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Meaning and Purpose (MaP) therapy II: Feasibility and acceptability from a pilot study in advanced cancer

Published online by Cambridge University Press:  02 January 2019

David W. Kissane ,
Carrie Lethborg ,
Joanne Brooker ,
Courtney Hempton ,
Sue Burney ,
Natasha Michael ,
Margaret Staples ,
Tanya Osicka ,
Merlina Sulistio  and
Jeremy Shapiro
...Show all authors
David W. Kissane*
Affiliation:
Szalmuk Family Psycho-Oncology Research Unit, Cabrini Health, Melbourne, Victoria, Australia Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia Department of Palliative Care, Cabrini Health, Melbourne, Victoria, Australia
Carrie Lethborg
Affiliation:
Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia Social Work Department, St Vincent's Health, Fitzroy, Victoria, Australia
Joanne Brooker
Affiliation:
Szalmuk Family Psycho-Oncology Research Unit, Cabrini Health, Melbourne, Victoria, Australia Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
Courtney Hempton
Affiliation:
Szalmuk Family Psycho-Oncology Research Unit, Cabrini Health, Melbourne, Victoria, Australia Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
Sue Burney
Affiliation:
Szalmuk Family Psycho-Oncology Research Unit, Cabrini Health, Melbourne, Victoria, Australia School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
Natasha Michael
Affiliation:
Department of Palliative Care, Cabrini Health, Melbourne, Victoria, Australia Department of Medicine, Notre Dame University, Sydney, New South Wales, Australia
Margaret Staples
Affiliation:
Szalmuk Family Psycho-Oncology Research Unit, Cabrini Health, Melbourne, Victoria, Australia
Tanya Osicka
Affiliation:
Szalmuk Family Psycho-Oncology Research Unit, Cabrini Health, Melbourne, Victoria, Australia
Merlina Sulistio
Affiliation:
Department of Palliative Care, Cabrini Health, Melbourne, Victoria, Australia
Jeremy Shapiro
Affiliation:
Department of Oncology, Cabrini Health, Melbourne, Victoria, Australia
Hilary Hiscock
Affiliation:
Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
*
Author for correspondence: David W. Kissane, AC, MD, MPM, FRANZCP, FAChPM, FACLP, Department of Psychiatry, Monash University, Block P, Level 3, Monash Medical Centre, 246 Clayton Road, Clayton, VIC 3168, Australia. E-mail: [email protected]
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Abstract

Objective

Meaning and Purpose (MaP) therapy aims to enhance meaning-based coping through a life review that focuses on the value and worth of the person, key relationships, sources of fulfillment, roles, and future priorities in living life out fully. We sought to test the feasibility and acceptability of a six-session model of MaP therapy against a wait-list control cohort in a pilot study seeking effect sizes on measures of adaptation.

Method

We randomized patients with advanced cancer to MaP therapy or wait-list control, with measures administered at baseline and after 6–8 weeks. Wait-list patients could then crossover to receive therapy, with further measures collected postintervention. Adherence to the manualized model was sustained through weekly supervision and fidelity coding of recorded sessions. We used generalized estimating equations to control for baseline and any correlation of data.

Result

From 134 eligible participants, 57 (43%) consented, and 40 of 45 (89%) offered therapy completed 6 sessions. Key barriers to consenting patients were poor health (15 refusers and 4 withdrawals) and death intervened in 6 participants. MaP therapy generated adequate effect sizes in posttraumatic growth (new possibilities, appreciation of life, and personal strength) and life attitudes (choices and goal seeking) to permit calculation of power for a formal randomized, controlled trial.

Significance of results

Delivery of this model of existentially oriented therapy is feasible and acceptable to patients. A properly powered randomized controlled trial is justified to examine the efficacy of this intervention.

Keywords

DemoralizationExistentialFulfillmentHope, Meaning-centered therapyPosttraumatic growthPurpose-in-lifeRelational meaningRoleSelf-worth
Type
Original Article
Information
Palliative & Supportive Care , Volume 17 , Issue 1 , February 2019 , pp. 21 - 28
Copyright
Copyright © Cambridge University Press 2019 

