Adapting Meaning-Centered Psychotherapy for the palliative care setting: Results of a pilot study

Abstract

Aims To establish preliminary evidence for the feasibility, acceptability, and utility of an abbreviated version of Meaning-Centered Psychotherapy tailored to the needs of palliative care patients in the final weeks or months of life. Background Surprisingly, few mental health interventions have specifically targeted the psychological needs of palliative care patients, when physical comfort seems to take precedence over mental health and emotional needs. Yet the need for mental health services targeting these patients is clear, as one in three palliative care patients experience clinically significant depression and an equal proportion experience clinically significant anxiety. Design This pilot study used an open-label design to assess the feasibility, acceptability, and perceived utility of Meaning-Centered Psychotherapy–palliative care, a brief intervention that focuses on enhancing meaning at the end of life. Setting/participants A total of 12 patients admitted to a palliative care hospital for supportive care consented to participate in the study. Results Of the 11 patients that began treatment (one patient died before the first session), 8 completed the three-session intervention. Patients expressed positive feedback about the structure, focus, and length of the intervention, but varied in precisely which elements they found most helpful. Conclusion An abbreviated version of Meaning-Centered Psychotherapy tailored to the needs of palliative care patients (Meaning-Centered Psychotherapy–palliative care) appears to be feasible, acceptable, and has the potential to help patients better cope with the challenges inherent in confronting death and dying. Further research, with larger and more representative samples, is needed in order to clarify the strengths and weaknesses of this approach.

Request for medical assistance in dying after a suicide attempt in a 75-year-old man with pancreatic adenocarcinoma

“…Therefore, the goal is to understand whether they are suffering (as it is one of the necessary conditions of MAiD), and to alleviate it where possible. Alleviation of suffering may take the form of symptom management or interventions such as dignity therapy 5 or meaning-centred therapy, 6 which may be helpful in treating emotional or existential suffering associated with end of life. Dignity therapy involves reflecting on a person's life experience, learning and achievements; and facilitates expression of their hopes for their loved ones in a legacy document.…”

“…5 Meaningcentred therapy attempts to develop a sense of meaning or purpose in a person's life, adapted to a palliative care setting. 6 Notably, as outlined in Bill C-14, there is no requirement that patients exhaust all options for symptom control before accessing MAiD (Box 1). 7 Although patients must be adequately informed of all available options for symptom control, a patient's rejection of any or all options that they find unacceptable does not preclude them from accessing MAiD.…”

Long‐term efficacy of meaning‐centered group psychotherapy for cancer survivors: 2‐Year follow‐up results of a randomized controlled trial

“…MCGP was adapted for cancer survivors (MCGP-CS) by Van der Spek et al 8 There is evidence that MCGP and MCGP-CS are effective in enhancing a sense of meaning, psychological well-being, and reducing depressive symptoms. 5,[8][9][10] MCGP-CS is likely to be cost-effective as well. 11 In a randomized controlled trial (RCT) among advanced cancer patients, MCGP was more effective than supportive group psychotherapy (SGP) in improving quality of life, spiritual well-being, and reducing depression and hopelessness.…”

“…These improvements were sustained during the 2-month follow-up period. 5 Van der Spek et al 9 Several other types of existential interventions have been developed, [12][13][14][15][16] and a few studies reported on the long-term effects of these interventions. In four RCT's on experiential-existential, 17 cognitiveexistential, 13 or supportive expressive group psychotherapy, 18 participants improved over the 1-year follow-up period, but not more than after a non-meaning-focused type of group psychotherapy 16,17 or the care as usual condition.…”

“…12,18 In a RCT on cognitive existential couple therapy, couples did better after the existential therapy compared to care as usual, and these results were maintained during the 9-month follow-up period. 19 The aim of this study is to investigate the long-term follow-up results of the RCT on the efficacy of MCGP-CS by Van der Spek et al 9 Survivors' sense of personal meaning as well as psychological well-being and posttraumatic growth were compared for MCGP-CS, SGP, and CAU until 2 years after the intervention, both for all participants (intention-to-treat, ITT), and only for those who completed the intervention. Because many other things can also influence one's sense of meaning over the course of 2 years, in additional sensitivity analyses, psychological treatment and cancer recurrence during these 2 years were taken into account.…”