Schedule For Meaning In Life Evaluation Research Articles

SMiLE to Life: Meaning in life in healthcare professionals working in palliative care and rehabilitation medicine.

Background: In the healthcare landscape, various protective factors are identified, such as meaning in life (MiL), namely what gives sense to life events. However, little is known about this construct in the healthcare population. Objectives: To describe MiL among healthcare professionals employed in palliative care and neuro-rehabilitation medicine, unveiling possible differences related to medical specialty and socio-demographic characteristics. Methods: In this cross-sectional and multicentre study, palliative care and neuro-rehabilitation professionals were recruited. MiL was evaluated with the Schedule for Meaning in Life Evaluation (SMiLE), which provides a list of meaningful areas, as well as related overall indexes of satisfaction (IoS), weighting (IoW), weighted satisfaction (IoWS). Descriptive statistics, t-test, chi-square, linear and binary logistic regressions were performed. Results: Overall, 297 healthcare professionals (palliative care=89, neuro-rehabilitation medicine=208, 47% of participants ≤ 40 years old) completed the evaluation. The sample was intra- and inter-groups heterogeneous, in particular concerning age and professional role. Conversely, no significant group differences emerged in MiL indexes comparisons, nor in the number of MiL listed areas. As for MiL areas, the category “family” increased the IoWS index, while terms related to “finances” contributed to decrease it. Comparing specialties, palliative care professionals were more likely to report areas like “partnership”, “social commitment”, and “satisfaction”. Nurses (n=116), nurse aides (n=47), and therapists (n=67) were more likely to mention health-related terms (e.g. health, physical wellbeing) than physicians and psychologists (n=65). Conclusion: This study highlighted MiL areas among professionals employed in palliative care and neuro-rehabilitation specialties, providing informative suggestions for tailored health prevention programs which should pay particular attention to social and family relationships, socio-economic status, and health.

Meaning in life and quality of life: palliative care patients versus the general population.

Meaning in life (MIL) represent a key topic in palliative care. The aims of this study were to explore (1) the differences in perceived MIL and in the meaning-relevant life areas between a representative sample of the Swiss population and palliative care patients, and (2) to what extent MIL can be considered as a significant predictor of quality of life (QOL). A cross-sectional study was conducted separately for the patients (face-to-face interviews) and the general population (telephone survey). MIL was measured with the Schedule for Meaning in Life Evaluation (SMILE) and QOL with a single-item visual analogue scale (0-10). Sociodemographic variables were controlled for in the analyses. 206 patients and 1015 participants from the Swiss population completed the protocol. Results indicated high MIL scores in both populations even if the difference was significant (patients 81.9 vs general population 87, p<0.001). Patients were more likely to cite 'family' (OR=1.78), 'social relations' (OR=1.9), 'spirituality and religion' (OR=3.93), 'social commitment' (OR=1.94) and 'growth' (OR=2.07), and less likely to cite 'finances' (OR=0.15) and 'health' (OR=0.21) as MIL-relevant areas. The SMILE scores and MIL areas explained 21.8% of the QOL variance for the patients and 15.1% for the representative sample. Our data emphasise the importance of MIL as a contributor to QOL in both populations. It highlights the importance of the life areas contributing to MIL, especially social interactions for both populations, and spirituality and areas related to growth in palliative care patients.

Meaning in life of older adults living in residential and nursing homes

ABSTRACTBackground: The purpose of this study was to contribute to the analysis of older people’s Meaning in Life and the implications of dwelling in residential and nursing homes. The transition from one’s private home to a residential or nursing care facility is a challenge for many older people. An individualized (not standardized) approach to meaning in life programming can help professionals in developing tailored interventions to support residents and their families.Participants: The participants (n = 106, 76% women, mean age 84.4 ± 6 years, 93% Christians) were living in residential (52%) and nursing homes (48%).Methods: An anonymous cross-sectional survey was conducted in nine care homes in Southern Germany using validated instruments such as the Schedule for Meaning in Life Evaluation (SMiLE) and Religious Trust (SpREUK-15 subscale).Results: Leisure time, nature experience, and family were the most important meaning-giving areas. Spirituality was also perceived as a major resource.Conclusions: Residents living in retirement homes were more spiritually satisfied than those living in nursing homes. It will be necessary to specifically support individuals living in institutional-care in their spiritual and psychosocial dimension to improve their feelings of security and to meet their core needs.

