Unmet spiritual care needs impact emotional and spiritual well-being in advanced cancer patients

Among the advanced cancer population, existential concerns are major issues that promote significant distress. For patients who are facing death, meaning and the preservation of meaning are not only clinically and existentially important but also central concepts to a therapeutic intervention. Based on Viktor Frankl’s logotherapy and the principles of existential psychology and philosophy, “meaning-centered psychotherapy” was developed to help patients with advanced cancer sustain or enhance a sense of meaning, peace, and purpose in their lives. This chapter provides an overview of work developing and testing individual meaning-centered psychotherapy (IMCP). It provides an overview of the session content in the IMCP intervention. It also presents findings from clinical trials, which support the efficacy of IMCP as an intervention to increase a sense of meaning, spiritual well-being, and hope while decreasing end-of-life despair. Furthermore, it presents difficult scenarios that may arise when delivering IMCP for clinicians interested in this work.

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Spiritual well-being of Italian advanced cancer patients in the home palliative care setting

European Journal of Cancer Care ◽

10.1111/ecc.12677 ◽

2017 ◽

Vol 26 (4) ◽

pp. e12677 ◽

Cited By ~ 7

Author(s):

A. A. Martoni ◽

S. Varani ◽

B. Peghetti ◽

D. Roganti ◽

E. Volpicella ◽

...

Keyword(s):

Palliative Care ◽

Cancer Patients ◽

Advanced Cancer ◽

Care Setting ◽

Well Being ◽

Advanced Cancer Patients ◽

Palliative Care Setting ◽

Spiritual Well Being

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Spiritual well-being mediates the association between attachment insecurity and psychological distress in advanced cancer patients

Supportive Care in Cancer ◽

10.1007/s00520-019-04744-x ◽

2019 ◽

Vol 27 (11) ◽

pp. 4317-4325 ◽

Cited By ~ 2

Author(s):

Katharina Scheffold ◽

Rebecca Philipp ◽

Sigrun Vehling ◽

Susan Koranyi ◽

Dorit Engelmann ◽

...

Keyword(s):

Psychological Distress ◽

Cancer Patients ◽

Advanced Cancer ◽

Well Being ◽

Advanced Cancer Patients ◽

Attachment Insecurity ◽

Spiritual Well Being

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Advanced Cancer Patients' Prognostic Awareness and Its Association With Anxiety, Depression and Spiritual Well-Being: A Multi-Country Study in Asia

Clinical Oncology ◽

10.1016/j.clon.2021.11.041 ◽

2021 ◽

Author(s):

S. Ozdemir ◽

S. Ng ◽

W.H.M. Wong ◽

I. Teo ◽

C. Malhotra ◽

...

Keyword(s):

Cancer Patients ◽

Advanced Cancer ◽

Well Being ◽

Advanced Cancer Patients ◽

Country Study ◽

Spiritual Well Being ◽

Anxiety Depression

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Meaning-Centered Group Psychotherapy for Advanced Cancer Patients

10.1093/med/9780199837229.003.0002 ◽

2017 ◽

Author(s):

William Breitbart ◽

Allison J. Applebaum ◽

Melissa Masterson

Keyword(s):

Cancer Patients ◽

Group Psychotherapy ◽

Advanced Cancer ◽

Symptom Burden ◽

Well Being ◽

Evidence Base ◽

Advanced Cancer Patients ◽

Spiritual Well Being ◽

Desire For Death ◽

Anxiety Depression

The ability to sustain a sense of meaning is significantly associated with important elements of end-of-life despair. Meaning-centered group psychotherapy (MCGP), an eight-session group psychotherapy intervention, was developed to help patients with advanced cancer sustain or enhance a sense of meaning. MCGP has been shown to significantly improve spiritual well-being, sense of meaning, and quality of life and to diminish anxiety, depression, hopelessness, symptom burden distress, and desire for death. The mechanism of this benefit is through the enhancement of meaning. MCGP appears to be a beneficial intervention for emotional and spiritual suffering in advanced cancer patients. This chapter describes the theoretical framework and research basis for pursuing an intervention to enhance or sustain meaning. It also describes the development of MCGP, its evidence base for clinical efficacy, and outlines the intervention in great detail.

