The Comparative Effectiveness of Education Modalities on Patient Adherence in Breast Cancer Survivors: A Systematic Review and Network Meta-Analysis

Abstract

Abstract Background: Educational interventions are central to breast cancer survivorship care, yet adherence may vary depending on delivery modality. Objective: To compare the effectiveness of face-to-face, online, telephonic, and mixed educational modalities on patient adherence among breast cancer survivors. Methods: A systematic review of randomized controlled trials and Bayesian network meta-analysis were conducted following PRISMA 2020 guidelines. Randomized controlled trials evaluating educational interventions in breast cancer survivors were included. Methodology quality of included studies was assessed using the RoB-2 tool. Pairwise meta-analyses using random-effects models estimated Odds Ratios (ORs) for adherence. A Bayesian network meta-analysis synthesized direct and indirect evidence, and treatment rankings were calculated using SUCRA values. Results: Eleven trials comprising 963 participants were included. In pairwise meta-analysis, no modality demonstrated statistically significant superiority over usual care: face-to-face (OR 0.79; 95% CI 0.44–1.41), mixed (OR 0.42; 95% CI 0.07–2.37), online (OR 0.90; 95% CI 0.49–1.68), and telephonic (OR 0.57; 95% CI 0.18–1.78). The network meta-analysis confirmed the absence of statistically significant differences across modalities. SUCRA rankings suggested that usual care (76.7%) and online modalities (73.1%) had the highest probability of being among the best-performing strategies, followed by face-to-face (51.9%), telephonic (25.4%), and mixed (23.0%). Conclusions: No educational modality demonstrated superior adherence compared to usual care. Delivery format alone may not determine engagement in breast cancer survivorship programs. Decisions should prioritize feasibility and patient preference.