003e2w\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 103px;\"\u003e\n\u003cp\u003eNR\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 529px;\"\u003e\n\u003cp\u003e\u003cstrong\u003eExperimental Group: \u003c/strong\u003eAdmission and commitment therapy combined with routine nursing care. The intervention content includes acceptance, cognitive isolation, experience of the present, self-awareness, clarification of values, and committed actions. The intervention time is 2 weeks from the second day after the patient's operation. A total of 5 to 6 times, 30 to 40 minutes each time, once every 2 days.\u003cbr /\u003e \u003cstrong\u003eControl Group: \u003c/strong\u003eRoutine nursing care.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd style=\"width: 96px;\"\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 96px;\"\u003e\n\u003cp\u003eLu et al. (2015) [30]\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 102px;\"\u003e\n\u003cp\u003eNurse\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 74px;\"\u003e\n\u003cp\u003e3m\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 103px;\"\u003e\n\u003cp\u003eCollaboration-care-mode (CCM)\u003c/p\u003e\n\u003c/td\u003e\n\u003ctd style=\"width: 529px;\"\u003e\n\u003cp\u003e\u003cstrong\u003eExperimental Group: \u003c/strong\u003eCollaboration care model combined with routine nursing care. Intervention started after diagnosis and lasted 3 months, the measures include establishing a good nurse-patient relationship, guiding patients to cope with bad emotions, lifestyle guidance (functional exercise, functional exercise, diet), and disease-related knowledge guidance.\u003cbr /\u003e \u003cstrong\u003eControl Group:\u003c/strong\u003e Routine nursing care.\u003c/p\u003e\n\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNR: Not Reported, h: hour, d: day, w: week, m: month\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Breast cancer, Resilience, Intervention, Systematic Review, Meta-Analysis","lastPublishedDoi":"10.21203/rs.3.rs-396869/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-396869/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eBreast cancer has now overtaken lung cancer as the world’s mostly commonly-diagnosed cancer. With the increasing prevalence of breast cancer, the psychological problems of breast cancer patients have also received more and more attention from scholars. The aim of our study was to synthesis the available research evidence on the effectiveness of interventions designed to promote or enhance the resilience of breast cancer patients.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eWe performed a systematic and comprehensive search of 12 databases from inception to February 4,2021: Web of Science, PubMed, Embase, MEDLINE, Scopus, Cochrane Library, CINAHL, PsycINFO, Chinese National Knowledge Infrastructure (CNKI), China Biology Medicine disc (CBM), WanFang and VIP. We conducted a comprehensive qualification screening of the retrieved records and analysed all the included data using Review Manager Version 5.3 and STATA/SE Version 15.1.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eA total of 23 RCTs involving 2,002 women with stage I-Ⅳ breast cancer met the eligibility criteria and 15 of them were included in the meta-analysis. The results showed that the effectiveness of resilience training program (SMD = 0.89; 95% CI 0.54, 1.24; \u003cem\u003ep\u003c/em\u003e \u0026lt; 0.00001), health education delivered via mobile devices (SMD = 1.84; 95% CI 0.86, 2.82; \u003cem\u003ep\u003c/em\u003e = 0.0002) and peer support (SMD = 2.62; 95% CI 0.61, 4.63; \u003cem\u003ep\u003c/em\u003e = 0.01) in the experimental groups was better than that of the control groups. Furthermore, there were seven other kind of interventions which might contribute to improve resilience but with very few evidences available.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\u003cp\u003eOur findings suggest that resilience training program, health education delivered via mobile devices and peer support are more effective than that of the routine nursing care in improving the resilience of breast cancer patients. In addition, this study cannot draw definitive conclusions regarding the effectiveness of other seven kind of interventions because the sample size in the included is small and cannot be conducted in the meta-analysis. More studies are needed in the future to clarify the effectiveness of these interventions.\u003c/p\u003e","manuscriptTitle":"The interventions for resilience of breast cancer patients: a systematic review and meta-analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2021-05-04 14:10:51","doi":"10.21203/rs.3.rs-396869/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"fadb3dd2-03da-444a-a7bc-c31dbdaf21c7","owner":[],"postedDate":"May 4th, 2021","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":4059292,"name":"Health Policy"}],"tags":[],"updatedAt":"2021-05-21T03:43:35+00:00","versionOfRecord":[],"versionCreatedAt":"2021-05-04 14:10:51","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-396869","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-396869","identity":"rs-396869","version":["v1"]},"buildId":"GqpaHPwrfC8PjnIFayRh5","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}