Individual Meaning-Centered Psychotherapy in Advanced Cancer Patients

晚期癌症患者以个体意义为中心的心理治疗

• 批准号: 8118424
• 负责人: William Breitbart
• 金额: $ 72.71万
• 依托单位: SLOAN-KETTERING INST CAN RESEARCH
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-08-01 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8118424
• 关键词: Address; Advanced Malignant Neoplasm; Anxiety; Awareness; Buffers; Cancer Patient; Caring; Cessation of life; Clinical; Data; Development; Distress; Dose; Elements; Ethnic Origin; Feeling hopeless; Gender; Individual; Institute of Medicine (U.S.); Intervention; Left; Life; Literature; Measures; Mediating; Mental Depression; Outcome; Palliative Care; Participant; Patient Self-Report; Patients; Personal Satisfaction; Psychotherapy; Quality of life; Race; Randomized; Randomized Controlled Trials; Relative (related person); Religion; Research; Role; Sampling; Schedule; Social support; Solid Neoplasm; Spirituality; Staging; Symptoms; Terminally Ill; Testing; Thermometers; Vacuum; Well in self; Work; World Health; World Health Organization; arm; base; comparative efficacy; design; end of life; flexibility; follow-up; improved; innovation; novel; optimism; palliative; post intervention; prognostic; psychologic; psychological distress; psychosocial; public health priorities; public health relevance; response; treatment as usual; trial comparing

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 patients, both by our research group and others, demonstrating the central role of spiritual well being, and sense of "meaning" in particular, in buffering against depression, hopelessness, and desire for hastened death. We have developed, manualized, and pilot-tested just such a novel intervention we call Meaning-Centered Psychotherapy (MCP). MCP, pilot-tested in both an 8-week group format and a 7-session individual format, is based on the principles of Viktor Frankl's work, and is designed to help patients with advanced cancer sustain or enhance a sense of meaning as they approach the end-of-life. Preliminary findings from our pilot randomized controlled trials demonstrate both the group and Individual formats of MCP significantly reduce psychological distress (e.g., depression, hopelessness, anxiety, and desire for hastened death), and significantly increase spiritual well-being and a sense of meaning and purpose in life in advanced cancer patients. However, the individual format of MCP has distinct advantages over the group format, particularly in a palliative care setting, in terms of practicality, flexibility of scheduling, significantly lower attrition and higher rates of delivery of the full dose of treatment. The overall aim of this project is to conduct a randomized controlled trial of the efficacy of an innovative individual psychotherapy intervention for advanced cancer patients. Specifically, we will compare Individual Meaning-Centered Psychotherapy (IMCP) to both a standardized Individual Supportive Psychotherapy (ISP) as well as enhanced usual care (EUC) in order to examine the efficacy of IMCP in enhancing spiritual well-being and quality of life and in reducing psychological distress and end-of-life despair (e.g., hopelessness, desire for hastened death). Specifically, we will compare Individual Meaning-Centered Psychotherapy (IMCP) to both a standardized Individual Supportive Psychotherapy (ISP) as well as enhanced usual care (EUC) in order to examine the efficacy of IMCP in enhancing spiritual well-being and quality of life and in reducing psychological distress and end-of-life despair. 415 advanced cancer patients, with Stage IV solid tumors and Distress Thermometer scores > 4, will be randomized to receive either IMCP, ISP, or EUC (138 patients randomized to each arm, anticipating an attrition rate of 35% would thus leave 90 patients per arm, or 270 patients, who complete the entire trial). In addition, we will examine variables that may moderate and mediate the effects of IMCP as well as the relative impact of IMCP on different aspects of spiritual well-being and meaning. Participants will be assessed with a battery of self-report measures at baseline/pre-intervention, mid-intervention, post-intervention, and at 2-month follow-up. This study will provide essential efficacy data on an innovative, 7-session, individual psychotherapy intervention for patients with advanced cancer, incorporating spiritual (meaning-centered) elements, which holds promise in the treatment of suffering at the end-of-life. PUBLIC HEALTH RELEVANCE: The improvement of palliative and end-of-life care is a public health priority. Specifically, the World Health Organization and the Institute of Medicine have both emphasized the importance of addressing the psychosocial, existential, and spiritual domains of palliative care, including needs related to maintaining a sense of meaning, purpose, and hope in the face of advancing cancer and approaching death. There is a compelling need for the development of novel and innovative psychotherapeutic interventions for advanced cancer patients to ameliorate existential and spiritual suffering, end-of-life despair, hopelessness and loss of meaning that is commonly encountered in the clinical setting. This project will have high positive impact because it will provide essential efficacy data on an innovative, 7-session, meaning-centered individual psychotherapy intervention for patients with advanced cancer, which holds great promise in the treatment of suffering at the end-of-life.

