Skip to main content Accessibility help

Meaning and Purpose (MaP) therapy II: Feasibility and acceptability from a pilot study in advanced cancer

  • David W. Kissane (a1) (a2) (a3), Carrie Lethborg (a2) (a4), Joanne Brooker (a1) (a2), Courtney Hempton (a1) (a2), Sue Burney (a1) (a5), Natasha Michael (a3) (a6), Margaret Staples (a1), Tanya Osicka (a1), Merlina Sulistio (a3), Jeremy Shapiro (a7) and Hilary Hiscock (a2)...



Meaning and Purpose (MaP) therapy aims to enhance meaning-based coping through a life review that focuses on the value and worth of the person, key relationships, sources of fulfillment, roles, and future priorities in living life out fully. We sought to test the feasibility and acceptability of a six-session model of MaP therapy against a wait-list control cohort in a pilot study seeking effect sizes on measures of adaptation.


We randomized patients with advanced cancer to MaP therapy or wait-list control, with measures administered at baseline and after 6–8 weeks. Wait-list patients could then crossover to receive therapy, with further measures collected postintervention. Adherence to the manualized model was sustained through weekly supervision and fidelity coding of recorded sessions. We used generalized estimating equations to control for baseline and any correlation of data.


From 134 eligible participants, 57 (43%) consented, and 40 of 45 (89%) offered therapy completed 6 sessions. Key barriers to consenting patients were poor health (15 refusers and 4 withdrawals) and death intervened in 6 participants. MaP therapy generated adequate effect sizes in posttraumatic growth (new possibilities, appreciation of life, and personal strength) and life attitudes (choices and goal seeking) to permit calculation of power for a formal randomized, controlled trial.

Significance of results

Delivery of this model of existentially oriented therapy is feasible and acceptable to patients. A properly powered randomized controlled trial is justified to examine the efficacy of this intervention.


Corresponding author

Author for correspondence: David W. Kissane, AC, MD, MPM, FRANZCP, FAChPM, FACLP, Department of Psychiatry, Monash University, Block P, Level 3, Monash Medical Centre, 246 Clayton Road, Clayton, VIC 3168, Australia. E-mail:


