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Enhancing meaning in the face of advanced cancer and pain: Qualitative evaluation of a meaning-centered psychosocial pain management intervention

Published online by Cambridge University Press:  02 March 2020

Joseph G. Winger Open the ORCID record for Joseph G. Winger [Opens in a new window] ,
Katherine Ramos ,
Karen E. Steinhauser ,
Tamara J. Somers ,
Laura S. Porter ,
Arif H. Kamal ,
William S. Breitbart  and
Francis J. Keefe
Joseph G. Winger*
Affiliation:
Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
Katherine Ramos
Affiliation:
Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC Center for the Study of Human Aging and Development, Duke University, Durham, NC Geriatric, Research, Education and Clinical Center (GRECC), Durham VA Medical Center, Durham, NC Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) for Health Services Research and Development, Durham VA Medical Center, Durham, NC
Karen E. Steinhauser
Affiliation:
Center for the Study of Human Aging and Development, Duke University, Durham, NC Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) for Health Services Research and Development, Durham VA Medical Center, Durham, NC Department of Population Health Sciences, Duke University School of Medicine, Durham, NC Department of Medicine, Duke University School of Medicine, Durham, NC
Tamara J. Somers
Affiliation:
Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
Laura S. Porter
Affiliation:
Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
Arif H. Kamal
Affiliation:
Department of Population Health Sciences, Duke University School of Medicine, Durham, NC Department of Medicine, Duke University School of Medicine, Durham, NC Duke Cancer Institute, Duke University Health System, Durham, NC Duke Fuqua School of Business, Durham, NC
William S. Breitbart
Affiliation:
Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
Francis J. Keefe
Affiliation:
Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC
*
Author for correspondence: Joseph G. Winger, Department of Psychiatry and Behavioral Sciences, Division of Behavioral Medicine, Duke University School of Medicine, 2200 West Main Street, Suite 340, Durham, NC27705, USA. E-mail: [email protected]
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Abstract

Objectives

The objectives of this study were to obtain patient evaluations of the content, structure, and delivery modality of Meaning-Centered Pain Coping Skills Training (MCPC), a novel psychosocial intervention for patients with advanced cancer and pain. MCPC aims to help patients connect with valued sources of meaning in their lives (e.g., family relationships), while providing training in evidence-based cognitive and behavioral skills (e.g., guided imagery) to reduce pain.

Methods

Semi-structured interviews were conducted with 12 patients with stage IV solid tumor cancers and persistent pain. Transcripts were analyzed using methods from applied thematic analysis.

Results

When evaluating MCPC's educational information and skills training descriptions, participants described ways in which this content resonated with their experience. Many coped with their pain and poor prognosis by relying on frameworks that provided them with a sense of meaning, often involving their personally held religious or spiritual beliefs. They also expressed a need for learning ways to cope with pain in addition to taking medication. A few participants offered helpful suggestions for refining MCPC's content, such as addressing common co-occurring symptoms of sleep disturbance and fatigue. Concerning MCPC's structure and delivery modality, most participants preferred that sessions include their family caregiver and described remote delivery (i.e., telephone or videoconference) as being more feasible than attending in-person sessions.

Significance of results

Participants were interested in an intervention that concurrently focuses on learning pain coping skills and enhancing a sense of meaning. Using remote delivery modalities may reduce access barriers (e.g., travel) that would otherwise prevent many patients from utilizing psychosocial services.

Keywords

Advanced cancerCopingMeaning in lifeMeaning-centered psychotherapyPain coping skills trainingSpiritual well-being
Type
Original Article
Information
Palliative & Supportive Care , Volume 18 , Issue 3 , June 2020 , pp. 263 - 270
Copyright
Copyright © Cambridge University Press 2020

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