The role of meaning in life in community-dwelling older adults with depression and relationship to other risk factors

ABSTRACTObjectives: The aims of this study were to examine the association of Meaning in Life (MiL) with sociodemographic and physical factors, and its association with depression in older people.Method: A cross-sectional survey with a sample of N = 2104 older adults from communities of four European countries was conducted, using an age-appropriate interview for the diagnosis of depression and the Schedule for Meaning in Life Evaluation (SMiLE) questionnaire to assess MiL.Results: Overall, MiL was particularly low in old male participants, in older people from Ferrara (Italy), those with a lower religious affiliation, fewer social contacts, and poorer physical health. Furthermore, younger old age (65–69 compared to 80–84 year olds), female gender, being married, living in Geneva and poorer physical health were significantly associated with a higher risk for depression. In addition, lower MiL significantly increased the likelihood to suffer from depression in older people. An interaction effect of study center and MiL also emerged: with decreasing MiL the risk for depression significantly increases in Hamburg compared to the other study centers.Conclusion: This study underlines the association of MiL and depression in old age. Integration of meaning-specific aspects in treatment for older adults with depression may be promising.

Relationship Between Spirituality, Meaning in Life, Psychological Distress, Wish for Hastened Death, and Their Influence on Quality of Life in Palliative Care Patients

ContextSpiritual, existential, and psychological issues represent central components of quality of life (QOL) in palliative care. A better understanding of the dynamic nature underlying these components is essential for the development of interventions tailored to the palliative context. ObjectivesThe aims were to explore 1) the relationship between spirituality, meaning in life, wishes for hastened death and psychological distress in palliative patients and 2) the extent to which these nonphysical determinants influence QOL. MethodsA cross-sectional study involving face-to-face interviews with Swiss palliative patients was performed, including the Schedule for Meaning in Life Evaluation (SMILE), the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp), the Idler Index of Religiosity (IIR), the Hospital Anxiety and Depression Scale (HADS), and the Schedule of Attitudes toward Hastened Death (SAHD). QOL was measured with a single-item visual analogue scale (0–10). ResultsTwo hundred and six patients completed the protocol (51.5% female; mean age = 67.5 years). The results indicated a significant negative relationship between FACIT-Sp/SMILE and HADS total scores (P = 0.000). The best model for QOL explained 32.8% of the variance (P = 0.000) and included the FACIT-Sp, SMILE, and SAHD total scores, the IIR “private religiosity” score, as well as the HADS “depression” score. ConclusionBoth spiritual well-being and meaning in life appear to be potential protective factors against psychological distress at the end of life. Since nonphysical determinants play a major role in shaping QOL at the end of life, there is a need for the development of meaning-oriented and spiritual care interventions tailored to the fragility of palliative patients.

Meaning in life and perceived quality of life in Switzerland: results of a representative survey in the German, French and Italian regions

