Understanding meaning in life interventions in patients with advanced disease: A systematic review and realist synthesis

Background: Among patients with advanced disease, meaning in life is thought to enhance well-being, promote coping and improve the tolerance of physical symptoms. It may also act as a buffer against depression and hopelessness. As yet, there has been no synthesis of meaning in life interventions in which contextual factors, procedures and outcomes are described and evaluated. Aims: To identify meaning in life interventions implemented in patients with advanced disease and to describe their context, mechanisms and outcomes. Design: Systematic review according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and realist synthesis of meaning in life interventions using criteria from the Realist And Meta-narrative Evidence Syntheses: Evolving Standards project. Data sources: The CINAHL, PsycINFO, PubMed and Web of Science databases were searched. Results: A total of 12 articles were included in the systematic review, corresponding to nine different interventions. Five articles described randomized controlled trials, two were qualitative studies, two were commentaries or reflections, and there was one pre–post evaluation, one exploratory study and one description of a model of care. Analysis of context, mechanisms and outcomes configurations showed that a core component of all the interventions was the interpersonal encounter between patient and therapist, in which sources of meaning were explored and a sense of connectedness was re-established. Meaning in life interventions were associated with clinical benefits on measures of purpose-in-life, quality of life, spiritual well-being, self-efficacy, optimism, distress, hopelessness, anxiety, depression and wish to hasten death. Conclusion: This review provides an explanatory model of the contextual factors and mechanisms that may be involved in promoting meaning in life. These approaches could provide useful tools for relieving existential suffering at the end of life.

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Experiences of children who have been separated from a parent due to military deployment:a systematic review of reviews

BJPsych Open ◽

10.1192/bjo.2021.702 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S263-S263

Author(s):

Jennifer Kent ◽

Pamela Taylor ◽

Sarah Argent ◽

Narasha Kalebic

Keyword(s):

Systematic Review ◽

English Language ◽

Child Outcomes ◽

Physical Symptoms ◽

Mental Illnesses ◽

Military Deployment ◽

Parental Relationships ◽

Negative Effect ◽

Review Of Reviews ◽

Meta Analyses

AimsTo conduct a systematic review of reviews to investigate how military deployment of a parent affects his/her child, and the extent to which the child's own perspectives have been documented.BackgroundLengthy but finite disruptions to parenting in any form may affect child development and mental and physical health.Military deployment means weeks or months of separation from one parent.2016 figures for the U.S. military showed that 40.5% of military personnel have children, and of these 1.7 million children the largest percentage are aged between 0–5 years (37.8%).MethodSeven databases were searched: AMED, Web of Science, Scopus, EMBASE 1947, Joanna Briggs Institute EMP database, Ovid MEDLINE 1946 and PsycINFO 1806 from the inception of each electronic database until 31st March 2018.Inclusion criteria:Child and young adults aged 0–24 yearsEnglish language papers onlyAll papers being systematic reviews or meta-analysesA focus on documenting the effects on child outcomesData extracted included the review methods and child outcomes reported, including educational attainment; physical symptoms; mental illnesses or disorders; changes to behaviours, and effects on peer and parental relationships.ResultThe eight reviews identified included 32 common and relevant studies.Across the various studies, only about 20% of data came directly from children.Five papers extracted from the reviews identified parental deployment as having a negative effect on school attainment.Nine studies extracted from the review papers found a positive correlation between having a deployed parent and a greater chance of experiencing depressive symptoms and feelings of anxiety.Strong correlations of increased prevalence of both externalising & internalising behaviours were conclusively found in 7 of the reviews.Increased resilience was detailed in only one study featured in multiple reviews.Just one study featured across the reviews reported on physiological measures - adolescents with deployed parents had higher blood pressures and significantly higher heart rates and stress scores than civilian children.ConclusionMore research obtaining the viewpoint of the child directly and observation of such children is required to properly understand the effects on children with a deployed parent, without the interference of parent or teacher reporting bias. Additionally, with only one study reporting on increased offspring resilience there has been limited exploration of potential positive correlates, so further research regarding these is important.

