Introduction

The incidence of oncological diseases has progressively increased, with an estimated 19.9 million new cancer cases diagnosed worldwide in 2022, of which 69.6 thousand were diagnosed in Portugal.¹ According to GLOBOCAN Statistics, 2022, it is projected that over 35 million new cancer cases will occur by 2050, an increase of 77% compared to the 20 million cases estimated in 2022.²Survival rates have also seen significant improvements, with approximately 12 million survivors in Europe, due to advances in early detection, effective therapies, and supportive care.³ Cancer diagnosis continues to be regarded as an adverse life event that requires emotional adjustment, which often negatively impacts the quality of life of individuals with cancer and may potentially affect their survival.⁴ Recent studies indicate that, despite significant scientific progress, the prevalence of clinically significant distress in individuals with oncological disease remains at approximately 50%.^5-6 Emotional issues, particularly anxiety and depression, are the most frequently reported problems, followed by family-related issues and the exacerbation of physical symptoms. ⁵ Scientific evidence suggests that about one-third of this population presents with symptoms of psychiatric disorders, with anxiety and depression being the most common, regardless of the type, stage, or phase of the disease.^7-9 However, the emotional response to stressors related to this condition is represented on a spectrum that can range from normative symptoms, such as distress, worry, uncertainty, sadness, and even hopelessness, to severe emotional symptoms that may eventually meet the diagnostic thresholds for psychiatric disorders.^10-12 Therefore, it is the responsibility of healthcare professionals to understand the difference between non-pathological fluctuations resulting from short-term emotional responses to life challenges and more specific and impactful psychopathological conditions, such as anxiety disorders and depressive disorders.¹³ According to some authors, early recognition and intervention optimise patients' emotional regulation, decision-making capacity, and treatment adherence.¹⁴ Additionally, the emotional support of individuals with cancer is considered an integral part of quality care delivery.¹⁵ International guidelines indicate that monitoring and intervening in the emotional distress of these patients is a minimum standard of practice in oncological care and is considered an indicator of the quality of care provided by healthcare professionals, particularly nurses.^16-18 Despite growing recognition of the nurse’s role in delivering holistic, patient-centred care that includes emotional and psychological support¹⁹ there remains a lack of standardised, well-documented interventions tailored to help cancer patients cope with the emotional impact of their diagnosis and treatment. ¹⁶ A preliminary exploratory search across major databases revealed no existing scoping reviews on this topic, highlighting a knowledge gap. Therefore, this study aims to map the available evidence on nursing interventions that promote coping in adults with cancer, providing a foundation for evidence-based practice, enhancing the quality of psychosocial care in oncology nursing, and supporting the optimisation of coping strategies implemented in clinical settings.

Methodology

This scoping review was conducted following the methodology recommended by the Joanna Briggs Institute (JBI) and aligned with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR)²⁰. The primary objective was to map nursing interventions and programmes aimed at promoting coping in adults with cancer. The research question guiding this review is: "What nursing interventions and programmes promote coping in adults with cancer?". The research question and the eligibility criteria were defined using the PCC mnemonic (Population, Concept, and Context) in accordance with the methodology proposed by the JBI.¹⁹ Regarding the context (C), all intervention contexts were considered without restriction. The review included primary studies, specifically quantitative studies, qualitative studies, and studies employing a mixed-methods approach, including those using methodological triangulation. Exclusion criteria applied were records that did not involve nursing interventions; those focused solely on family members, partners, or caregivers; and records with therapeutic interventions aimed at children and adolescents, due to the specific nature of interventions required for these groups. To ensure both the relevance and recency of the data, a temporal filter was applied, covering the period from 1 February 2019 to 1 February 2024. The search was conducted via EBSCOhost Web® using the following databases: Cumulative Index to Nursing and Allied Health (CINAHL Ultimate®), MedicLatina®, Medical Literature Analysis and Retrieval System Online (MEDLINE®), Library, Information Science & Technology Abstracts, and Nursing & Allied Health Collection Comprehensive. The Boolean equation used was: (((Neoplasms) OR (Cancer) OR ("Cancer Patient")) NOT (Child))) AND ((Adaptation) OR (Psychological) OR (Coping)) AND ((Nursing) OR ("Nursing care")). For the Cochrane Library® database, a Boolean equation tailored to its specific cataloguing and indexing structure was employed to maximise search sensitivity and precision (Lefebvre et al., 2019): (Neoplasms OR Cancer OR "Cancer Patient" NOT Child) AND (Adaptation, Psychological OR Coping) AND (Nursing OR "Nursing care"). The search results were exported to Rayyan software, where duplicate records were removed. The review involved two independent reviewers who analysed the selected records according to the predefined inclusion and exclusion criteria. Discrepancies were resolved through consensus or consultation with a third reviewer. Record selection occurred in three stages: first, titles and abstracts were screened against the inclusion criteria. Second, reference lists of included studies were checked to identify additional relevant studies. In the third stage, full texts were reviewed to confirm eligibility. To map the data, the reviewers developed collection instruments, and the extracted information was presented in a narrative format, discussing the results in relation to the research objectives. The analysis was conducted in two phases: the first involved a descriptive analysis of the methodological characteristics of the records, including the year, origin, study design, cancer type and stage, and sample size. The second phase categorised the evidence into four groups of nursing interventions: typology, format, frequency, and assessment tools. The study protocol was registered on OSF with the registration number 10.17605/OSF.IO/TUCMA on October 2024.