BackgroundThe concept of meaning in life (MIL) has become a central one in recent years, particularly in psycho-oncology and palliative care. The Schedule for Meaning in Life Evaluation (SMILE) has been developed to allow individuals to choose the life areas that they consider to be important for their own MIL. This approach relates to the “World Health Organisation” definition of quality of life (QOL) as an individual’s perception of his own position. The aims of this study were (i) to assess MIL in a representative sample of the Swiss population according to the three linguistic regions and (ii) to evaluate whether MIL constitutes a significant determinant of the perceived QOL.MethodsA telephone survey of the Swiss population, performed by a professional survey company, was conducted between November and December 2013. The interview included the SMILE, perceived QOL (0–10) and health status (1–5), and various sociodemographic variables. In the SMILE, an index of weighting (IOW, 20–100), an index of satisfaction (IOS, 0–100), and a total SMILE index (IOWS, 0–100) are calculated from the areas mentioned by the participants as providing MIL.ResultsAmong the 6671 telephonic contacts realized, 1015 (15 %) participants completed the survey: 405 French, 400 German and 210 Italian participants. “Family” (80.2 %), “occupation/work” (51 %), and “social relations” (43.3 %) were the most cited MIL-relevant categories. Italian participants listed “health” more frequently than German and French participants (50.4 % vs 31.5 % and 24.8 % respectively, χ2 = 12.229, p = .002). Age, gender, education, employment, and marital status significantly influenced either the MIL scores or the MIL-relevant categories. Linear regression analyses indicate that 24.3 % of the QOL variance (p = .000) is explained by health status (B = .609, IC = .490-.728, p = .000), MIL (B = .034, IC = .028-.041, p = .000) and socioeconomic status (F = 11.01, p = .000).ConclusionThe major finding of our analysis highlights the positive and significant influence of MIL on the perceived QOL in a representative sample of a general, multilingual and multicultural population. This result indicates that the existential dimension is not only determinant for QOL in some critical life events, as shown e.g. in psycho-oncology and palliative care, but also in everyday life.

What Gives Meaning in Life to Patients With Advanced Cancer? A Comparison Between Spanish, German, and Swiss Patients

ContextMeaning in life (MiL) is a construct that varies across individuals, situations, cultures, and countries, and protects against emotional distress at the end of life. ObjectivesTo examine MiL in inpatients with advanced cancer from Barcelona, Spain, and to compare the findings with those obtained in German and Swiss samples. MethodsThis was a cross-sectional study in which the Schedule for Meaning in Life Evaluation (SMiLE) was administered. The SMiLE asks respondents to list individual areas that give meaning in their lives and then to rate their current level of importance and satisfaction with the listed areas. ResultsA total of 101 inpatients completed the SMiLE. The Index of Satisfaction was 76.8 ± 21.1, the Index of Weighting was 88.0 ± 13.0, and the Index of Weighted Satisfaction was 76.9 ± 20.7. Family, partnership, well-being, and friends were the four areas listed by the largest proportion of Spanish patients. Compared with the German sample, Spanish patients were more likely to list well-being (P < 0.01) and pleasure (P < 0.05) and less likely to list animals/nature, leisure time, and finances (P < 0.01). With respect to their Swiss counterparts, Spanish patients were more likely to list health (P < 0.01) and less likely to list friends, leisure time, animals/nature, and finances (P < 0.01). ConclusionDifferences were identified in the areas of MiL listed by the participants according to country of origin. Compared with their German and Swiss counterparts, the Spanish patients listed more areas involving interpersonal relationships. Interpersonal relationships, at both the family and wider social level, are reported to be the areas that give the greatest MiL to these patients. These aspects, therefore, should be considered when drawing up care plans designed to help patients achieve the maximum possible comfort and quality of life.

Individual meaning in life assessed with the Schedule for Meaning in Life Evaluation: toward a circumplex meaning model