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Understanding Hospice Patients’ Beliefs About Their Life Expectancy: A Qualitative Interview Study

American Journal of Hospice and Palliative Medicine® ◽

10.1177/1049909120948486 ◽

2020 ◽

pp. 104990912094848

Author(s):

Jennifer M. Taber ◽

Clare L. Stacey ◽

Denice K. Sheehan

Keyword(s):

Life Expectancy ◽

Advanced Disease ◽

Well Being ◽

Physical Symptoms ◽

Future Research ◽

Common Source ◽

Structured Interviews ◽

Qualitative Interview Study ◽

Hospice Patients ◽

Length Of Life

Background: Patients with advanced disease often overestimate their life expectancy, which potentially impacts decision making. Objective: To examine the nature and source of hospice patients’ life expectancy estimates, about which little is known. Design: Using semi-structured interviews, patients were asked to estimate their life expectancy and elaborate on their response. Setting/Subjects: Participants were hospice patients ( n = 20, 55% male; 60% cancer). Measurement: We conducted thematic analysis using open and focused coding. Results: Many participants had difficulty answering the life expectancy question and expressed uncertainty about when they would die. One-third overestimated their length of life relative to actual survival. The most common source of patients’ prognostic beliefs was knowledge about their body, including physical symptoms and change over time. Half of patients reported that a provider had given them a prognostic estimate, and one-third agreed with, or gave estimates consistent with, the provider’s estimate. Some patients said providers do not know prognosis or that time of death was unknowable. Conclusions: Key findings were that 1) many hospice patients had difficulty estimating life expectancy, and 2) hospice patients’ life expectancy estimates were frequently based on their body and not on information from medical providers. These findings have implications for measuring prognostic awareness, as valid assessment is a necessary component of determining whether prognostic awareness is beneficial for patients. Future research should examine how life expectancy estimates are associated with well-being and whether results extend to larger samples of patients with advanced disease not in hospice.

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A systematic review evaluating the impact of paid home carer training, supervision, and other interventions on the health and well-being of older home care clients

International Psychogeriatrics ◽

10.1017/s1041610216002386 ◽

2017 ◽

Vol 29 (4) ◽

pp. 595-604 ◽

Cited By ~ 6

Author(s):

Claudia Cooper ◽

Blerta Cenko ◽

Briony Dow ◽

Penny Rapaport

Keyword(s):

Systematic Review ◽

Home Care ◽

Controlled Trial ◽

Meta Analysis ◽

Life Quality ◽

Well Being ◽

Qualitative Synthesis ◽

Model Learning ◽

The Impact ◽

Health And Well Being

ABSTRACTBackground:Interventions to support and skill paid home carers and managers could potentially improve health and well-being of older home care clients. This is the first systematic review of interventions to improve how home carers and home care agencies deliver care to older people, with regard to clients’ health and well-being and paid carers’ well-being, job satisfaction, and retention.Methods:We reviewed 10/731 papers found in the electronic search (to January 2016) fitting predetermined criteria, assessed quality using a checklist, and synthesized data using quantitative and qualitative techniques.Results:Ten papers described eight interventions. The six quantitative evaluations used diverse outcomes that precluded meta-analysis. In the only quantitative study (a cluster Randomized Controlled Trial), rated higher quality, setting meaningful goals, carer training, and supervision improved client health-related quality of life. The interventions that improved client outcomes comprised training with additional implementation, such as regular supervision and promoted care focused around clients’ needs and goals. In our qualitative synthesis of four studies, intervention elements carers valued were greater flexibility to work to a needs-based rather than a task-based model, learning more about clients, and improved communication with management and other workers.Conclusions:There is a dearth of evidence regarding effective strategies to improve how home care is delivered to older clients, particularly those with dementia. More research in this sector including feasibility testing of the first home care intervention trials to include health and life quality outcomes for clients with more severe dementia is now needed.

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Self-compassionate Aging: A Systematic Review

The Gerontologist ◽

10.1093/geront/gny108 ◽

2018 ◽

Vol 59 (4) ◽

pp. e311-e324 ◽

Cited By ~ 5

Author(s):

Lydia Brown ◽

Jeff C Huffman ◽

Christina Bryant

Keyword(s):

