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治疗的核心问题。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“意义”，在缓解抑郁、绝望和加速死亡的欲望方面。我们已经开发、指导并试行了一项为期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在接近生命终点时维持或增强意义、和平、目标、精神健康和希望。基于R21基金的初步研究结果表明，我们以意义为中心的干预显著减少了晚期癌症患者的心理痛苦和加速死亡的愿望，并显著提高了精神幸福感和生活的意义和目的感。该项目的总体目标是进行一项随机对照试验，以验证这种新的、独特的以精神为基础的心理治疗干预对晚期癌症患者在提高心理和精神健康以及生活质量方面的疗效。具体来说，我们将检验以意义为中心的团体心理治疗的有效性，与标准化的支持性团体心理治疗相比，在提高精神健康和生活质量，减少心理困扰（焦虑和抑郁）和临终绝望（概念为绝望，渴望加速死亡和自杀意念）方面。此外，我们将检查临床和人口变量，可能调解或缓和治疗反应的意义为中心的群体心理治疗在这一人群。320名IV期实体瘤癌症患者将被随机分配接受这两种干预措施中的一种（160名患者随机分配到每组，预计损耗率为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个月随访时，通过一系列自我报告测量在3点进行评估。本研究将为晚期癌症患者提供一种新颖创新的心理治疗干预方法的基本疗效数据，该方法结合了精神（以意义为中心）元素，在治疗临终精神痛苦方面具有很大的前景。

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.