Meaning-Centered Group Psychotherapy in Advanced Cancer

描述(由申请人提供)：灵性及其在临终关怀中的作用已成为姑息关怀的中心问题。我们的研究小组最近对晚期癌症和艾滋病患者进行了几项研究，证明了精神健康的核心作用，特别是在缓冲抑郁、绝望和加速死亡的欲望方面。我们已经开发、操作并试行了为期8周的以意义为中心的团体心理疗法，旨在帮助晚期癌症患者在生命即将结束时维持或增强意义、和平、目标、精神福祉和希望。基于R21赠款的初步研究结果表明，在一组晚期癌症患者中，我们以意义为中心的干预显著减少了心理痛苦和加速死亡的欲望，并显著增加了精神幸福感以及对生活的意义和目标的感觉。该项目的总体目标是对这种新的、独特的基于精神的心理疗法干预晚期癌症患者在提高心理和精神健康和生活质量方面的有效性进行随机对照试验。具体地说，我们将检验以意义为中心的团体心理疗法与标准化的支持性团体心理疗法在提高精神健康和生活质量、减少心理痛苦(焦虑和抑郁)和临终绝望(概念化为绝望、加速死亡欲望和自杀意念)方面的有效性。此外，我们将检查临床和人口统计学变量，这些变量可能会在这一人群中调节或缓和以意义为中心的团体心理治疗的治疗反应。320名IV期实体瘤癌症患者将随机接受这两种干预措施中的一种(160名患者被随机分配到每组，预计磨损率为40%，因此每组有96名患者完成整个试验)。受试者将在基线/干预前、干预后和干预后2个月的3个时间点用一系列自我报告测量进行评估。这项研究将为晚期癌症患者提供一种新颖而创新的心理治疗干预措施的基本疗效数据，该干预措施纳入了精神(以意义为中心)元素，在治疗临终精神痛苦方面前景广阔。

DESCRIPTION (provided by applicant): Spirituality and its role in end-of-life care has 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. We have developed, manualized and piloted an 8-week Meaning-Centered Group Psychotherapy, designed to help patients with advanced cancer sustain or enhance a sense of meaning, peace, purpose, spiritual well-being and hope as they approach the end-of-life. Preliminary findings, based on an R21 grant, suggest that our Meaning-Centered intervention significantly reduced psychological distress and desire of hastened death, and significantly increased spiritual well-being and sense of meaning and purpose in life in a sample of advanced cancer patients. This project's overall aim is to conduct a randomized controlled trial of the efficacy of this new and-unique spiritually-based psychotherapy intervention for advanced cancer patients in enhancing psychological and spiritual well-being and quality of life. Specifically, we will examine the efficacy of Meaning-Centered Group Psychotherapy, compared to a standardized Supportive Group Psychotherapy, in enhancing spiritual well being and quality of life, and reducing psychological distress (anxiety and depression) and end-of-life despair (conceptualized as hopelessness, desire for hastened death, and suicidal ideation). In additon, we will examine clinical and demographic variables that may mediate or moderate treatment response to Meaning-Centered Group Psychotherapy in this population. 320 patients with stage IV solid tumor cancers will be randomized to receive 1 of these 2 interventions(160 patients randomized to each arm, anticipating an attrition rate of 40% would thus leave 96 patients per arm who complete the entire trial). Subjects will be assessed with a battery of self-report measure at 3 points: baseline/pre-intervention, post-intervention, and at 2 months post-intervention follow-up. This study will provide essential 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.