Spirituality and meaning in supportive care: spirituality- and meaning-centered group psychotherapy interventions in advanced cancer

Abstract

Existential and spiritual issues are at the frontier of new clinical and research focus in palliative and supportive care of cancer patients. As concepts of adequate supportive care expand beyond a focus on pain and physical symptom control, existential and spiritual issues such as meaning, hope and spirituality in general have received increased attention from supportive care clinicians and clinical researchers. This paper reviews the topics of spirituality and end-of-life care, defines spirituality, and suggests measures of spirituality that deal with two of its main components: faith/religious beliefs and meaning/spiritual well-being. These two constructs of spirituality are reviewed in terms of their role in supportive care. Finally, a review of existing psychotherapeutic interventions for spiritual suffering are reviewed and a novel meaning-centered group psychotherapy for advanced cancer patients is described.

Symptom Burden, Depression, and Spiritual Well-Being: A Comparison of Heart Failure and Advanced Cancer Patients

“…29 Several interventions that have been tested primarily in patients who have advanced cancer enhance spiritual-well being, including dignity therapy 66 and meaning-centered psychotherapy. 67 These interventions should be evaluated in patients with heart failure, particularly those with poor heart-failure specific health status, given our finding that heart failure patients with poor heart failure-specific health status had lower spiritual wellbeing than patients with advanced cancer. In summary, patients with symptomatic heart failure and advanced cancer had a similar burden of symptoms, depression, and low spiritual well-being.…”

Dying, Dignity, and New Horizons in Palliative End-of-Life Care

“…87 These group therapy approaches primarily fall within the categories of patient education, supportive-expressive interventions that encourage the expression of feelings toward illness and changing life circumstances, and cognitive-behavioral interventions. As Breitbart notes, however, few cancer group psychotherapy intervention trials have focused specifically on existential or spiritual themes.…”

“…Spira and Breitbart 35,92,93 address spiritual suffering in ambulatory advanced cancer patients with meaning-centered group psychotherapy. This therapeutic approach is based on the work of existential psychotherapist Viktor Frankl.…”

Effects of Perception of Prognosis on Existential Well-Being and Ego-Integrity Among Advanced Cancer Patients

“…11,35,36 Existential quest is without any doubt an intrinsic, introspective process, and as noted, tends to intensify related lifethreatening situations. The individual's perception of prognosis is in a way a measurable estimate of that subjective sense of threat.…”

“…37 It is one of the main existential issues of which a person deals with at some point in life, especially towards their end. 29,36,37 Despite the sense of threat to life, meaning provides people the motivation to engage in life alongside with the physical, psychosocial, spiritual, and existential changes imposed by the illness. 38 Due to its dynamic characteristic, it assists the person in transcending suffering and restoring sense of coherence.…”