The experience of "meaning in life" (MiL) is a major aspect of life satisfaction and psychological well-being. To assess this highly individual construct, idiographic measures with open-response formats have been developed. However, it can be challenging to categorize these individual experiences for interindividual comparisons. Our study aimed to derive MiL categories from individual listings and develop an integrative MiL model. University students were asked to rate 58 MiL providing aspects recently found in a nationwide study using the Schedule for Meaning in Life Evaluation (SMiLE), an MiL instrument allowing for open responses. Pearson's correlations and factor analyses were used to test the unidimensionality of subsequently derived higher-order MiL categories. Multidimensional scaling, cluster analysis, and factor analysis were performed to further analyze a latent MiL structure. A total of 340 students participated in the study. Some 11 unidimensional categories consisting of 34 meaning-providing aspects were summarized into a circumplex model with four MiL domains: leisure/health, work/finances, culture/spirituality, and relationships (family, partnership, social relations). This model seems to incorporate a major portion of individual respondent-generated MiL listings. It may be useful for future idiographic MiL studies to help organize individual experiences of MiL and allow for higher-level interindividual comparisons. Further studies including different samples are necessary to confirm this model or derive other MiL domains, for example, in palliative care patients or patients who are confronted with a loss of meaning.

Meaning in Life Experience at the End of Life: Validation of the Hindi Version of the Schedule for Meaning in Life Evaluation and a Cross-Cultural Comparison Between Indian and German Palliative Care Patients

ContextThe experience of Meaning in Life (MiL) is a major protective factor against feelings of hopelessness and wishes for hastened death in palliative care (PC) patients. However, most instruments for MiL assessment have been developed only in Western countries so far. Little is known about MiL experience in Asian PC patients. ObjectivesThis study aimed to provide a Hindi version of the Schedule for Meaning in Life Evaluation (SMiLE), test its feasibility and validity in Indian PC patients, and compare the results with previous studies in Germany. MethodsIndian PC patients in a hospice for the destitute were eligible to participate in this cross-sectional study. In the SMiLE instrument, respondents individually listed MiL-giving areas before rating their satisfaction with and importance of these areas. Overall indices of satisfaction (IoS, range 0–100), weighting (IoW, range 0–100), and weighted satisfaction (IoWS, range 0–100) were calculated. ResultsA Hindi forward-backward translation of the SMiLE was made. Two hundred fifty-eight Indian PC patients took part in the study (response rate 93.5%). Convergent validity of the SMiLE was found with the World Health Organization Quality of Life-Brief version (r = 0.17; P = 0.008) and the Idler Index of Religiosity (public religiousness: r = 0.25, P < 0.001 and private religiousness: r = 0.29, P < 0.001). Indian PC patients' IoW was 65.8 ± 22.1, IoS 68.6 ± 17.4, and IoWS 70.2 ± 17.0. In multivariate analyses of covariance, they differed significantly from German PC patients only in IoW (IoW: 84.8 ± 11.5, P < 0.001; IoS: 70.2 ± 19.7; IoWS: 72.0 ± 19.4). Compared with Germans, Indians more often listed spirituality (P < 0.001) and social commitment (P < 0.001) and less often social relations (P = 0.008). ConclusionPreliminary results indicate good feasibility and validity of the Hindi version of the SMiLE. MiL experience also seems to be a coping resource for Indian PC patients.

The meaning in life for patients recently hospitalized with congestive heart failure

Quality of life (QOL) is based on individual values and is identified by what each person believes it to be. To provide patient centered care, practitioners must have an understanding of what each individual identifies as important in their lives. The purpose of this study was to identify what provides meaning to the lives of patients recently hospitalized with congestive heart failure (CHF). Participants for this pilot study were a convenience sample of 32 patients hospitalized as a result of complications of CHF. Study methodology was a cross-sectional, interview style survey, utilizing the Schedule for Meaning in Life Evaluation (SMiLE). No statistical significance was found between SMiLE scores and demographic data, including number of admissions or length of time since diagnosis. These findings suggest meaning in life (MIL), and subsequently QOL, may not be related to having a diagnosis of CHF. Identifying patients' relationship with their families, through the use of the SMiLE, has the ability to guide advanced planning decision making. Knowing, and preparing for, various family dynamics before the final stages of CHF may decrease episodes of care provided in opposition to patients' wishes, whether or not their wishes were previously stated or documented.

