Abstract
To describe the feasibility of a meaning-centered group psychotherapy (MCGP) adaptation in a sample of Portuguese cancer patients. 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). 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). 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.
Highlights
The goal of this study is to describe the feasibility of an meaning-centered group psychotherapy (MCGP) adaptation in a sample of Portuguese cancer patients
It was carried out two assessments (T1 — MCGP: before the 1st session vs. care as usual (CAU): 1st moment; T2 — MCGP: after the last session vs. CAU: 1 month after T1) with sociodemographic and clinical questionnaires and self-report instruments to measure quality of life (QoL), spiritual, and psychological well-being: Distress Thermometer (DT; Ouakinin et al, 2015; National Comprehensive Cancer Network, 2017), McGill Quality of Life Questionnaire (MQOL; Cohen et al, 1997; Duarte et al, 2010), Functional Assessment of Chronic Illness Therapy — Spiritual Well-Being Scale (FACIT-Sp-12; FACIT Group, 2011; Pereira and Santos, 2011), and Hospital Anxiety and Depression Scale (HADS; subscales: depression [HADS-D] and anxiety [HADS-A]; Zigmond and Snaith, 1983; Pais-Ribeiro et al, 2007)
MCGP transcultural adaptation and validation showed that existential themes, “sources of meaning” or “transcendence,” raised questions culturally determined and related to the “meaning of life” (Hambleton and Patsula, 1990; Swaine-Verdier et al, 2004; Goes, 2007; Pasquali, 2009; Epstein et al, 2015; Medeiros et al, 2015; Da Ponte et al, 2017)
Summary
The importance of the existential care lead to the emergence of meaning-focused interventions (Breitbart, 2002; Chochinov et al, 2005; Puchalski, 2013) in advanced cancer patients or terminally ill (Yalom and Greaves, 1977; Spiegel et al, 1981; Edelman et al, 1999; Edmonds et al, 1999; Classen et al, 2001; Kissane et al, 2003, 2007; Lee et al, 2006; Breitbart et al, 2010; Chochinov et al, 2011). Further studies suggested that more severe forms of despair respond better to existential interventions (Breitbart et al, 2015)
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