Meaning-Centered Group Psychotherapy in Advanced Cancer

灵性及其在临终关怀中的作用已经成为姑息关怀的中心问题。曾经有过 我们的研究小组最近对晚期癌症和艾滋病患者进行的几项研究表明 精神上的幸福，特别是“意义”，在缓解抑郁、绝望、 以及对加速死亡的渴望。我们已经开发、手册并试行了为期8周的以意义为中心的 团体心理治疗，旨在帮助晚期癌症患者维持或增强 意义、和平、目标、精神幸福和希望，因为他们即将走到生命的尽头。初步 基于R21拨款的研究结果表明，我们以意义为中心的干预显著减少 心理上的痛苦和欲望加速了死亡，并显著增加了精神上的幸福感和 晚期癌症患者对生活意义和目标的感悟。这个项目的总体目标是 对这种新的、独特的精神心理疗法的疗效进行随机对照试验 晚期癌症患者提高心理健康和生活质量的干预 生活。具体地说，我们将检验以意义为中心的团体心理治疗的有效性，与 标准化支持性团体心理治疗，提高精神健康和生活质量，以及 减少心理痛苦(焦虑和抑郁)和临终绝望(概念为 绝望、加速死亡的欲望和自杀的念头)。此外，我们还将检查临床和 可能调节或缓和意义中心型群体治疗反应的人口统计学变量 心理治疗在这一人群中。320名IV期实体瘤癌症患者将被随机分配到 接受这两种干预措施中的一种(160名患者被随机分配到每一组，预计磨损率为 因此，40%的患者每只手臂有96名患者完成整个试验)。受试者将通过一个 3个时间点的一整套自我报告测量：基线/干预前、干预后和2个月 干预后随访。本研究将为新药开发提供必要的药效数据 晚期癌症患者的心理治疗干预，纳入精神(以意义为中心) 元素，这在治疗临终精神痛苦方面大有可为

Spirituality and it's 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 one of these two 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