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Meaning-centered group psychotherapy in Portuguese cancer patients: A pilot exploratory trial

Published online by Cambridge University Press:  27 May 2021

Guida da Ponte Open the ORCID record for Guida da Ponte [Opens in a new window] ,
Sílvia Ouakinin ,
Jorge Espírito Santo ,
Afolabi Ohunakin ,
Domingos Prata ,
Inês Amorim ,
Zita Gameiro ,
Estêvão Soares dos Santos  and
William Breitbart
Guida da Ponte*
Affiliation:
Department of Psychiatry and Mental Health, Centro Hospitalar Barreiro-Montijo, EPE, Barreiro, Portugal Medical School of Lisbon, University of Lisbon, Lisbon, Portugal
Sílvia Ouakinin
Affiliation:
University Clinic of Medical Psychology and Psychiatry, Medical School of Lisbon, University of Lisbon, Lisbon, Portugal
Jorge Espírito Santo
Affiliation:
Oncology Unit, Centro Hospitalar Barreiro-Montijo, EPE, Barreiro, Portugal
Afolabi Ohunakin
Affiliation:
Department of Family Medicine, Ekiti State University Teaching Hospital, Ado-ekiti, Nigeria
Domingos Prata
Affiliation:
Faculty of Economics, University of Algarve, Faro, Portugal
Inês Amorim
Affiliation:
Algarve Cancer Association, Faro, Portugal
Zita Gameiro
Affiliation:
Department of Psychiatry and Mental Health, Centro Hospitalar Barreiro-Montijo, EPE, Barreiro, Portugal
Estêvão Soares dos Santos
Affiliation:
Public Health Center, Leiria, Portugal
William Breitbart
Affiliation:
Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
*
Author for correspondence: Guida da Ponte, Department of Psychiatry and Mental Health, Centro Hospitalar Barreiro-Montijo, EPE, Barreiro, Portugal; Medical School of Lisbon, University of Lisbon, Lisbon, Portugal. E-mail: guidadaponte@gmail.com
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Abstract

Objective

To describe the feasibility of a meaning-centered group psychotherapy (MCGP) adaptation in a sample of Portuguese cancer patients.

Method

The study was carried out according to four steps: 1st — Transcultural adaptation and validation (focus groups); 2nd — Preliminary study with MCGP original version (to test its feasibility); 3rd — Adaptation of MCGP original version to a 4-session version (and internal pilot study); and 4th — Pilot exploratory trial (MCGP-4 session version), implemented between January 1, 2018 and December 31, 2019. Inclusion criteria were >18 years, psychological complaints, and difficulty to adapt to cancer. Allocation was according to participants’ preference: MCGP vs. care as usual (CAU). Primary outcomes were: MCGP adapted version improved quality of life (QoL) and spiritual well-being; secondary outcomes were improvement of depression, anxiety, and distress. Assessments were done at baseline (T1) and 1 month after (T2), with self-report socio-demographic and clinical questionnaires, Distress Thermometer (DT), McGill Quality of Life Questionnaire (MQOL), Functional Assessment of Chronic Illness Therapy — Spiritual Well-Being Scale (FACIT-Sp-12), Hospital Anxiety and Depression Scale, and its subscales (HADS — HADS-D, HADS-A).

Results

In the 1st step, and through focus groups, the manual was reformulated and tested. The preliminary study (2nd step) with MCGP original version showed a high number of dropouts which could jeopardize the study and, after reframing the sessions content, MCGP was adapted to a 4-session version, and its feasibility was tested by an internal pilot study (3rd step). The pilot exploratory trial (4th step) had 91 participants. Most socio-demographic and clinical characteristics between the groups (51: MCGP; 40: CAU) had no statistically significant differences. A comparison between the two groups at T2 showed that the MCGP group scored significantly higher in the general (U = 552.00, P < 0.001), and existential (U = 727.50, P = 0.018) domains and total score (U = 717.50, P = 0.015) of QoL, and CAU presented statistical higher levels in DT (U = 608.50, P = 0.001). Comparing the groups between T1 and T2, the MCGP group had a statistically significant improvement in the general (Z = −3.67, P < 0.001) and psychosocial (Z = −2.89, P = 0.004) domains and total score (Z = −2.71, P = 0.007) of QoL, and a statistically significant decrease in DT (Z = −2.40, P = 0.016). In terms of group effects, the MCGP group presented increased general (b = 1.42, P < 0.001, η2p = 0.179), and support (b = 0.80, P = 0.045, η2p = 0.048) domains and total score (b = 0.81, P = 0.013, η2p = 0.073) of QoL (small to elevated dimensions), and decreased levels of depression (b = −1.14, P = 0.044, η2p = 0.048), and distress (b = −1.38, P = 0.001, η2p = 0.127) (small to medium dimensions), compared with CAU. At T2, participants who attended ≥3 sessions (n = 38) had a statistically significant higher score in the general domain (U = 130.50, P = 0.009) of QoL, comparing with those who attended 1 or 2 sessions (n = 13).

