An offline to online cognitive behavioral stress management caring program effectively improves psychological pressure, spiritual well-being, and quality of life in postoperative hepatocellular carcinoma patients: offline-to-online CBSM in hepatocellular carcinoma

Background: This study designed an offline to online cognitive behavioral stress management (OO[sbnd]CBSM) caring program, intending to investigate its effect on mental health and quality of life (QoL) using multiple scales in postoperative hepatocellular carcinoma (HCC) patients. Methods: 254 postoperative HCC patients were randomly (1:1) allocated into OO[sbnd]CBSM (included a 10‐week offline CBSM and subsequent online CBSM until M6) and normal care (NC) groups (10‐week NC). Hospital anxiety‐and‐depression scale (HADS), Zung's self‐reporting anxiety (SAS) and depression scale (SDS), FACIT‐SP, European quality‐of‐life‐5 dimensions (EQ‐5D), and quality‐of‐life questionnaire‐core30 (QLQ‐C30) were assessed over 6 months (M). Results: HADS‐defined‐anxiety rates at M3 (P = 0.036) and M6 (P = 0.025), SAS‐defined‐anxiety rate at M6 (P = 0.049), HADS‐defined‐depression rates at M3 (P = 0.026) and M6 (P = 0.049), and SDS‐defined‐depression rates at M3 (P = 0.015) and M6 (P = 0.043) were all lower in OO[sbnd]CBSM group compared to NC group. Furthermore, FACIT‐SP scores at M1 (P = 0.004), M3 (P = 0.003), and M6 (P<0.001) were higher in OO[sbnd]CBSM group compared with NC group. EQ‐5D scores at M1 (P = 0.025) and M3 (P = 0.030) but not M6 (P = 0.128), and QLQ‐C30‐symptom score at M3 (P = 0.014) but not M1 (P = 0.198) and M6 (P = 0.058) were lower in OO[sbnd]CBSM group versus NC group; QLQ‐C30‐global‐health‐status scores at M3 (P = 0.027) and M6 (P = 0.001) but not M1 (P = 0.312), QLQ‐C30‐function scores at M3 (P = 0.005) and M6 (P = 0.001) but not M1 (P = 0.084) were higher in OO[sbnd]CBSM group versus NC group. Patients with younger ages or higher education benefited more from OO[sbnd]CBSM. Conclusion: OO[sbnd]CBSM improves psychological pressure, spiritual well‐being, and QoL in postoperative HCC patients, especially in those with younger ages or higher education.