Psychotherapeutic Interventions at the End of Life: A Focus on Meaning and Spirituality

Abstract

Medical and psychological discourse on end-of-life care has steadily shifted over the years from focusing primarily on symptom control and pain management to incorporating more person-centred approaches to patient care. Such approaches underscore the significance of spirituality and meaning making as important resources for coping with emotional and existential suffering as one nears death. Though existential themes are omnipresent in end-of-life care, little has been written about their foundations or import for palliative care practitioners and patients in need. In this article, we explore the existential foundations of meaning and spirituality in light of terminal illness and palliative care. We discuss existential themes in terms of patients' awareness of death and search for meaning and practitioners' promotion of personal agency and responsibility as patients face life-and-death issues. Viktor Frankl's existential logotherapy is discussed in light of emerging psychotherapeutic interventions. Meaning-centred group therapy is one such novel modality that has successfully integrated themes of meaning and spirituality into end-of-life care. We further explore spiritual and existential themes through this meaning-oriented approach that encourages dying patients to find meaning and purpose in living until their death.

Spiritual Well-Being in Hispanic and Non-Hispanic Survivors of Allogeneic Hematopoietic Stem Cell Transplantation

“…Adelstein et al (2014) have suggested that meaning-making interventions for HSCT recipients may have an important role in reducing psychological morbidity, and improving HRQL and coping (Adelstein, Anderson, & Taylor, 2014; Scheffold et al, 2014). However, the effects on SpWB and HRQL of meaning-making interventions tested in the context of end-of-life care (Breitbart, Gibson, Poppito, & Berg, 2004; Breitbart et al, 2012) have not been evaluated for their effectiveness in HSCT survivors, though studies in cancer survivors are currently underway (van der Spek et al, 2014; van der Spek et al, 2013). Our findings support the provision of interventions to enhance a sense of meaning that include meaning-making, since this component of spirituality, not influenced by ethnicity in this sample, may enhance HRQL.…”

Coping strategies for existencial and spiritual suffering in Israeli patients with advanced cancer

“…This training would include special interventions that afford patients an opportunity for greater comfort at the end of life. Such intervention models have been developed in other countries in the past decade, specifically targeting these issues in patients with life-threatening illnesses [13,30,37]. Most are group interventions while a few are individual, mainly short-term treatments.…”

Living Fully in the shadow of Mortal Time: Psychosocial Assets in Advanced Cancer

“…(23) People also engaged in dignity-enhancing life review, which is a natural and healthy life integration and end-of-life activity. (6, 26, 27)…”

“…Some noted, “This is the first time I’ve spoken about this.” Although this discovery is anecdotal, life review is a positive life integration activity to make meaning of their life. (26, 27)Chochinov found that providing hospice patients with a well-honed life story developed from a life review interview reduced distress. (27) We also collected people’s cancer narrative, which encouraged them to appraise their situation, identify options, reflect on strengths and challenges, articulate goals, appreciate paradox, and celebrate the complexity inherent in living a rich life.…”