The Effectiveness of Positive Psychological Intervention Based on PERMA Model in Cancer Patients: A Systematic Review and Meta‐Analysis

BACKGROUND: Happiness is a fundamental goal for all individuals. However, cancer patients often find themselves at risk of happiness deprivation owing to the psychological and physical challenges posed by their condition. OBJECTIVES: This systematic review aimed to evaluate the effectiveness of positive psychological interventions based on the PERMA model in enhancing happiness/well-being in cancer patients. A secondary objective was to assess their effects on anxiety, depression, fatigue, and fear of cancer recurrence. METHODS: A systematic review and meta-analysis were performed according to PRISMA guidelines. PubMed, EMBASE, CINAHL, Cochrane Library, PsycINFO, Scopus, and Web of Science databases were searched for experimental studies on PERMA-based positive psychological interventions for cancer patients (from inception to 15 May 2024). Two researchers independently performed data screening, extraction, and risk of bias assessments using Cochrane's Risk of Bias Tool (RoB 2). Meta-analysis techniques were applied, and evidence certainty was evaluated using the GRADE system. RESULTS: Fourteen studies involving 1200 cancer patients met the inclusion criteria, with thirteen included in the meta-analysis. PERMA model-based positive psychological interventions significantly improved happiness/well-being (standardized mean difference [SMD]: 1.19; 95% confidence interval [CI]: 0.68-1.70) and were associated with reductions in anxiety (MD: -2.98; 95% CI: -3.29 to -2.67), depression (MD: -2.08; 95% CI: -2.20 to -1.96), fatigue (MD: -2.14; 95% CI: -2.20 to -2.08) and fear of cancer recurrence (MD: -5.10; 95% CI: -6.27 to -3.94). The certainty of evidence for all outcomes was rated as low or very low. CONCLUSIONS: This meta-analysis provides preliminary evidence that PERMA-based positive psychological interventions have the potential to enhance happiness/well-being in cancer patients while alleviating psychological distress. However, substantial heterogeneity and methodological limitations preclude definitive recommendations, highlighting the need for further high-quality research.