Significance of results

This study supports the benefits of an MCGP adapted version in improving QoL and psychologic well-being. More studies are necessary to address the limitations of this pilot exploratory trial, as its small sample size.

Keywords

CancerMeaning-centered group psychotherapy adaptationPortugueseQuality-of-life benefits
Type
Original Article
Information
Palliative & Supportive Care , Volume 19 , Issue 4 , August 2021 , pp. 464 - 473
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Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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References

Applebaum, AJ, Lichtenthal, WG, Pessin, HA, et al. (2012) Factors associated with attrition from a randomized controlled trial of meaning-centered group psychotherapy for patients with advanced cancer. Psycho-Oncology 21(11), 1195–1204.CrossRefGoogle ScholarPubMed
Applebaum, AJ, Kulikowski, JR and Breitbart, W (2015) Meaning-centered psychotherapy for cancer caregivers (MCP-C): Rationale and overview. Palliative and Supportive Care 13(6), 1631–1641.CrossRefGoogle ScholarPubMed
Breitbart, W (2000) Spirituality and meaning in supportive care: Spirituality and meaning-centered group psychotherapy intervention in advanced cancer. Supportive Care in Cancer 10, 272–278.CrossRefGoogle Scholar
Breitbart, W (2002) Spirituality and meaning in supportive care: Spirituality- and meaning-centered group psychotherapy interventions in advanced cancer. Supportive Care in Cancer 10(4), 272–280.CrossRefGoogle ScholarPubMed
Breitbart, W and Alici, Y (2014) Psychosocial Palliative Care. New York: Oxford University Press.CrossRefGoogle Scholar
Breitbart, W and Poppito, SR (2014) Meaning Centered Group Psychotherapy for Patients with Advanced Cancer. New York: Oxford University Press.Google Scholar
Breitbart, W, Rosenfeld, B, Gibson, C, et al. (2010) Meaning-centered group psychotherapy for patients with advanced cancer: A pilot randomized controlled trial. Psycho-Oncology 19(1), 21–28.CrossRefGoogle ScholarPubMed
Breitbart, W, Poppito, S, Rosenfeld, B, et al. (2012) Pilot randomized controlled trial of individual meaning-centered psychotherapy for patients With advanced cancer. Journal of Clinical Oncology 30(12), 1304–1309.CrossRefGoogle ScholarPubMed
Breitbart, W, 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), 749–754.CrossRefGoogle ScholarPubMed
Breitbart, W, Pessin, H, Rosenfeld, B, et al. (2018) Individual meaning-centered psychotherapy for the treatment of psychological and existential distress: A randomized controlled trial in patients with advanced cancer. Cancer 124(15), 3231–3239.CrossRefGoogle ScholarPubMed
Chochinov, HM, Hack, T, Hassard, T, et al. (2005) Understanding the will to live in patients nearing death. Psychosomatics 46, 7–10.CrossRefGoogle Scholar
Chochinov, HM, Kristjanson, LJ, Breitbart, W, et al. (2011) Effect of dignity therapy on distress and end-of-life experience in terminally ill patients: A randomised controlled trial. The Lancet Oncology 12(8), 753–762.CrossRefGoogle ScholarPubMed
Classen, C, Butler, LD, Koopman, C, et al. (2001) Supportive-expressive group therapy and distress in patients with metastatic breast cancer: A randomized clinical intervention trial. Archives of General Psychiatry 58, 494–501.CrossRefGoogle ScholarPubMed
Cohen, SR, Mount, BM, Bruera, E, et al. (1997) Validity of the McGill quality of life questionnaire in the palliative care setting: A multi-centre Canadian study demonstrating the importance of the existential domain. Palliative Medicine 11(1), 3–20.CrossRefGoogle ScholarPubMed
Conway, CC, Forbes, MK, Forbush, KT, et al. (2019) A hierarchical taxonomy of psychopathology can transform mental health research. Perspectives on Psychological Science 14(3), 419–436.CrossRefGoogle ScholarPubMed
