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The Meaning of Life Intervention for Patients With Advanced-Stage Cancer: Development and Pilot Study

Esther Mok

Ka-po Lau

Theresa Lai

Shirley Ching

palliative care, quality of life
ONF 2012, 39(6), E480-E488. DOI: 10.1188/12.ONF.E480-E488

Purpose/Objectives: To develop the Meaning of Life Intervention in response to the need for brief and meaning-focused interventions in palliative care and to establish potential effect sizes for future full-scale randomized, controlled trials.

Design: A randomized, controlled trial conducted to pilot test the Meaning of Life Intervention.

Setting: A 68-bed oncology inpatient ward in an urban acute general hospital in Hong Kong.

Sample: 84 patients with advanced-stage cancer. Fifty-eight completed the study.

Methods: Assessments of outcome variables were conducted at baseline and one day and two weeks after the intervention. Patients were randomly allocated to the intervention group or the control group. Repeated measures analysis of covariance were conducted to assess the impact of the Meaning of Life Intervention on participants' quality of life.

Main Research Variables: The primary outcome was quality of life and was measured by the Quality-of-Life Concerns in the End-of-Life (QOLC-E) questionnaire and with a single-item scale on global quality of life. The eight subscales of the QOLC-E served as secondary outcomes.

Findings: Statistically significant main effects were noted for the group in the QOLC-E questionnaire total score, the single-item scale on global quality of life, and the existential distress subscale of the QOLC-E questionnaire. The effects represented a medium effect size.

Conclusions: The results of this pilot study show that the Meaning of Life Intervention can improve quality of life, particularly existential distress.

Implications for Nursing: The Meaning of Life Intervention represents a potentially effective and efficient intervention that is feasible for implementation by nursing staff for patients with advanced-stage cancer in a palliative care setting.

