Psychosocial coping interventions in adolescent oncology: a scoping review of developmental framework alignment, continuum positioning, and outcome measurement

Technical Summary: Psychosocial Coping Interventions in Adolescent Oncology

Problem Statement
Adolescents diagnosed with cancer face unique psychosocial distress that intersects with critical developmental processes, including identity formation, autonomy, and peer belonging. While psychosocial interventions are widely delivered in paediatric oncology, there is no comprehensive synthesis examining whether these interventions are aligned with adolescent developmental frameworks, how they are distributed across the cancer care continuum (specifically the prehabilitation window), or how "coping" is operationalized and measured. Existing reviews have largely focused on intervention efficacy or single modalities (e.g., survivorship) rather than treating coping as a distinct target. Consequently, it remains unclear if current interventions are theoretically grounded in adolescent development or if they effectively measure changes in coping processes versus broader wellbeing proxies.

Methodology
This study is a systematic scoping review conducted in accordance with the Joanna Briggs Institute (JBI) methodology and reported using the PRISMA-ScR extension.

• Search Strategy: A three-step search was conducted across six electronic databases (APA PsycINFO, CINAHL, Google Scholar, Medline, Scopus, Web of Science) and grey literature sources (trial registries, dissertations, professional organization websites) up to March 2026.
• Eligibility Criteria: Using the Population, Concept, Context (PCC) framework, the review included studies targeting adolescents aged 13–19 years with cancer. The "Concept" was defined as non-pharmacological psychosocial interventions with an explicit intent to support coping (enhancing adaptive or reducing maladaptive strategies). The "Context" covered the cancer care continuum from diagnosis through survivorship, excluding palliative and end-of-life phases. Mixed-age samples were included if ≥70% of participants were adolescents.
• Data Synthesis: Twenty-eight publications reporting 22 distinct interventions were included. Data were extracted using a structured charting form and synthesized descriptively across four domains: intervention types/delivery, distribution across the care continuum, developmental/theoretical frameworks, and coping measurement. Intervention components were mapped against the TIDieR checklist to assess reporting completeness. No formal risk-of-bias assessment was performed, consistent with JBI scoping review guidance.

Key Contributions and Results
The review identified 28 publications (1988–2026) describing 22 distinct psychosocial interventions. The findings reveal four systematic gaps in the current evidence base:

1. Absence of Prehabilitation Interventions: No included publication reported designing, delivering, or evaluating a coping-focused intervention within the prehabilitation window (the period between diagnosis and the start of active treatment). While some interventions enrolled participants shortly after diagnosis (e.g., within 1–10 weeks), none explicitly conceptualized the intervention as prehabilitation or aimed to build coping capacity prior to treatment-related stressors.
2. Disconnect Between Developmental Theory and Operationalization: Although 27 of 28 publications cited at least one theoretical framework, there was a consistent disconnect between cited developmental theories (e.g., Piaget, Erikson, Bronfenbrenner, Bowlby) and their operationalization. No publication explicitly reported using these developmental theories to inform specific intervention design, structure, or content. Cited frameworks were predominantly therapeutic (e.g., Cognitive-Behavioural Therapy, Resilience, Stress-and-Coping) rather than developmental. Developmental concepts appeared in rationales but were not translated into specific intervention components.
3. Under-representation of Specific Coping Domains: Interventions predominantly targeted cognitive (n=28), emotional (n=27), and behavioural (n=25) coping. Interpersonal coping was less targeted (n=15), and spiritual/existential coping was the least addressed (n=3), despite these domains being central to adolescent developmental needs.
4. Reliance on Proxy Outcomes: The measurement of coping was highly variable and often indirect. Only nine of 28 publications administered a coping or coping-related measure. Crucially, 18 of the 28 publications relied on proxy wellbeing measures (e.g., quality of life, emotional distress, posttraumatic stress symptoms) rather than validated coping instruments. No established paediatric coping instruments (e.g., Responses to Stress Questionnaire, Children's Coping Strategies Checklist) were used in any included publication. Consequently, it is often impossible to determine whether targeted coping processes actually changed.

Intervention Landscape

• Modality: Cognitive-behavioural therapy (CBT) and resilience-oriented approaches predominated (n=10 for CBT-based skills). The PRISM programme was the most extensively published single intervention. Other modalities included mindfulness, peer support, creative arts, and Acceptance and Commitment Therapy (ACT).
• Delivery: Interventions were primarily delivered face-to-face (n=19) during active treatment (n=10) or survivorship (n=8). No publication targeted the prehabilitation phase.
• Effectiveness: Acceptability findings were consistently positive. Effectiveness results were mixed; only four publications reported statistically significant improvements on primary outcomes in controlled designs. Several studies using validated coping instruments as primary outcomes reported null findings, while others using proxy measures reported positive results, suggesting potential measurement misalignment.

Significance and Claims
The authors claim that the current evidence base for adolescent oncology coping interventions is characterized by a concentration of CBT-based approaches delivered during active treatment or survivorship, with a notable absence of prehabilitation-focused interventions. The review highlights that while interventions are often described as "developmentally tailored," this claim is not supported by transparent reporting of how developmental theory informed design decisions.

The paper asserts that the reliance on proxy outcomes (such as quality of life) rather than direct coping measures prevents the field from determining whether interventions successfully alter the specific coping processes they target. The authors conclude that future research and practice must prioritize:

1. The development of psychosocial prehabilitation interventions.
2. The explicit operationalization of named developmental frameworks in intervention design, moving beyond retrospective justification.
3. The inclusion of interpersonal and existential coping domains.
4. The use of validated, coping-specific outcome measures to establish mechanistic efficacy.

The review does not propose new experimental protocols or specific clinical applications but calls for a shift in how interventions are designed, theorized, and evaluated to better align with the developmental realities of adolescents with cancer.