Results

Search and Selection Process

The initial search yielded 1,547 records, comprising 262 from CINAHL Ultimate®, 980 from MEDLINE®, 3 from the Library, Information Science & Technology Abstracts, 6 from MedicLatina®, 96 from the Nursing & Allied Health Collection Comprehensive, and 200 from the Cochrane Library®. Among these, 261 duplicates were identified and removed. Following this process, 1,286 records were retained for screening and analysis, ultimately leading to the inclusion of 18 records. No additional relevant records were identified through checking the reference lists of included studies. Figure 1 depicts the PRISMA-ScR flowchart, illustrating the process of record selection and inclusion.

Figure 1 Flowchart PRISMA extension for scoping reviews  

Discussion

The variety of methodologies used reflects the complexity of the subject and the need for multidisciplinary approaches.

Cognitive-behavioural interventions appear to be widely supported in the scientific community. According to Hamidian et al.,²⁷ group interventions enhance cognitive and emotional adaptation by fostering discussion, sharing experiences, and restructuring beliefs. Pourfallahi et al.,²¹ argue that individual interventions provide personalized attention and are effective for addressing specific needs and emotional challenges, but they limit peer support, which is crucial for coping. Dyadic interventions, on the other hand, strengthen support and communication within the family context.³⁴ Mixed interventions combine the benefits of the approaches, although they are more complex in terms of operationalisation.

Regarding the setting of interventions, the inclusion of digital methodologies has been noted, offering increased convenience, accessibility, and, when asynchronous, flexibility.^28,29,32,34 However, face-to-face interventions allow for more direct interaction, which can facilitate a deeper understanding of individual needs and foster trust and security.

Individual, dyadic, and group interventions, delivered through both face-to-face and online formats, play a crucial role in supporting adults with cancer. Each approach offers distinct advantages and presents unique challenges. The choice of the most suitable strategy should be based on the individual's specific needs and preferences, in conjunction with available resources and logistical support from healthcare professionals.

The literature widely agrees that the phase of the dis ease between initial diagnosis and treatment is crucial, with homework assignments recognized as an effective strategy for consolidating knowledge and skills during this stage.^25,33,34,26

The recommended number of sessions for a programme that addresses the emotional and psychosocial needs of individuals with cancer generally ranges from 6 to 12 sessions (n = 11).^{23,26,28-30,32,33,35-38}

Regarding session duration, there was greater consensus on durations between 45 and 90 minutes (n = 9)^{21,23,25,27,29,31,36,38} depending on the intervention methodology, depth of content, and planned activities.

In terms of session frequency, the analysed records indicated that weekly interventions were predominant (n = 9).^{21-23,26,30,33,35,37,38}

Despite the valuable findings, several limitations should be noted. The diversity of methodologies, the cancer types studied, and the lack of long-term follow-up limit the generalisability of results. Therefore, future research should focus on standardising interventions, assessing long-term effects, and comparing digital with face-to-face approaches on coping.

Conclusions and Implications for Clinical Practice

The results indicate that the scientific community has increasingly developed programmes aimed at facilitating the adaptation and emotional adjustment of patients and their families to cancer. This is largely due to the recognition of the importance of such interventions in optimising the management of emotional and psychosocial challenges associated with the disease, which have both direct and indirect effects on the well-being and quality of life of this population.

A holistic and personalised approach, tailored to individual and contextual needs, remains essential for fostering healthy adaptation to the disease process and improving the quality of life for cancer patients.

Although the results suggest the potential effectiveness of these interventions, it is important to acknowledge the limitations of this review, including the possible exclusion of relevant studies due to the limited selection of databases and the lack of an evaluation of the methodological quality of the included studies.

These findings underscore the ongoing need for further research in this field, with the goal of enhancing nursing interventions and providing more effective support to cancer patients and their caregivers.

Mapping the therapeutic interventions implemented by nurses to promote coping in individuals with cancer could serve as a valuable tool to support nursing decision-making and clinical practice. It could also contribute to the development of nursing programmes aimed at promoting coping in adults with cancer, as well as facilitate the dissemination of existing evidence on this subject.