Psychometric properties of the Spanish form of the schedule for meaning in life evaluation (SMiLE)

The objective of this study was to validate the Spanish version of the SMiLE (Schedule for Meaning in Life Evaluation). The SMiLE is a respondent-generated instrument: respondents are first asked to list three to seven areas, which provide meaning to their lives, and then to rate their current satisfaction with the listed areas, as well as the individual importance of each one. Indices of total weighting (IoW), total satisfaction (IoS), and total weighted satisfaction (IoWS) are calculated. Two hundred and fifty University students responded to the Spanish version of the SMiLE, as well as to instruments for measuring self-esteem, quality of life, depression, and anxiety. The Cronbach alphas (α=0.61 for IoS and α=0.41 for IoW) and test-retest correlations were comparable to those found in the initial validation of the instrument (IoS: r=0.55; IoW: r=0.61). The SMiLE showed positive correlations with self-esteem (r=0.28, P<0.05 for IoS) and the mental dimension of the quality of life scale (r=0.31, P<0.05 for IoS), while negative correlations were observed with depression (r=-0.23, P<0.01) and anxiety (r=-0.17, P<0.05). The results support the validity of the Spanish version of the SMiLE as an instrument for assessing meaning in life.

Meaning in Life in Palliative Care Patients

The construct "meaning in life" (MiL) has recently raised the interest of clinicians working in psycho-oncology and end-of-life care and has become a topic of scientific investigation. The aim of this study was to compare MiL in palliative care (PC) patients with a representative sample of the German population. In this cross-sectional study, all PC patients treated in the PC inpatient unit and through the PC consult service at Ludwig-Maximilians-University Hospital, Munich, from May 2005 to July 2007 were eligible to participate. Patients were interviewed by a doctoral student, psychologist, or physician, all previously trained to administer the Schedule for Meaning in Life Evaluation (SMiLE) in a standardized way. In the SMiLE, respondents first list individual areas that provide meaning to their life before rating their current level of importance and satisfaction with each area. Overall indices of weighting (IoW, range 20-100), satisfaction (IoS, range 0-100), and weighted satisfaction (IoWS, range 0-100) are calculated. One hundred PC patients completed the SMiLE: the IoS was 70.2 ± 19.7, the IoW was 84.7 ± 11.5, and the IoWS was 72.0 ± 19.4. The representative sample (n=977) scored significantly higher in the IoS (82.8 ± 14.7) and IoWS (83.3 ± 14.8) but not in the IoW (85.6 ± 12.3). Compared with healthy individuals, PC patients are more likely to list partner, friends, leisure, spirituality, well-being, nature/animals, and pleasure as meaningful areas. Examining the satisfaction ratings, it is noteworthy that PC patients' satisfaction scores are fairly high (and not lower than their healthy counterparts') in a number of domains: family, partner, home/garden, spirituality, and finances. On the other hand, they score significantly lower in nature/animals, leisure, friends, well-being, altruism, work, pleasure, and health. These findings underscore the potential of the SMiLE for identifying areas that are particularly important to individuals, and that can be targeted by the PC team to improve overall life satisfaction at the end of life.

The Schedule for Meaning in Life Evaluation (SMiLE): Validation of a New Instrument for Meaning-in-Life Research

