Hostname: page-component-669899f699-chc8l Total loading time: 0 Render date: 2025-04-25T16:56:44.414Z Has data issue: false hasContentIssue false
  • English
  • Français

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: joseph.winger@duke.edu
Get access Rights & Permissions [Opens in a new window]

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

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Applebaum, AJ, Lichtenthal, WG, Pessin, HA, et al. (2012) Factors associated with attrition from a randomized controlled trial of meaning-centered group psychotherapy for patients with advanced cancer. Psycho-Oncology 21(11), 1195–1204.CrossRefGoogle ScholarPubMed
Balboni, TA and Balboni, MJ (2018) The spiritual event of serious illness. Journal of Pain and Symptom Management 56(5), 816–822.CrossRefGoogle ScholarPubMed
Bandura, A (1986) Social Foundations of Thought and Action: A Social Cognitive Theory. Englewood Cliffs, NJ: Prentice-Hall.Google Scholar
Bandura, A (2004) Health promotion by social cognitive means. Health Education and Behavior 31(2), 143–164.CrossRefGoogle ScholarPubMed
Blumer, H (1986) Symbolic Interactionism: Perspective and Method. Los Angeles, CA: University of California Press.Google Scholar
Breitbart, W and Poppito, SR (2014) Individual Meaning-Centered Psychotherapy for Patients with Advanced Cancer: A Treatment Manual. New York, NY: Oxford University Press.CrossRefGoogle Scholar
Breitbart, W, Rosenfeld, B, Gibson, C, et al. (2010) Meaning-centered group psychotherapy for patients with advanced cancer: A pilot randomized controlled trial. Psycho-Oncology 19(1), 21–28.CrossRefGoogle ScholarPubMed
Breitbart, W, Poppito, S, Rosenfeld, B, et al. (2012) Pilot randomized controlled trial of individual meaning-centered psychotherapy for patients with advanced cancer. Journal of Clinical Oncology 30(12), 1304–1309.CrossRefGoogle ScholarPubMed
Breitbart, W, 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.CrossRefGoogle ScholarPubMed
Breitbart, W, Pessin, H, Rosenfeld, B, et al. (2018) Individual meaning-centered psychotherapy for the treatment of psychological and existential distress: A randomized controlled trial in patients with advanced cancer. Cancer 124(15), 3231–3239.CrossRefGoogle ScholarPubMed
Buck, HG and Meghani, SH (2012) Spiritual expressions of African Americans and Whites in cancer pain. Journal of Holistic Nursing 30(2), 107–116.CrossRefGoogle ScholarPubMed
Cleeland, C and Ryan, K (1994) Pain assessment: Global use of the Brief Pain Inventory. Annals of the Academy of Medicine, Singapore 23(2), 129–138.Google ScholarPubMed
Delgado-Guay, MO, Chisholm, G, Williams, J, et al. (2016) Frequency, intensity, and correlates of spiritual pain in advanced cancer patients assessed in a supportive/palliative care clinic. Palliative and Supportive Care 14(4), 341–348.CrossRefGoogle Scholar
Dezutter, J, Casalin, S, Wachholtz, A, et al. (2013) Meaning in life: An important factor for the psychological well-being of chronically ill patients? Rehabilitation Psychology 58(4), 334.CrossRefGoogle ScholarPubMed
Dezutter, J, Luyckx, K and Wachholtz, A (2015) Meaning in life in chronic pain patients over time: Associations with pain experience and psychological well-being. Journal of Behavioral Medicine 38(2), 384–396.CrossRefGoogle ScholarPubMed
Dorfman, CS, Kelleher, SA, Winger, JG, et al. (2019) Development and pilot testing of an mHealth behavioral cancer pain protocol for medically underserved communities. Journal of Psychosocial Oncology 37(3), 335–349.CrossRefGoogle ScholarPubMed
