Context: Goal-setting is a key characteristic of modern rehabilitation. However, goals need to be meaningful and of importance to the client. Axioms: Both theories and empirical evidence support the importance of a hierarchy of goals: one or more overall goals that clients find personally meaningful and specific goals that are related to the overall goals. We posit that the client’s fundamental beliefs, goals and attitudes (“global meaning”) need to be explored before setting any rehabilitation goal. A chaplain or other person with similar skills can be involved in doing so in an open-ended way. The client’s fundamental beliefs, goals and attitudes serve as a point of departure for setting rehabilitation goals. Setting goals: We set out a three-stage process to set goals: (1) exploring the client’s global meaning (i.e. fundamental beliefs, goals and attitudes), (2) deriving a meaningful overall rehabilitation goal from the client’s global meaning and (3) setting specific rehabilitation goals that serve to achieve the meaningful overall rehabilitation goal. Conclusion: This is an extension of current practice in many rehabilitation teams, which may help counter the drive toward exclusively functional goals based around independence.
PurposeTo evaluate psychometric characteristics of a questionnaire (the Northwestern Ego-integrity Scale (NEIS)) on ego-integrity (the experience of wholeness and meaning in life, even in spite of negative experiences) and despair (the experience of regret about the life one has led, and feelings of sadness, failure and hopelessness) among cancer patients.MethodsCancer patients (n = 164) completed patient reported outcome measures on ego-integrity and despair (NEIS), psychological distress, anxiety and depression (Hospital Anxiety and Depression Scale (HADS)), and quality of life (EORTC QLQ-C30 (cancer survivors, n = 57) or EORTC QLQ-C15-PAL (advanced cancer patients, n = 107)). Confirmatory Factor Analysis was used to assess construct validity. Cronbach’s alpha was used to assess internal consistency. Convergent validity was tested based on a priori defined hypotheses: a higher level of ego-integrity was expected to be related to a higher level of quality of life, and lower levels of distress, depression and anxiety; a higher level of despair was expected to be related to a lower level of quality of life, and higher levels of distress, depression and anxiety.ResultsThe majority of all items (94.5%) of the NEIS were completed by patients and single item missing rate was below 2%. The two subscales, labeled as Ego-integrity (5 items) and Despair (4 items) had acceptable internal consistency (Cronbach’s alpha .72 and .61, respectively). The Ego-integrity subscale was not significantly associated with quality of life, distress, anxiety, or depression. The Despair subscale correlated significantly (p <.001) with quality of life (r = -.29), distress (r = .44), anxiety (r = .47) and depression (r = .32).ConclusionThe NEIS has good psychometric characteristics to assess ego-integrity and despair among cancer patients.
In the confrontation with cancer, spiritual re-evaluation may help people to transform all-encompassing suffering into spiritual growth and psycho-spiritual wellbeing. The aim of this study was to examine whether spiritual life review (SLR), a semi-structured group narrative intervention that supports people with cancer to write and present their spiritual life story, is effective for the improvement of spiritual re-evaluation, spiritual growth, and psycho-spiritual wellbeing. In this mixed methods study, 57 cancer patients participated. Quantitative data were collected by means of patient reported outcomes (SAIL, Dutch Ryff, and NEIS) at baseline, post-intervention, and three and nine months follow-up (44 participants completed up to 9 months post-intervention). Changes over time were assessed via linear mixed model analysis (LMM). Qualitative data were collected by means of semi-structured interviews with 33 participants nine months post-intervention, and were coded in a two-stage process. Participating in SLR facilitated spiritual re-evaluation, and improved the course of spiritual growth, psycho-spiritual wellbeing, and ego-integrity. This study provides evidence that SLR is likely to improve spiritual re-evaluation, spiritual growth, and psycho-spiritual wellbeing after confrontation with cancer; it also suggests the importance of self-affirmation and ego-integrity for spirituality; and underscores the relevance of narrative spiritual interventions in the oncology setting.
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