Croy, P (2010) An Investigation of the Outcomes of Psycho-Oncology Interventions. New Zealand: Massey University.Google Scholar
Da Ponte, G, Ouakinin, S, Breitbart, W (2017) Adaptation of meaning centered psychotherapy to Portuguese language. Publication Manual of the America Psychosomatic Society, A27.Google Scholar
Deeks, J, Dinnes, J, D'Amico, R, et al. (2003) Evaluating non-randomised intervention studies. Health Technology Assessment 7(27), 1–173.CrossRefGoogle ScholarPubMed
Duarte, AC, Querido, AI and Dixe, MA (2010) Validação trancultural da “McGill quality of life questionnaire”- Qualidade de vida dos doentes em cuidados paliativos. International Journal of Developmental and Educational Psychology 4(1), 437–448.Google Scholar
Edelman, S, Bell, DR and Kidman, AD (1999) A group cognitive therapy programme with metastatic breast cancer patients. Psycho-Oncology 8, 295–305.3.0.CO;2-Y>CrossRefGoogle ScholarPubMed
Edmonds, CV, Lockwood, GA and Cunningham, AJ (1999) Psychological response to long-term group therapy: A randomized trial with metastatic breast cancer patients. Psycho-Oncology 8, 74–91.3.0.CO;2-K>CrossRefGoogle ScholarPubMed
Epstein, J, Santo, RM and Guillemin, F (2015) A review of guidelines for cross-cultural adaptation of questionnaires could not bring out a consensus. Journal of Clinical Epidemiology 68(4), 435–441.CrossRefGoogle Scholar
FACIT Group (2011) FACIT Functional Assessment of Chronic Illness Therapy. Available at: www.facit.org (retrieved October 11, 2014).Google Scholar
Field, MJ and Cassel, CK (1997). Approaching Death: Improving Care at the End of Life. Washington, DC: National Academies Press.Google Scholar
Goes, PS (2007) Validação de Instrumentos de Pesquisa. Available at: https://docs.ufpr.br/~niveam/micro da sala/aulas/tecnicas_de_pesquisa/validação_odonto.pdf (retrieved July 8, 2014).Google Scholar
Greenstein, M and Breitbart, W (2000) Cancer and the experience of meaning: A group psychotherapy program for people with cancer. American Journal of Psychotherapy 54, 486–500.CrossRefGoogle ScholarPubMed
Hambleton, RK and Patsula, L (1990) Increasing the validity of adapted tests: Myths to be avoided and guidelines for improving test adaptation practices. Journal of Applied Testing Technology 1(1), 1–30.Google Scholar
Julião, M (2014). Eficácia da Terapia da Dignidade no Sofrimento Psicossocial de Doentes em Fim de Vida Seguidos em Cuidados Paliativos - Ensaio Clínico Aleatorizado e Controladp. Universidade de Lisboa.Google Scholar
Kissane, DW, Bloch, S, Smith, GC, et al. (2003) Cognitive-existential group psychotherapy for women with primary breast cancer: A randomised controlled trial. Psycho-Oncology 12(6), 532–546.CrossRefGoogle ScholarPubMed
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. Psycho-Oncology 1(16), 277–286.CrossRefGoogle Scholar
Kotov, R, Waszczuk, MA, Krueger, RF, et al. (2017) The hierarchical taxonomy of psychopathology (HiTOP): A dimensional alternative to traditional nosologies. Journal of Abnormal Psychology 126(4), 454–477.CrossRefGoogle ScholarPubMed
Lee, V, Cohen, SR, Edgar, L, et al. (2006) Meaning-making intervention during breast or colorectal cancer treatment improves self-esteem, optimism, and self-efficacy. Social Science & Medicine 62, 3133–3145.CrossRefGoogle ScholarPubMed
Lichtenthal, WG, Corner, GW, Sweeney, CR, et al. (2015) Mental health services for parents who lost a child to cancer: If we build them, will they come? Journal of Clinical Oncology 33(20), 2246–2253.CrossRefGoogle ScholarPubMed
McFarland, DC, Walsh, L, Napolitano, S, Morita, J, et al. (2019). Suicide in patients with cancer: Identifying the risk factors. Retrieved June 30, 2020, from https://www.cancernetwork.com/view/suicide-patients-cancer-identifying-risk-factors.Google Scholar