The Schedule for Meaning in Life Evaluation (SMiLE) is a respondent-generated instrument for the assessment of individual meaning in life (MiL). In the SMiLE, the respondents list three to seven areas that provide meaning to their lives before rating the current level of importance and satisfaction of each area. Indices of total weighting (IoW; range, 20–100), total satisfaction (IoS; range, 0–100), and total weighted satisfaction (IoWS; range, 0–100) are calculated. The objective of this study was to assess the feasibility, acceptability, and psychometric properties of this newly developed instrument in its German and English versions. A total of 599 students of the Ludwig-Maximilians University, Munich and the Royal College of Surgeons, Dublin, took part in the study (response rate, 95.4%). The mean IoW was 85.7 ± 9.4, the mean IoS was 76.7 ± 14.3, and the mean IoWS was 77.7 ± 14.2. The instrument was neither distressing (1.3 ± 1.9) nor time-consuming (1.9 ± 1.9), as assessed by numeric rating scales (range, 0–10). Test–retest reliability of the IoWS was r = 0.72 ( P < 0.001); 85.6% of all areas were listed again after a test–retest period of seven days. Convergent validity was demonstrated with the Purpose in Life test ( r = 0.48, P < 0.001), the Self-Transcendence Scale ( r = 0.34, P < 0.001), and a general numeric rating scale on MiL ( r = 0.53, P < 0.001). There was no correlation of the SMiLE with the Idler Index of Religiosity. Preliminary data indicate good feasibility and acceptability of the SMiLE in palliative care patients. The psychometrics of the SMiLE are reported according to the recommendations of the Scientific Advisory Committee of the Medical Outcomes Trust.

Meaning in life assessed with the “Schedule for Meaning in Life Evaluation” (SMiLE): a comparison between a cancer patient and student sample

The aims of the study were (a) to assess individual meaning in life (MiL) in a mixed sample of cancer patients with the Schedule for Meaning in Life Evaluation (SMiLE), (b) to evaluate the acceptability of its French version, and (c) to compare it to a student sample. Consecutive cancer patients (N = 100) treated as outpatients in the University Hospital Lausanne (N = 80) and in a nearby hospice (N = 20) were evaluated with the SMiLE, a reliable and validated respondent-generated instrument for the assessment of MiL. The respondents list three to seven areas, which provide meaning to their life and rate the level of importance (weighting) and satisfaction of each area. Indices of total weighting (index of weighting (IoW), range 20-100), total satisfaction (index of satisfaction (IoS), range 0-100), and total weighted satisfaction (index of weighted satisfaction (IoWS), range 0-100) are calculated. Patients most often indicated areas related to relationships as providing MiL, while material things were listed less often. Since satisfaction with relevant areas was high, cancer patients reported the same level of weighted satisfaction (IoWS) as a healthy student sample, assessed with the SMiLE in a prior validation study. Patients judged the SMiLE as reflecting well their MiL, not distressing to fill in and were moderately positive with regard to its helpfulness. MiL of cancer patients was surprisingly high, possibly due to the "response shift" of the severely ill. The SMiLE might become a useful tool for research and an opener to communication between patients and clinicians about this highly relevant topic in cancer care. Further studies with larger sample sizes and different designs, complemented by qualitative research, are needed to deepen our understanding of this so characteristically human topic, which is so easy to perceive and so difficult to grasp.

Reframing hope: meaning-centered care for patients near the end of life. Interview by Karen S. Heller.

979 Dr. William Breitbart, chief of the Psychiatry Service at Memorial Sloan-Kettering Cancer Center in New York City, describes his current research on a meaning-centered psychotherapeutic intervention that he has designed in order to help terminally ill patients with cancer sustain hope and meaning as they approach the end of their lives. Drawing inspiration and ideas from the works of psychiatrist and Holocaust survivor Viktor Frankl, Dr. Breitbart and his fellow, Dr. Mindy Greenstein, designed an 8-week, group-focused, manualized course of experiential exercises, which is being compared to an 8-week, manualized cancer support group intervention, to see how well meaning-focused care can address a constellation of constructs that he and his colleagues are calling “despair at the end of life.” The component constructs of despair at the end of life include hopelessness, depression, loss of meaning, suicidal ideation, and desire for hastened death. In the following interview with Innovations Associate Editor Karen S. Heller, Dr. Breitbart describes the conceptual evolution of his thinking about despair at the end of life, and details the research on meaning-centered psychotherapy in which he is now engaged. Although the study is still ongoing, preliminary findings suggest that although both types of group intervention reduce patients’ psychological distress and depression and enhance social support, the meaning-centered intervention is more effective in increasing spiritual well-being and a sense of meaning, and in reducing hopelessness and desire for death.