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    References

    Arraf, K., Cox, G., & Oberle, K. (2004). Using the Canadian code of ethics for registered nurses to explore ethics in palliative care research. Nursing Ethics, 11, 600-609. doi:10.1191/0969733004ne741oa
    Breitbart, W. (2002). Spirituality and meaning in supportive care: Spirituality- and meaning-centered group psychotherapy interventions in advanced cancer. Supportive Care in Cancer, 10, 272-280. doi:10.1007/s005200100289
    Breitbart, W., & Heller, K. S. (2003). Reframing hope: Meaning-centered for patients near the end of life. Journal of Palliative Medicine, 6, 979-988. doi:10.1089/109662103322654901
    Breitbart, W., Rosenfeld, B., Gibson, C., Pessin, H., Poppito, S., Nelson, C., … Olden, M. (2010). Meaning-centered group psychotherapy for patients with advanced cancer: A pilot randomized controlled trial. Psycho-Oncology, 19, 21-28. doi:10.1002/pon.1556
    Chochinov, H. M., Hack, T., Hassard, T., Kristjanson, L. J., McClement, S., & Harlos, M. (2005). Dignity therapy: A novel psychotherapeutic intervention for patients near the end of life. Journal of Clinical Oncology, 23, 5520-5525. doi:10.1200/JCO.2005.08.391
    Cohen, J. (1988). Statistical power analysis for the behavioral sciences (2nd ed.). Hillsdale, NJ: Lawrence Erlbaum Associates.
    Cohen, S. R., Mount, B. M., Tomas, J., & Mount, B. F. (1996). Existential well-being is an important determinant of quality of life: Evidence from the McGill Quality of Life Questionnaire. Cancer, 77, 576-586. doi:10.1002/(SICI)1097-0142(19960201)77:3<576::AID-CNCR22>3.0.CO;2-0
    Colaizzi, P. F. (1978). Psychological research as the phenomenologist views it. In R. S. Valle & M. King (Eds.), Existential-phenomenological alternatives for psychology (pp. 48-71). New York, NY: Oxford University Press.
    Crane, H. M., Van Rompaey, S. E., Dillingham, P. W., Herman, E., Diehr, P., & Kitahata, M. M. (2006). A single-item measure of health-related quality of life for HIV-infected patients in routine clinical care. AIDS Patient Care and STDs, 20, 161-174. doi:10.1089/apc.2006.20.161
    de Boer, A. G., van Lanschot, J. J., Stalmeier, P. F., van Sandick, J. W., Hulscher, J. B., de Haes, J. C., & Sprangers, M. A. (2004). Is a single-item visual analogue scale as valid, reliable and responsive as multi-item scales in measuring quality of life? Quality of Life Research, 13, 311-320. doi:10.1023%2FB%3AQURE.0000018499.64574.1f
    Field, M. J., & Cassel, C. K. (Eds.). (1997). Approaching death: Improving care at the end of life. Washington, DC: National Academies Press.
    Frankl, V. E. (1961). Basic concepts of logotherapy. Confinia Psychiatrica, 4, 99-109.
    Frankl, V. E. (1967). Logotherapy. Israel Annals of Psychiatry and Related Disciplines, 5, 142-155.
    Frankl, V. E. (2006). Man's search for meaning. Boston, MA: Beacon Press.
    Greenstein, M., & Breitbart, W. (2000). Cancer and the experience of meaning: A group psychotherapy program for people with cancer. American Journal of Psychotherapy, 54, 486-500.
    Henry, M., Cohen, S. R., Lee, V., Sauthier, P., Provencher, D., Drouin, P., … Mayo, N. (2010). The meaning-making intervention (MMi) appears to increase meaning in life in advanced ovarian cancer: A randomized controlled pilot study. Psycho-Oncology, 19, 1340-1347. doi:10.1002/pon.1764
    Lawton, M. P., & Brody, E. M. (1969). Assessment of older people: Self-maintaining and instrumental activities of daily living. Gerontologist, 9, 179-186. doi:10.1093/geront/9.3_Part_1.179
    Lee, V., Cohen, R., Edgar, L., Laizner, A. M., & Gagnon, A. J. (2006). Meaning-making intervention during breast or colorectal cancer treatment improves self-esteem, optimism, and self-efficacy. Social Science and Medicine, 62, 3133-3145. doi:10.1016/j.socscimed.2005.11.041
    LeMay, K., & Wilson, K. G. (2008). Treatment of existential distress in life threatening illness: A review of manualized interventions. Clinical Psychology Review, 28, 472-493. doi:10.1016/j.cpr.2007.07.013
    Murata, H., & Morita, T. (2006). Conceptualization of psycho-existential suffering by the Japanese Task Force: The first step of a nationwide project. Palliative and Supportive Care, 4, 279-285. doi:10.1017/S1478951506060354
    O'Boyle, C. A., & Waldron, D. (1997). Quality of life issues in palliative medicine. Journal of Neurology, 244(Suppl. 4), S18-S25. doi:10.1007/PL00007720
    Palmer, J. L. (2004). Analysis of missing data in palliative care studies. Journal of Pain and Symptom Management, 28, 612-618. doi:10.1016/j.jpainsymman.2004.02.026
    Pang, S. M., Chan, K. S., Chung, B. P., Lau, K. S., Leung, E. M., Leung, A. W., … Chan, T. M. (2005). Assessing quality of life of patients with advanced chronic obstructive pulmonary disease in the end of life. Journal of Palliative Care, 21, 180-187.
    Pessin, H., Galietta, M., Nelson, C. J., Brescia, R., Rosenfeld, B., & Breitbart, W. (2008). Burden and benefit of psychosocial research at the end of life. Journal of Palliative Medicine, 11, 627-632.
    Saunders, C. (1988). Spiritual pain. Journal of Palliative Care, 4, 29-32.
    Sepúlveda, C., Marlin, A., Yoshida, T., & Ullrich, A. (2002). Palliative care: The World Health Organization's global perspective. Journal of Pain and Symptom Management, 24, 91-96.
    Stiel, S., Kues, K., Krumm, N., Radbruch, L., & Elsner, F. (2011). Assessment of quality of life in patients receiving palliative care: Comparison of measurement tools and single item on subjective well-being. Journal of Palliative Medicine, 14, 599-606. doi:10.1089/jpm.2010.0473
    Thompson, P. (2007). The relationship of fatigue and meaning of life in breast cancer survivors. Oncology Nursing Forum, 34, 653-660. doi:10.1188/07.ONF.653-660
    World Health Organization. (2002). National cancer control programmes: Policies and managerial guidelines (2nd ed.). Geneva, Switzerland: Author.
    Zigmond, A. S., & Snaith, R. P. (1983). The Hospital Anxiety and Depression Scale. Acta Psychiatrica Scandinavica, 67, 361-370. doi:10.1111/j.1600-0447.1983.tb09716.x
    Zuehlke, T. E., & Watkins, J. T. (1975). The use of psychotherapy with dying patients: An exploratory study. Journal of Clinical Psychology, 31, 729-732. doi:10.1002/1097-4679(197510)31:4<729::AID-JCLP2270310439>3.0.CO;2-G