Systematic Review ◽

Older Adults ◽

Psychological Symptoms ◽

Meta Analysis ◽

Later Life ◽

Well Being ◽

Physical Symptoms ◽

Search Term ◽

Self Compassion ◽

The Impact

Abstract Abstract Background and Objectives There is considerable heterogeneity in experiences of aging, with some experiencing greater well-being and adapting more successfully to the challenges of aging than others. Self-compassion is a modifiable psychological skill that might help explain individual differences in well-being and adjustment in later life. The aim of this study was to systematically review the literature on self-compassion and well-being outcomes in studies of older adults aged 65 and older. Research Design and Methods This systematic review was conducted according to PRISMA guidelines, using databases PsycINFO, Medline, and Embase. The search term self-compassion was paired with terms relating to well-being, psychological symptoms, and adjustment. Meta-analysis was used to synthesize results on the relationship between self-compassion and four outcomes including depression, anxiety, hedonic well-being, and eudaimonic well-being. Results Eleven studies met inclusion criteria for this review. Meta-analysis revealed that self-compassion was associated with lower levels of depression (r = −.58, 95% CI [−.66, −.48]) and anxiety (r = −.36, 95% CI [−.60, −.07]), and higher levels of hedonic (r = .41, 95% CI [.15, .62]) and eudaimonic (r = .49, 95% CI [.41, .57]) well-being. Further, three studies found self-compassion weakened the impact of physical symptoms on well-being outcomes. Discussion and Implications We found preliminary evidence that self-compassion is associated with well-being outcomes in older adults, and that self-compassion may buffer the psychological sequelae of health symptoms in later life. Higher quality studies with uniform outcome measures are needed to replicate and extend these results.

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Understanding patients’ experiences of the wish to hasten death: an updated and expanded systematic review and meta-ethnography

BMJ Open ◽

10.1136/bmjopen-2017-016659 ◽

2017 ◽

Vol 7 (9) ◽

pp. e016659 ◽

Cited By ~ 32

Author(s):

Andrea Rodríguez-Prat ◽

Albert Balaguer ◽

Andrew Booth ◽

Cristina Monforte-Royo

Keyword(s):

Systematic Review ◽

Meaning In Life ◽

Assisted Suicide ◽

Advanced Disease ◽

Sense Of Self ◽

Free Text ◽

Qualitative Synthesis ◽

Care Plans ◽

Wish To Hasten Death ◽

Life Threatening

ObjectivesPatients with advanced disease sometimes express a wish to hasten death (WTHD). In 2012, we published a systematic review and meta-ethnography of qualitative studies examining the experience and meaning of this phenomenon. Since then, new studies eligible for inclusion have been reported, including in Europe, a region not previously featured, and specifically in countries with different legal frameworks for euthanasia and assisted suicide. The aim of the present study was to update our previous review by including new research and to conduct a new analysis of available data on this topic.SettingEligible studies originated from Australia, Canada, China, Germany, The Netherlands, Switzerland, Thailand and USA.ParticipantsStudies of patients with life-threatening conditions that had expressed the WTHD.DesignThe search strategy combined subject terms with free-text searching of PubMed MEDLINE, Web of Science, CINAHL and PsycInfo. The qualitative synthesis followed the methodology described by Noblit and Hare, using the ‘adding to and revising the original’ model for updating a meta-ethnography, proposed by Franceet al. Quality assessment was done using the Critical Appraisal Skills Programme checklist.Results14 studies involving 255 participants with life-threatening illnesses were identified. Five themes emerged from the analysis: suffering (overarching theme), reasons for and meanings and functions of the WTHD and the experience of a timeline towards dying and death. In the context of advanced disease, the WTHD emerges as a reaction to physical, psychological, social and existential suffering, all of which impacts on the patient’s sense of self, of dignity and meaning in life.ConclusionsThe WTHD can hold different meanings for each individual—serving functions other than to communicate a genuine wish to die. Understanding the reasons for, and meanings and functions of, the WTHD is crucial for drawing up and implementing care plans to meet the needs of individual patients.

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Passive Sensing of Health Outcomes Through Smartphones: Systematic Review of Current Solutions and Possible Limitations (Preprint)

10.2196/preprints.12649 ◽

2018 ◽

Author(s):

Alina Trifan ◽

Maryse Oliveira ◽

José Luís Oliveira

Keyword(s):