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References

Breitbart, WS and Poppito, SR (2014) Meaning-centered Group Psychotherapy for Patients with Advanced Cancer. New York: Oxford University Press.Google Scholar
Breitbart, WS, Rosenfeld, B, Pessin, H, et al. (2015) Meaning-centered group psychotherapy: An effective intervention for improving psychological well-being in patients with advanced cancer. Journal of Clinical Oncology 33(7), 749–754. doi: 10.1200/JCO.2014.57.2198Google Scholar
Caruso, R (2014) The experience of cancer in advanced phases of illness: Italian CALM Project. Psycho-Oncology 23, 26–27.Google Scholar
Chochinov, HM (2002) Dignity-conserving care - a new model for palliative care: helping the patient feel valued. Journal of the American Medical Association 287(17), 2253–2260.Google Scholar
Chochinov, HM, Kristjanson, LJ, Breitbart, WS, et al. (2011) Effect of dignity therapy on distress and end-of-life experience in terminally ill patients: A randomised controlled trial. Lancet Oncology 12(8), 753–762. doi: 10.1016/S1470-2045(11)70153-XGoogle Scholar
Derogatis, L (2000). Brief Symptom Inventory 18. Minneapolis, MN: National Computer Systems Inc.Google Scholar
Derogatis, L and Melisaratos, N (1983) The Brief Symptom Inventory. Psychological Medicine 13, 595–605.Google Scholar
Folkman, S and Moskowitz, JT (2000) Positive affect and the other side of coping. The American Psychologist 55(6), 647–654.Google Scholar
Frankl, V (1963). Man's search for meaning: An introduction to logotherapy, 6th ed. New York: Washington Square Press.Google Scholar
Kissane, DW, Grabsch, B, Clarke, DM, et al. (2007) Supportive-expressive group therapy for women with metastatic breast cancer: Survival and psychosocial outcome from a randomized controlled trial. Psychooncology 16(4), 277–286.Google Scholar
Lethborg, C, Aranda, S, Bloch, S, et al. (2006) The role of meaning in advanced cancer-integrating the constructs of assumptive world, sense of coherence and meaning-based coping. Journal of Psychosocial Oncology 24(1), 27–42. doi: 10.1300/J077v24n01_03Google Scholar
Lethborg, C, Aranda, S, Cox, S, et al. (2007) To what extent does meaning mediate adaptation to cancer? The relationship between physical suffering, meaning in life, and connection to others in adjustment to cancer. Palliative & Supportive Care 5(4), 377–388.Google Scholar
Lethborg, C, Schofield, P, Kissane, DW (2012) The advanced cancer patient experience of undertaking meaning and purpose (MaP) therapy. Palliative & Supportive Care 10(3), 177–188. doi: 10.1017/S147895151100085XGoogle Scholar
Lethborg, C, Schofield, P, Kissane, DW (2018) Meaning and Purpose (MaP) Therapy I: Therapeutic processes and paradox in how it helps people with advanced cancer. Palliative and Supportive Care. Pax-OA-2017-0211-R2.Google Scholar
Lo, C, Hales, S, Chiu, A, et al. (2016) Managing Cancer And Living Meaningfully (CALM): Randomised feasibility trial in patients with advanced cancer. BMJ Supportive and Palliative Care. Epub ahead of print Jan 19, 2016. doi: 10.1136/bmjspcare-2015-000866Google Scholar
Lo, C, Hales, S, Jung, J, et al. (2014) Managing Cancer and Living Meaningfully (CALM): Phase 2 trial of a brief individual psychotherapy for patients with advanced cancer. Palliative Medicine 28(3), 234–242. doi: 10.1177/0269216313507757Google Scholar
Lo, C, Hales, S, Rydall, A, et al. (2015) Managing Cancer and Living Meaningfully: Study protocol for a randomized controlled trial. Trials 16, 391. doi: 10.1186/s13063-015-0811-1.Google Scholar
Reker, GT and Peacock, EJ (1981) The Life Attitude Profile (LAP): A multidimensional instrument for assessing attitudes toward life. Canadian Journal of Behavioral Science 13, 264–273.Google Scholar
Reker, GT (2001) Life Attitude Profile - Revised, Manual, Student Psychologists Press, Peterborough, Ontario, Canada, 2001, 13 (Vol. 13). Peterborough, Ontario: Student Psychologists Press.Google Scholar
Robinson, S, Kissane, DW, Brooker, J, et al. (2016a) Refinement and revalidation of the Demoralization Scale: The DS-II - External Validity. Cancer 122, 2260–2267. doi: doi/10.1002/cncr.30012/pdfGoogle Scholar
Robinson, S, Kissane, DW, Brooker, J, et al. (2016b). Refinement and revalidation of the Demoralization Scale: The DS-II - Internal Validity. Cancer 122, 2251–2259. doi: 10.1002/cncr.30015Google Scholar
Ronaldson, S, Adamson, J, Dyson, L, et al. (2014) Waiting list randomized controlled trial within a case-finding design: Methodological considerations. Journal of Evaluation in Clinical Practice 20(5), 601–605. doi: 10.1111/jep.12161Google Scholar
Spiegel, D (1993) Living beyond limits: New hope and help for facing life-threatening illness. New York: Times Books.Google Scholar
Spiegel, D and Classen, C (2000) Group therapy for cancer patients: A research-based handbook of psychosocial care. New York: Basic Books.Google Scholar
StataCorp (2015) Statistical Software: Release 14.Google Scholar
Stefanek, ME, Derogatis, LP, and Shaw, A (1987) Psychological distress among oncology outpatients. Prevalence and severity as measured with the Brief Symptom Inventory. Psychosomatics 28(10), 530–532.Google Scholar
Tedeschi, RG and Calhoun, LG (1996) The posttraumatic growth inventory: Measuring the positive legacy of trauma. Journal of Traumatic Stress 9(3), 455–471.Google Scholar
Yalom, ID (1980) Existential psychotherapy. New York: Basic Books.Google Scholar
Zabora, JR, Smith-Wilson, R, Fetting, JH, et al. (1990) An efficient method for psychosocial screening of cancer patients. Psychosomatics 31(2), 192–196.Google Scholar