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

Published online by Cambridge University Press:  02 January 2019

David W. Kissane ,
Carrie Lethborg ,
Joanne Brooker ,
Courtney Hempton ,
Sue Burney ,
Natasha Michael ,
Margaret Staples ,
Tanya Osicka ,
Merlina Sulistio  and
Jeremy Shapiro
...Show all authors
David W. Kissane*
Affiliation:
Szalmuk Family Psycho-Oncology Research Unit, Cabrini Health, Melbourne, Victoria, Australia Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia Department of Palliative Care, Cabrini Health, Melbourne, Victoria, Australia
Carrie Lethborg
Affiliation:
Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia Social Work Department, St Vincent's Health, Fitzroy, Victoria, Australia
Joanne Brooker
Affiliation:
Szalmuk Family Psycho-Oncology Research Unit, Cabrini Health, Melbourne, Victoria, Australia Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
Courtney Hempton
Affiliation:
Szalmuk Family Psycho-Oncology Research Unit, Cabrini Health, Melbourne, Victoria, Australia Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
Sue Burney
Affiliation:
Szalmuk Family Psycho-Oncology Research Unit, Cabrini Health, Melbourne, Victoria, Australia School of Psychological Sciences, Monash University, Clayton, Victoria, Australia
Natasha Michael
Affiliation:
Department of Palliative Care, Cabrini Health, Melbourne, Victoria, Australia Department of Medicine, Notre Dame University, Sydney, New South Wales, Australia
Margaret Staples
Affiliation:
Szalmuk Family Psycho-Oncology Research Unit, Cabrini Health, Melbourne, Victoria, Australia
Tanya Osicka
Affiliation:
Szalmuk Family Psycho-Oncology Research Unit, Cabrini Health, Melbourne, Victoria, Australia
Merlina Sulistio
Affiliation:
Department of Palliative Care, Cabrini Health, Melbourne, Victoria, Australia
Jeremy Shapiro
Affiliation:
Department of Oncology, Cabrini Health, Melbourne, Victoria, Australia
Hilary Hiscock
Affiliation:
Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Clayton, Victoria, Australia
*
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: david.kissane@monash.edu
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Abstract

Objective

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.

Method

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.

Result

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.

Keywords

DemoralizationExistentialFulfillmentHope, Meaning-centered therapyPosttraumatic growthPurpose-in-lifeRelational meaningRoleSelf-worth
Type
Original Article
Information
Palliative & Supportive Care , Volume 17 , Issue 1 , February 2019 , pp. 21 - 28
Copyright
Copyright © Cambridge University Press 2019 

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