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: 8725598
• 负责人: William Breitbart
• 金额: $ 61.7万
• 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/8725598
• 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。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，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、手动化并进行了试点测试这样一种新颖的干预措施，我们称之为以意义为中心的心理治疗（MCP）。 MCP 以为期 8 周的团体形式和为期 7 次的个人形式进行了试点测试，以 Viktor Frankl 的工作原理为基础，旨在帮助晚期癌症患者在接近生命终结时维持或增强意义感。我们的试点随机对照试验的初步结果表明，MCP 的团体和个人形式均可显着减少晚期癌症患者的心理困扰（例如抑郁、绝望、焦虑和加速死亡的欲望），并显着增加精神健康以及生活的意义和目的感。然而，MCP 的个体形式比团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、时间安排的灵活性、显着较低的损耗和较高的全剂量治疗交付率方面。该项目的总体目标是针对晚期癌症患者创新的个体心理治疗干预的功效进行随机对照试验。具体来说，我们将把个人意义中心心理治疗 (IMCP) 与标准化个人支持性心理治疗 (ISP) 以及强化常规护理 (EUC) 进行比较，以检验 IMCP 在增强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。具体来说，我们将把个人意义中心心理治疗（IMCP）与标准化的个人支持性心理治疗（ISP）以及强化常规护理（EUC）进行比较，以检验 IMCP 在增强精神福祉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 期实体瘤且应激温度计评分 > 4 的晚期癌症患者将被随机分配接受 IMCP、ISP 或 EUC（每组 138 名患者被随机分配，预计 35% 的流失率将导致每组留下 90 名患者，即 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 对精神福祉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、干预后以及 2 个月随访时接受一系列自我报告措施的评估。这项研究将为晚期癌症患者提供创新的、为期 7 个疗程的个体心理治疗干预的基本疗效数据，其中融入精神（以意义为中心）元素，这有望治疗临终痛苦。