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Health-related quality of life and its socio-economic and cultural predictors among advanced cancer patients: evidence from the APPROACH cross-sectional survey in Hyderabad-India

BMC Palliative Care ◽

10.1186/s12904-019-0465-y ◽

2019 ◽

Vol 18 (1) ◽

Cited By ~ 8

Author(s):

Jean Jacob ◽

Gayatri Palat ◽

Naina Verghese ◽

Priya Chandran ◽

Vineela Rapelli ◽

...

Keyword(s):

Cancer Patients ◽

Advanced Cancer ◽

Well Being ◽

Pain Severity ◽

Psychological State ◽

Advanced Cancer Patients ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Minority Religions ◽

Spiritual Well Being

Abstract Background Patients with advanced cancer often experience poor health-related quality-of-life (HRQoL) due to cancer and treatment-related side-effects. With India’s palliative care landscape in its infancy, there is a concern that advanced cancer patients, especially individuals who are from disadvantaged populations experience poor HRQoL outcomes. We aim to assess HRQoL of advanced cancer patients in terms of general well-being (physical, functional, emotional, and social/family well-being), pain experiences, psychological state, and spiritual well-being, and determine the relationship between belonging to a disadvantaged group and HRQoL outcomes. We hypothesize that patients from disadvantaged or minority backgrounds, identified in this paper as financially distressed, female, lower years of education, lower social/family support, minority religions, and Non-General Castes, would be associated with worse HRQoL outcomes compared to those who are not from a disadvantaged group. Methods We administered a cross-sectional survey to 210 advanced cancer patients in a regional cancer center in India. The questionnaire included standardized instruments for general well-being (FACT-G), pain experiences (BPI), psychological state (HADS), spiritual well-being (FACT-SP); socio-economic and demographic characteristics. Results Participants reported significantly lower general well-being (mean ± SD) (FACT-G = 62.4 ± 10.0) and spiritual well-being (FACT-SP = 32.7 ± 5.5) compared to a reference population of cancer patients in the U.S. Patients reported mild to moderate pain severity (3.2 ± 1.8) and interference (4.0 ± 1.6), normal anxiety (5.6 ± 3.1) and borderline depressive symptoms (9.7 ± 3.3). Higher financial difficulty scores predicted most of the HRQoL domains (p ≤ 0.01), and being from a minority religion predicted lower physical well-being (p ≤ 0.05) and higher pain severity (p ≤ 0.05). Married women reported lower social/family well-being (p ≤ 0.05). Pain severity and interference were significant predictors of most HRQoL domains. Conclusions Advanced cancer patients, especially those with lower financial well-being and belonging to minority religions, reported low physical, functional, emotional, social/family, and spiritual well-being, and borderline depressive symptoms. Future studies should be directed at developing effective interventions supporting vulnerable groups such as those with financial distress, and those belonging to minority religions.

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Death anxiety interventions in patients with advanced cancer: A systematic review

Palliative Medicine ◽

10.1177/0269216317722123 ◽

2017 ◽

Vol 32 (1) ◽

pp. 172-184 ◽

Cited By ~ 22

Author(s):

Christopher H Grossman ◽

Joanne Brooker ◽

Natasha Michael ◽

David Kissane

Keyword(s):