Systematic Review ◽

English Language ◽

Well Being ◽

Monitoring Systems ◽

User Engagement ◽

Positioning Systems ◽

Health Related ◽

Being There ◽

Meta Analyses ◽

Health And Well Being

BACKGROUND Technological advancements, together with the decrease in both price and size of a large variety of sensors, has expanded the role and capabilities of regular mobile phones, turning them into powerful yet ubiquitous monitoring systems. At present, smartphones have the potential to continuously collect information about the users, monitor their activities and behaviors in real time, and provide them with feedback and recommendations. OBJECTIVE This systematic review aimed to identify recent scientific studies that explored the passive use of smartphones for generating health- and well-being–related outcomes. In addition, it explores users’ engagement and possible challenges in using such self-monitoring systems. METHODS A systematic review was conducted, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, to identify recent publications that explore the use of smartphones as ubiquitous health monitoring systems. We ran reproducible search queries on PubMed, IEEE Xplore, ACM Digital Library, and Scopus online databases and aimed to find answers to the following questions: (1) What is the study focus of the selected papers? (2) What smartphone sensing technologies and data are used to gather health-related input? (3) How are the developed systems validated? and (4) What are the limitations and challenges when using such sensing systems? RESULTS Our bibliographic research returned 7404 unique publications. Of these, 118 met the predefined inclusion criteria, which considered publication dates from 2014 onward, English language, and relevance for the topic of this review. The selected papers highlight that smartphones are already being used in multiple health-related scenarios. Of those, physical activity (29.6%; 35/118) and mental health (27.9; 33/118) are 2 of the most studied applications. Accelerometers (57.7%; 67/118) and global positioning systems (GPS; 40.6%; 48/118) are 2 of the most used sensors in smartphones for collecting data from which the health status or well-being of its users can be inferred. CONCLUSIONS One relevant outcome of this systematic review is that although smartphones present many advantages for the passive monitoring of users’ health and well-being, there is a lack of correlation between smartphone-generated outcomes and clinical knowledge. Moreover, user engagement and motivation are not always modeled as prerequisites, which directly affects user adherence and full validation of such systems.

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Wunder-women: Systematic review of causes, treatment and outcomes of Wunderlich syndrome during pregnancy

Journal of Clinical Urology ◽

10.1177/2051415818759367 ◽

2018 ◽

Vol 12 (2) ◽

pp. 134-144

Author(s):

Thomas Ahn ◽

Matthew J Roberts ◽

Anojan Navaratnam ◽

Eric Chung ◽

Simon T Wood

Keyword(s):

Systematic Review ◽

Pregnant Women ◽

Case Reports ◽

Contemporary Literature ◽

Case Series ◽

Artery Aneurysm ◽

Well Being ◽

Renal Neoplasm ◽

Level Of Evidence ◽

Meta Analyses

Objective: The objective of this article is to conduct a contemporary literature review on Wunderlich syndrome, or spontaneous renal haemorrhage (SRH), among pregnant women to describe contemporary aetiology, investigations and management patterns. Methods: A systematic review of MEDLINE and CENTRAL in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed. All articles, including case reports and case series on SRH published from 2000 to 2016, were included. Full-text manuscripts describing SRH among pregnant women were reviewed for clinical parameters, which were collated and analysed. Results: Twenty cases of SRH in pregnant women were identified. The median age and gestation were 32.1 years and 26.5 weeks, respectively, with SRH most commonly occurring in the third trimester (nine patients; 45%) and due to renal neoplasm, specifically angiomyolipoma (AML; 12 patients; 60%), followed by renal artery aneurysm (RAA; five patients; 25%). Surgical intervention (55%) was most commonly used for acute SRH. Foetal demise was not uncommon (15%). Conclusions: SRH in pregnant women is an uncommon but complex urological and obstetric emergency with potentially catastrophic consequences. A multidisciplinary approach is key to timely diagnosis and appropriate management considering the well-being both of mother and foetus. Pre-emptive diagnosis and intervention may reduce complications. Level of evidence: 4

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A systematic review of physical activity and quality of life and well-being

Translational Behavioral Medicine ◽

10.1093/tbm/ibz198 ◽

2020 ◽

Vol 10 (5) ◽

pp. 1098-1109 ◽

Cited By ~ 1

Author(s):

David X Marquez ◽

Susan Aguiñaga ◽

Priscilla M Vásquez ◽

David E Conroy ◽

Kirk I Erickson ◽

...

Keyword(s):