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。我们的研究小组和其他人最近对绝症癌症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，对“意义”的感觉。我们已经开发了一种被称为以意义为中心的心理治疗(MCP)的新型干预措施，并将其人性化，并进行了试点测试。MCP在8周的小组模式和7次个人模式下进行了试点测试，基于Viktor Frankl的工作原理，旨在帮助晚期癌症患者在生命即将结束时维持或增强他们的意义。我们的试点随机对照试验的初步结果表明，小组和个人形式的MCP显著减少了晚期癌症患者的心理痛苦(例如，抑郁、绝望、焦虑和加速死亡的欲望)，并显著增加了精神幸福感以及对生活的意义和使命感。然而，个人形式的MCP在实用性、调度的灵活性、显著降低的消耗量和更高的全量治疗的递送率方面具有明显的优势，特别是在姑息治疗环境中。这个项目的总体目标是对晚期癌症患者进行一项创新的个体化心理治疗干预的有效性的随机对照试验。具体地说，我们将把以个人意义为中心的心理治疗(IMCP)与标准化的个人支持性心理治疗(ISP)以及增强型日常护理(EUC)进行比较，以检验IMCP在提高精神福祉和生活质量以及减少心理痛苦和临终绝望(例如，绝望、加速死亡的欲望)方面的有效性。具体地说，我们将把以个人意义为中心的心理治疗(IMCP)与标准化的个人支持性心理治疗(ISP)以及增强型日常护理(EUC)进行比较，以检验IMCP在提高精神福祉和生活质量、减少心理痛苦和临终绝望方面的有效性。415名具有IV期实体瘤和危难温度计评分&gt；4的晚期癌症患者将被随机分为IMCP、ISP或EUC接受治疗(138名患者随机分配到每支手臂，预计磨损率为35%，因此每支手臂有90名患者，或270名患者，他们完成了整个试验)。此外，我们将考察可能调节IMCP效果的变量，以及IMCP对精神幸福和意义的不同方面的相对影响。参与者将在基线/干预前、干预中期、干预后和2个月的随访时接受一系列自我报告测量。这项研究将为晚期癌症患者提供创新的、7个疗程的个体化心理治疗干预的基本疗效数据，纳入精神(以意义为中心)元素，这有望在治疗生命末期的痛苦中发挥作用。 公共卫生相关性：改善姑息和临终关怀是公共卫生的优先事项。具体地说，世界卫生组织和医学研究所都强调了解决姑息治疗的心理社会、生存和精神领域的重要性，包括在癌症进展和濒临死亡的情况下保持意义、目的和希望的相关需求。迫切需要为晚期癌症患者开发新颖和创新的心理治疗干预措施，以改善临床环境中常见的生存和精神痛苦、临终绝望、绝望和意义丧失。该项目将产生很高的积极影响，因为它将为晚期癌症患者提供创新的、7个疗程的、以意义为中心的个人心理治疗干预的基本疗效数据，这在治疗临终痛苦方面前景广阔。