Frankl, VE (1964) Man's Search for Meaning: An Introduction to Logotherapy. New York, NY: Pocket Books.Google Scholar
George, LS and Park, CL (2016) Meaning in life as comprehension, purpose, and mattering: Toward integration and new research questions. Review of General Psychology 20(3), 205–220.CrossRefGoogle Scholar
Guerrero-Torrelles, M, Monforte-Royo, C, Tomás-Sábado, J, et al. (2017) Meaning in life as a mediator between physical impairment and the wish to hasten death in patients with advanced cancer. Journal of Pain and Symptom Management 54(6), 826–834.CrossRefGoogle ScholarPubMed
Guest, G, Bunce, A and Johnson, L (2006) How many interviews are enough? An experiment with data saturation and variability. Field Methods 18(1), 59–82.CrossRefGoogle Scholar
Guest, G, MacQueen, KM and Namey, EE (2011) Applied Thematic Analysis. Thousand Oaks, CA: Sage Publications.Google Scholar
Ho, F, Lau, F, Downing, MG, et al. (2008) A reliability and validity study of the Palliative Performance Scale. BMC Palliative Care 7(1), 1–10.CrossRefGoogle ScholarPubMed
Holland, JC and Bultz, BD (2007) The NCCN guideline for distress management: A case for making distress the sixth vital sign. Journal of the National Comprehensive Cancer Network 5(1), 3–7.CrossRefGoogle ScholarPubMed
Hu, Y, Liu, T and Li, F (2019) Association between dyadic interventions and outcomes in cancer patients: A meta-analysis. Supportive Care in Cancer 27(3), 745–761.CrossRefGoogle ScholarPubMed
Hui, D, Glitza, I, Chisholm, G, et al. (2013) Attrition rates, reasons, and predictive factors in supportive care and palliative oncology clinical trials. Cancer 119(5), 1098–1105.CrossRefGoogle ScholarPubMed
Jim, HS and Andersen, BL (2007) Meaning in life mediates the relationship between social and physical functioning and distress in cancer survivors. British Journal of Health Psychology 12(3), 363–381.CrossRefGoogle ScholarPubMed
Keefe, FJ, Abernethy, AP and Campbell, LC (2005a) Psychological approaches to understanding and treating disease-related pain. Annual Review of Psychology 56, 601–630.CrossRefGoogle Scholar
Keefe, FJ, Ahles, TA, Sutton, L, et al. (2005b) Partner-guided cancer pain management at the end of life: A preliminary study. Journal of Pain and Symptom Management 29(3), 263–272.CrossRefGoogle Scholar
Kelleher, SA, Winger, JG, Dorfman, CS, et al. (2019) A behavioral cancer pain intervention: A randomized noninferiority trial comparing in-person to videoconference delivery. Psycho-Oncology 28, 1671–1678.CrossRefGoogle ScholarPubMed
Koffman, J, Morgan, M, Edmonds, P, et al. (2008) Cultural meanings of pain: A qualitative study of Black Caribbean and White British patients with advanced cancer. Palliative Medicine 22(4), 350–359.CrossRefGoogle ScholarPubMed
Kwekkeboom, KL, Tostrud, L, Costanzo, E, et al. (2018) The role of inflammation in the pain, fatigue, and sleep disturbance symptom cluster in advanced cancer. Journal of Pain and Symptom Management 55(5), 1286–1295.CrossRefGoogle ScholarPubMed
O'Mahony, S, Goulet, J, Kornblith, A, et al. (2005) Desire for hastened death, cancer pain and depression: Report of a longitudinal observational study. Journal of Pain and Symptom Management 29(5), 446–457.CrossRefGoogle ScholarPubMed
Park, CL (2010) Making sense of the meaning literature: An integrative review of meaning making and its effects on adjustment to stressful life events. Psychological Bulletin 136(2), 257–301.CrossRefGoogle ScholarPubMed