Hide All
Breitbart, WS and Poppito, SR (2014) Meaning-centered Group Psychotherapy for Patients with Advanced Cancer. New York: Oxford University Press.
Breitbart, WS, Rosenfeld, B, Pessin, H, et al. (2015) Meaning-centered group psychotherapy: An effective intervention for improving psychological well-being in patients with advanced cancer. Journal of Clinical Oncology 33(7), 749754. doi: 10.1200/JCO.2014.57.2198
Caruso, R (2014) The experience of cancer in advanced phases of illness: Italian CALM Project. Psycho-Oncology 23, 2627.
Chochinov, HM (2002) Dignity-conserving care - a new model for palliative care: helping the patient feel valued. Journal of the American Medical Association 287(17), 22532260.
Chochinov, HM, Kristjanson, LJ, Breitbart, WS, et al. (2011) Effect of dignity therapy on distress and end-of-life experience in terminally ill patients: A randomised controlled trial. Lancet Oncology 12(8), 753762. doi: 10.1016/S1470-2045(11)70153-X
Derogatis, L (2000). Brief Symptom Inventory 18. Minneapolis, MN: National Computer Systems Inc.
Derogatis, L and Melisaratos, N (1983) The Brief Symptom Inventory. Psychological Medicine 13, 595605.
Folkman, S and Moskowitz, JT (2000) Positive affect and the other side of coping. The American Psychologist 55(6), 647654.
Frankl, V (1963). Man's search for meaning: An introduction to logotherapy, 6th ed. New York: Washington Square Press.
Kissane, DW, Grabsch, B, Clarke, DM, et al. (2007) Supportive-expressive group therapy for women with metastatic breast cancer: Survival and psychosocial outcome from a randomized controlled trial. Psychooncology 16(4), 277286.
Lethborg, C, Aranda, S, Bloch, S, et al. (2006) The role of meaning in advanced cancer-integrating the constructs of assumptive world, sense of coherence and meaning-based coping. Journal of Psychosocial Oncology 24(1), 2742. doi: 10.1300/J077v24n01_03
Lethborg, C, Aranda, S, Cox, S, et al. (2007) To what extent does meaning mediate adaptation to cancer? The relationship between physical suffering, meaning in life, and connection to others in adjustment to cancer. Palliative & Supportive Care 5(4), 377388.
Lethborg, C, Schofield, P, Kissane, DW (2012) The advanced cancer patient experience of undertaking meaning and purpose (MaP) therapy. Palliative & Supportive Care 10(3), 177188. doi: 10.1017/S147895151100085X
Lethborg, C, Schofield, P, Kissane, DW (2018) Meaning and Purpose (MaP) Therapy I: Therapeutic processes and paradox in how it helps people with advanced cancer. Palliative and Supportive Care. Pax-OA-2017-0211-R2.
Lo, C, Hales, S, Chiu, A, et al. (2016) Managing Cancer And Living Meaningfully (CALM): Randomised feasibility trial in patients with advanced cancer. BMJ Supportive and Palliative Care. Epub ahead of print Jan 19, 2016. doi: 10.1136/bmjspcare-2015-000866
Lo, C, Hales, S, Jung, J, et al. (2014) Managing Cancer and Living Meaningfully (CALM): Phase 2 trial of a brief individual psychotherapy for patients with advanced cancer. Palliative Medicine 28(3), 234242. doi: 10.1177/0269216313507757
Lo, C, Hales, S, Rydall, A, et al. (2015) Managing Cancer and Living Meaningfully: Study protocol for a randomized controlled trial. Trials 16, 391. doi: 10.1186/s13063-015-0811-1.
Reker, GT and Peacock, EJ (1981) The Life Attitude Profile (LAP): A multidimensional instrument for assessing attitudes toward life. Canadian Journal of Behavioral Science 13, 264273.
Reker, GT (2001) Life Attitude Profile - Revised, Manual, Student Psychologists Press, Peterborough, Ontario, Canada, 2001, 13 (Vol. 13). Peterborough, Ontario: Student Psychologists Press.
Robinson, S, Kissane, DW, Brooker, J, et al. (2016a) Refinement and revalidation of the Demoralization Scale: The DS-II - External Validity. Cancer 122, 22602267. doi: doi/10.1002/cncr.30012/pdf
Robinson, S, Kissane, DW, Brooker, J, et al. (2016b). Refinement and revalidation of the Demoralization Scale: The DS-II - Internal Validity. Cancer 122, 22512259. doi: 10.1002/cncr.30015
Ronaldson, S, Adamson, J, Dyson, L, et al. (2014) Waiting list randomized controlled trial within a case-finding design: Methodological considerations. Journal of Evaluation in Clinical Practice 20(5), 601605. doi: 10.1111/jep.12161
Spiegel, D (1993) Living beyond limits: New hope and help for facing life-threatening illness. New York: Times Books.
Spiegel, D and Classen, C (2000) Group therapy for cancer patients: A research-based handbook of psychosocial care. New York: Basic Books.
StataCorp (2015) Statistical Software: Release 14.
Stefanek, ME, Derogatis, LP, and Shaw, A (1987) Psychological distress among oncology outpatients. Prevalence and severity as measured with the Brief Symptom Inventory. Psychosomatics 28(10), 530532.
Tedeschi, RG and Calhoun, LG (1996) The posttraumatic growth inventory: Measuring the positive legacy of trauma. Journal of Traumatic Stress 9(3), 455471.
Yalom, ID (1980) Existential psychotherapy. New York: Basic Books.
Zabora, JR, Smith-Wilson, R, Fetting, JH, et al. (1990) An efficient method for psychosocial screening of cancer patients. Psychosomatics 31(2), 192196.



Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed