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: 8509614
• 负责人: William Breitbart
• 金额: $ 18.56万
• 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 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8509614
• 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 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.

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治疗的核心问题。最近，我们的研究小组和其他人对癌症晚期患者进行了几项研究，证明了精神健康，特别是“意义”感，在缓解抑郁、绝望和加速死亡的欲望方面的核心作用。我们已经开发了一种新的干预方法，我们称之为以意义为中心的心理治疗（MCP）。MCP以8周的小组形式和7期的个人形式进行了试点测试，它基于维克多·弗兰克尔的工作原理，旨在帮助晚期癌症患者在接近生命终点时维持或增强他们的意义感。我们的试点随机对照试验的初步结果表明，群体和个人形式的MCP都能显著减少心理困扰（例如，抑郁、绝望、焦虑和加速死亡的欲望），并显著增加晚期癌症患者的精神幸福感和生活的意义和目的感。然而，MCP的个体形式比群体形式具有明显的优势，特别是在姑息治疗环境中，在实用性、安排灵活性、明显降低的损耗率和更高的全剂量治疗递送率方面。该项目的总体目标是进行一项随机对照试验，研究一种创新的个体心理治疗干预对晚期癌症患者的疗效。具体而言，我们将比较个体意义中心心理治疗（IMCP）与标准化的个体支持性心理治疗（ISP）以及强化常规护理（EUC），以检验IMCP在提高精神健康和生活质量以及减少心理困扰和临终绝望（例如，绝望，渴望加速死亡）方面的功效。具体而言，我们将比较个体意义中心心理治疗（IMCP）与标准化的个体支持性心理治疗（ISP）以及强化常规护理（EUC），以检验IMCP在提高精神健康和生活质量以及减少心理困扰和临终绝望方面的功效。415名患有IV期实体瘤且Distress温度计评分为bbbb4的晚期癌症患者将被随机分配接受IMCP、ISP或EUC（每组138名患者随机分配，预计损耗率为35%，因此每组有90名患者，或270名患者完成整个试验）。此外，我们将研究可能调节和调节IMCP影响的变量，以及IMCP对精神幸福感和意义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一种创新的、7期的个体心理治疗干预的基本疗效数据，其中包括精神（以意义为中心）元素，这对治疗生命末期的痛苦有希望。