Park, CL (2013) The meaning making model: A framework for understanding meaning, spirituality, and stress-related growth in health psychology. European Health Psychologist 15(2), 40–47.Google Scholar
Park, CL, Masters, KS, Salsman, JM, et al. (2017) Advancing our understanding of religion and spirituality in the context of behavioral medicine. Journal of Behavioral Medicine 40(1), 39–51.CrossRefGoogle ScholarPubMed
Porter, LS, Keefe, FJ, Baucom, DH, et al. (2017) A randomized pilot trial of a videoconference couples communication intervention for advanced GI cancer. Psycho-Oncology 26(7), 1027–1035.CrossRefGoogle ScholarPubMed
Puchalski, C, Ferrell, B, Virani, R, et al. (2009) Improving the quality of spiritual care as a dimension of palliative care: The report of the consensus conference. Journal of Palliative Medicine 12, 885–904.CrossRefGoogle Scholar
Rosenfeld, B, Cham, H, Pessin, H, et al. (2018) Why is meaning-centered group psychotherapy (MCGP) effective? Enhanced sense of meaning as the mechanism of change for advanced cancer patients. Psycho-Oncology 27(2), 654–660.CrossRefGoogle ScholarPubMed
Saunders, DC (1988) Spiritual pain. Journal of Palliative Care 4(3), 29–32.CrossRefGoogle ScholarPubMed
Sela, RA, Bruera, E, Conner-spady, B, et al. (2002) Sensory and affective dimensions of advanced cancer pain. Psycho-Oncology 11(1), 23–34.CrossRefGoogle ScholarPubMed
Seow, H, Barbera, L, Sutradhar, R, et al. (2011) Trajectory of performance status and symptom scores for patients with cancer during the last six months of life. Journal of Clinical Oncology 29(9), 1151–1158.CrossRefGoogle ScholarPubMed
Sheinfeld Gorin, S, Krebs, P, Badr, H, et al. (2012) Meta-analysis of psychosocial interventions to reduce pain in patients with cancer. Journal of Clinical Oncology 30(5), 1–14.CrossRefGoogle ScholarPubMed
Siddiqi, AA, Sikorskii, A, Given, CW, et al. (2008) Early participant attrition from clinical trials: Role of trial design and logistics. Clinical Trials 5(4), 328–335.CrossRefGoogle ScholarPubMed
Siddall, PJ, Lovell, M and MacLeod, R (2015) Spirituality: What is its role in pain medicine? Pain Medicine 16(1), 51–60.CrossRefGoogle ScholarPubMed
Simonelli, LE, Fowler, J, Maxwell, GL, et al. (2008) Physical sequelae and depressive symptoms in gynecologic cancer survivors: Meaning in life as a mediator. Annals of Behavioral Medicine 35(3), 275–284.CrossRefGoogle ScholarPubMed
Somers, TJ, Abernethy, AP, Edmond, SN, et al. (2015) A pilot study of a mobile health pain coping skills training protocol for patients with persistent cancer pain. Journal of Pain and Symptom Management 50(4), 553–558.CrossRefGoogle ScholarPubMed
Tang, ST, Liu, LN, Lin, K-C, et al. (2014) Trajectories of the multidimensional dying experience for terminally ill cancer patients. Journal of Pain and Symptom Management 48(5), 863–874.CrossRefGoogle ScholarPubMed
Tong, A, Sainsbury, P and Craig, J (2007) Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care 19(6), 349–357.CrossRefGoogle ScholarPubMed
van den Beuken-van, MH, Hochstenbach, LM, Joosten, EA, et al. (2016) Update on prevalence of pain in patients with cancer: Systematic review and meta-analysis. Journal of Pain and Symptom Management 51(6), 1070–1090.CrossRefGoogle Scholar
Wachholtz, AB, Fitch, CE, Makowski, S, et al. (2016) A comprehensive approach to the patient at end of life: Assessment of multidimensional suffering. Southern Medical Journal 109(4), 200.CrossRefGoogle ScholarPubMed
Yalom, ID (1980) Existential Psychotherapy. New York, NY: Basic Books.Google Scholar