Cancer Patients ◽

Advanced Cancer ◽

Death Anxiety ◽

Well Being ◽

Adult Patients ◽

Cancer Therapies ◽

Advanced Cancer Patients ◽

Quantitative Studies ◽

Spiritual Well Being ◽

Randomised Controlled

Background: Death anxiety is a common issue in adult patients with advanced cancer and can have a large impact on quality of life and end-of-life care. Interventions are available to assist but are scarcely used in everyday practice. Aim: To assess quantitative studies on interventions for adult patients with advanced cancer suffering from death anxiety. Data sources: MEDLINE, PsycINFO, Embase and CINAHL were searched to identify quantitative or mixed studies on death anxiety or relatable existential intervention studies in advanced cancer patients published from 1990 to December 2016. Two reviewers independently screened titles and abstracts and assessed relevant studies for eligibility. Data were then extracted from included studies for analysis. Results: Nine unique quantitative studies were identified, including five randomised controlled trials, involving a total overall of 1179 advanced cancer patients. All studies were psychotherapeutic in nature and centred on existential themes such as meaning, dignity, relationships and spiritual well-being. The therapies investigated shared overlapping themes but varied in duration, therapist experience, training required and burden on patient. Heterogeneity of studies and measures prevented determination of an overall effect size. Conclusion: Interventions were identified for this clinical scenario of death anxiety in patients with advanced cancer. Therapies of short duration incorporating spiritual well-being and those evoking a sense of meaning were claimed to be the most beneficial, despite lacking rigorous statistical analysis. More high-quality studies with tailored outcome measures are required to fully evaluate the most effective interventions for death anxiety in patients with advanced cancer.

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Symptom Burden, Depression, and Spiritual Well-Being: A Comparison of Heart Failure and Advanced Cancer Patients

Journal of General Internal Medicine ◽

10.1007/s11606-009-0931-y ◽

2009 ◽

Vol 24 (5) ◽

pp. 592-598 ◽

Cited By ~ 158

Author(s):

David B. Bekelman ◽

John S. Rumsfeld ◽

Edward P. Havranek ◽

Traci E. Yamashita ◽

Evelyn Hutt ◽

...

Keyword(s):

Heart Failure ◽

Cancer Patients ◽

Advanced Cancer ◽

Symptom Burden ◽

Well Being ◽

Advanced Cancer Patients ◽

Spiritual Well Being

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Palliative Referrals in Advanced Cancer Patients: Utilizing the Supportive and Palliative Care Indicators Tool and Rothman Index

American Journal of Hospice and Palliative Medicine® ◽

10.1177/10499091211017873 ◽

2021 ◽

pp. 104990912110178

Author(s):

Abigail Sy Chan ◽

Amit Rout ◽

Christopher R. D.’Adamo ◽

Irina Lev ◽

Amy Yu ◽

...

Keyword(s):

Palliative Care ◽

Cancer Patients ◽

Advanced Cancer ◽

Length Of Hospital Stay ◽

Inpatient Setting ◽

Advanced Cancer Patients ◽

Care Needs ◽

Early Palliative Care ◽

Code Status ◽

Palliative Care Needs

Background: Timely identification of palliative care needs can reduce hospitalizations and improve quality of life. The Supportive & Palliative Care Indicators Tool (SPICT) identifies patients with advanced medical conditions who may need special care planning. The Rothman Index (RI) detects patients at high risk of acutely decompensating in the inpatient setting. SPICT and RI among cancer patients were utilized in this study to evaluate their potential roles in palliative care referrals. Methods: Advanced cancer patients admitted to an institution in Baltimore, Maryland in 2019 were retrospectively reviewed. Patient demographics, length of hospital stay (LOS), palliative care referrals, RI scores, and SPICT scores were obtained. Patients were divided into SPICT positive or negative and RI > 60 or RI < 60.Unpaired t-tests and chi-square tests were utilized to determine the associations between SPICT and RI and early palliative care needs and mortality. Results: 227 patients were included, with a mean age of 68 years, 63% Black, 59% female, with the majority having lung and GI malignancies. Sixty percent were SPICT +, 21% had RI < 60. SPICT + patients were more likely to have RI < 60 (p = 0.001). SPICT + and RI < 60 patients were more likely to have longer LOS, change in code status, more palliative/hospice referrals, and increased mortality (p <0.05). Conclusions: SPICT and RI are valuable tools in predicting mortality and palliative/hospice care referrals. These can also be utilized to initiate early palliative and goals of care discussions in patients with advanced cancer.

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