A bibliotherapy intervention to improve emotional wellbeing during cancer treatment: a pilot study

Abstract Background: Bibliotherapy, or reading for therapy, has been shown to help with a variety of mental health conditions, yet reading can be difficult for those undergoing treatment due to cancer-related cognitive impairment (CRCI). Listening is likely to be easier than reading when experiencing CRCI and fatigue. Currently, no studies examine the potential impact of read-aloud programs on the emotional wellbeing of people undergoing cancer treatment. Methods: To explore a way to introduce or reinstate reading and the benefits it can bring, a new bibliotherapy model was developed and delivered to 38 people who were undergoing or had recently completed treatment. Most participants (97%) were older than 45 years, 34% were palliative, and 13% had incurable but treatable cancer, while 95% self-reported symptoms of CRCI. The bibliotherapy model was personalized in its approach to book selection and delivery (one-on-one in-person or via Zoom). Using a pragmatic, mixed-methods framework, participant wellbeing was measured preintervention to postintervention and qualitative interviews were conducted to explore psychosocial effects from participants' (n = 35) and family members' (n = 17) perspectives and were analyzed using reflexive thematic analysis. Results: Stress, anxiety, and depression decreased (as measured by DASS-21, P = .004, P = .000 and P = .015, respectively), and wellbeing increased (as measured by Warwick-Edinburgh Mental Wellbeing Scale [WEMWBS], P = .001) preintervention to postintervention. Qualitative analyses highlighted the aspects of the program participants valued: relaxation, mood lift, increased self-efficacy, time out, and feelings of warmth/nurturing. Distraction/escapism was viewed by participants as having benefits to their mood, pain, and nausea. Human interaction was also highly valued: the sense of connection with the reader was important. Family members expressed feelings of comfort and respite. Conclusions: Findings suggest a tailored bibliotherapy program may be associated with increases in the emotional wellbeing of people undergoing or recently completed cancer treatment, and comfort and respite for their family members. While further research using a randomized controlled trial design is needed, these findings suggest this model is eminently suitable as an offering in integrative cancer centers and palliative settings, with no negative unintended consequences being observed.