Meaning-Centered Psychotherapy in Advanced Cancer

描述（由申请人提供）：灵性及其在生命末期的作用

DESCRIPTION (provided by applicant): Spirituality and its role in end-of-life care has recently emerged as a central issue in palliative care. There have been several recent studies of terminally ill cancer and AIDS patients by our research group demonstrating the central role of spiritual well being, and "meaning" in particular, in buffering against depression, hopelessness, and desire for hastened death. Spirituality can be defined as a construct involving components of both faith and/or meaning. Interventions based on the faith/religious component of spirituality have limited acceptance by health care practitioners and patients. Interventions based on the meaning component of spirituality may have more universal acceptance and applicability. We have developed and manualized an 8-week Meaning-Centered Group Psychotherapy, based on the principles of Viktor Frankl's Logotherapy, designed to help patients with advanced cancer sustain or enhance a sense of meaning, peace and purpose as they approach the end-of-life. This project's overall aim is to explore the efficacy of this new and unique psychotherapy intervention for advanced cancer patients in enhancing psychological and spiritual well being and quality of life. Specifically, we will preliminarily examine the efficacy of Meaning-Centered Group Psychotherapy, compared to a standard supportive group psychotherapy, in enhancing spiritual well being and quality of life and reducing psychological distress. 118 advanced cancer patients will be randomized to receive one of these two interventions. In addition, we will explore the relationships among-spiritual well being, psychological distress, hopelessness, physical symptom severity and distress, quality of life, and perceived social support. Subjects will be assessed with a battery of self-report measures at baseline (point of accrual), prior to intervention, post-intervention, and at 3 month follow-up. This study will provide essential preliminary efficacy data on a novel and innovative psychotherapy intervention for patients with advanced cancer, incorporating spiritual (meaning-centered) elements, which holds great promise in the treatment of spiritual suffering at the end-of-life. Larger, randomized controlled trials of Meaning-Centered Group Psychotherapy will be conducted in the future utilizing the insights learned from this pilot intervention study.