Quality Of Life ◽

Physical Activity ◽

Systematic Review ◽

Well Being ◽

Evidence Base ◽

Committee Report ◽

High Quality Research ◽

Physical Activity Guidelines ◽

Meta Analyses

Abstract Maintaining or improving quality of life (QoL) and well-being is a universal goal across the lifespan. Being physically active has been suggested as one way to enhance QoL and well-being. In this systematic review, conducted in part for the 2018 U.S. Health and Human Services Physical Activity Guidelines for Americans Scientific Advisory Committee Report, we examined the relationship between physical activity (PA) and QoL and well-being experienced by the general population across the lifespan and by persons with psychiatric and neurologic conditions. Systematic reviews, meta-analyses, and pooled analyses from 2006 to 2018 were used for the evidence base. Strong evidence (predominantly from randomized controlled trials [RCTs]) demonstrated that, for adults aged 18–65 years and older adults (primarily 65 years and older), PA improves QoL and well-being when compared with minimal or no-treatment controls. Moderate evidence indicated that PA improves QoL and well-being in individuals with schizophrenia and Parkinson’s disease, and limited evidence indicated that PA improves QoL and well-being for youth and for adults with major clinical depression or bipolar disorder. Insufficient evidence existed for individuals with dementia because of a small number of studies with mixed results. Future high-quality research designs should include RCTs involving longer interventions testing different modes and intensities of PA in diverse populations of healthy people and individuals with cognitive (e.g., dementia) and mental health conditions (e.g., schizophrenia) to precisely characterize the effects of different forms of PA on aspects of QoL and well-being.

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A Systematic Review to Examine the Evidence in Developing Social Prescribing Interventions That Apply a Co-Productive, Co-Designed Approach to Improve Well-Being Outcomes in a Community Setting

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18083896 ◽

2021 ◽

Vol 18 (8) ◽

pp. 3896

Author(s):

Gwenlli Thomas ◽

Mary Lynch ◽

Llinos Haf Spencer

Keyword(s):

Systematic Review ◽

Grey Literature ◽

Community Setting ◽

Well Being ◽

Community Members ◽

Assessment Development ◽

Social Prescribing ◽

Framework Approach ◽

Meta Analyses ◽

Sustainable Health

This systematic review aims to investigate the evidence in applying a co-design, co-productive approach to develop social prescribing interventions. A growing body of evidence suggests that co-production and co-design are methods that can be applied to engage service users as knowledgeable assets who can contribute to developing sustainable health services. Applying the Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic literature search was conducted. Peer-reviewed articles were sought using electronic databases, experts and grey literature. The review search concluded with eight observational studies. Quality appraisal methods were influenced by the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) Framework approach. A narrative thematic synthesis of the results was conducted. The evidence suggests that a co-design and co-productive social prescribing can lead to positive well-being outcomes among communities. Barriers and facilitators of co-production and co-design approach were also highlighted within the evidence. The evidence within this review confirms that a co-production and co-design would be an effective approach to engage stakeholders in the development and implementation of a SP intervention within a community setting. The evidence also implies that SP initiatives can be enhanced from the outset, by drawing on stakeholder knowledge to design a service that improves health and well-being outcomes for community members.

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Psychometric Properties of Preference-Based Measures for Economic Evaluation in Amyotrophic Lateral Sclerosis: A Systematic Review

Neurology Research International ◽

10.1155/2021/6681554 ◽

2021 ◽

Vol 2021 ◽

pp. 1-13

Author(s):

Nicole Peters ◽

Vanina Dal Bello-Haas ◽

Tara Packham ◽

Ava Mehdipour ◽

Ayse Kuspinar

Keyword(s):

Systematic Review ◽

Amyotrophic Lateral Sclerosis ◽

Psychometric Properties ◽

Full Text ◽

Convergent Validity ◽

Well Being ◽

Global Scale ◽

Meta Analyses ◽

Lateral Sclerosis

Objective. The aim of this review was to synthesize the psychometric properties of generic preference-based measures (PBMs) of health-related quality of life (HRQL) in Amyotrophic Lateral Sclerosis (ALS). Methods. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Four databases were searched from inception to April 2019: OVID Medline, Embase, PsycINFO, and CINAHL. Studies were included if (1) the sample represented individuals with ALS, (2) a generic PBM was utilized and reported on, and (3) information on the psychometric property of a generic PBM was provided. Results. Ninety-one articles were screened, and 39 full-text articles were reviewed. Seven full-text articles were included in this review. The mean age of participants ranged from 58.1 to 63.8 years, and mean time since diagnosis ranged from 20.5 to 44.6 months. Two generic PBMs were found, the EQ-5D-3L (n = 6) and the Quality of Well-Being Self-Administered (QWB-SA) scale (n = 1). Convergent validity of the EQ-5D-3L was large against a global scale of self-perceived health (r = 0.60) and small to large against ALS specific HRQL measures (r = 0.19 to 0.75). For the QWB-SA scale, correlations were small against a generic measure (r = 0.21) and large against ALS specific measures (r = 0.55). The EQ-5D-3L discriminated across different disease severity; however, floor effects were reported. Conclusion. This review highlights the need for more rigorously designed studies to assess the psychometric properties of generic PBMs in ALS and the development of an ALS specific PBM that adequately reflects the health concerns of individuals with ALS.

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