Medeiros, R, Júnior, M, Pinto, D, et al. (2015) Modelo de validação de conteúdo de Pasquali nas pesquisas em Enfermagem. Revista de Enfermagem Referência 4, 127–135.CrossRefGoogle Scholar
Moyer, A, Sohl, SJ, Knapp-Oliver, SK, et al. (2009) Characteristics and methodological quality of 25 years of research investigating psychosocial interventions for cancer patients. Cancer Treatment Reviews 35(5), 475–484.CrossRefGoogle ScholarPubMed
MSKKC (2016) Meaning Centered Psychotherapy Web Portal. Available at: https://mskcc.cloud-cme.com/ (retrieved February 13, 2017).Google Scholar
National Comprehensive Cancer Network (2017) Distress management - NCCN guidelines. Available at: https://www.nccn.org/patients/guidelines/distress/files/assets/basic-html/page-1.html# (retrieved December 21, 2019).Google Scholar
Ouakinin, S, Eusebio, S, Torrado, M, et al. (2015) Stress reactivity, distress and attachment in newly diagnosed breast cancer patients. Health Psychology and Behavioral Medicine 3(1), 424–438.CrossRefGoogle Scholar
Pais-Ribeiro, J, Silva, I, Ferreira, T, et al. (2007) Validation study of a Portuguese version of the hospital anxiety and depression scale. Psychology Health & Medicine 12(2), 225–235.CrossRefGoogle ScholarPubMed
Pasquali, L (2009) Psicometria. Revista da Escola de Enfermagem da USP 43, 992–999.CrossRefGoogle Scholar
Pereira, F and Santos, C (2011) Adaptação cultural da functional assessment of chronic illness therapy-spiritual well-being (FACIT-Sp): estudo de validação em doentes oncológicos na fase final de fim de vida. Cadernos de Saúde 2(4), 37–45.Google Scholar
Puchalski, CM (2013) Integrating spirituality into patient care: An essential element of person-centered care. Polskie Archiwum Medycyny Wewnętrznej 123(9), 491–497.Google Scholar
Rosenfeld, B, Saracino, R, Tobias, K, et al. (2017) Adapting meaning-centered psychotherapy for the palliative care setting: Results of a pilot study. Palliative Medicine 31(2), 140–146.CrossRefGoogle ScholarPubMed
Sinclair, S, Pereira, J and Raffin, S (2006) A thematic review of the spirituality literature within palliative care. Journal of Palliative Medicine 9, 464–479.CrossRefGoogle ScholarPubMed
Spiegel, DYI (1978) A support group for dying patients. Int J Group Psychother 28(2), 233–245.CrossRefGoogle ScholarPubMed
Spiegel, D, Bloom, JR and Yalom, I (1981) Group support for patients with metastatic cancer: A randomized outcome study. Archives of General Psychiatry 38, 527–533.CrossRefGoogle ScholarPubMed
Swaine-Verdier, A, Doward, LC, Hagell, P, et al. (2004) Adapting quality of life instruments. Value in Health 7(1), 27–30.CrossRefGoogle ScholarPubMed
Teixeira, J (2006) Introdução à psicoterapia existencial. Análise Psicológica 3, 289–309.Google Scholar
van der Spek, N, Vos, J, van Uden-Kraan, CF, et al. (2013) Meaning making in cancer survivors: A focus group study. PLoS ONE 8(9), 22–26.CrossRefGoogle ScholarPubMed
van der Spek, N, Vos, J, van Uden-Kraan, CF, et al. (2014) Effectiveness and cost-effectiveness of meaning-centered group psychotherapy in cancer survivors: Protocol of a randomized controlled trial. BMC Psychiatry 14(1), 22.CrossRefGoogle ScholarPubMed
Van der Spek, N, Vos, J, van Uden-Kraan, CF, et al. (2016) Efficacy of meaning-centered group psychotherapy for cancer survivors: A randomized controlled trial. Psychological Medicine 47(11), 1990–2001.CrossRefGoogle Scholar
van Lankveld, JDM, Fleer, J, Schroevers, ML, et al. (2018) Recruitment problems in psychosocial oncology research. Psycho-Oncology 27(9), 2296–2298.CrossRefGoogle ScholarPubMed
Yalom, ID and Greaves, C (1977) Group therapy with the terminally ill. American Journal of Psychiatry 134, 396–400.Google ScholarPubMed
Zigmond, AS and Snaith, RP (1983) The hospital anxiety and depression scale. Acta Psychiatrica Scandinavica 63, 361–370.CrossRefGoogle Scholar