Meaning-based intervention programs applied to people diagnosed with cancer: A systematic review

Yıl 2023, Cilt: 7 Sayı: 3, 468 - 494, 25.12.2023

Selva Ülbe Gülay Dirik

https://doi.org/10.57127/kpd.26024438m0000104

Öz

In recent years, various meaning-based intervention programs aiming not only to reduce the negative psychological symptoms experienced by people diagnosed with cancer but also to enrich their lives by connecting with their sources of meaning and values in life, have been developed. The aim of the present study was to systematically examine the characteristics and outcomes of interventions that focus directly on developing a sense of meaning and purpose in life in people diagnosed with cancer. In this context, a systematic literature review was conducted using six electronic databases, namely PsycINFO, MEDLINE, CINAHL Complete, PubMed, Scopus, and Web of Science. As a result of the literature search conducted between 2000 and 2022, 20 studies including 14 different intervention programs focusing on meaning-making and meaning in life for people diagnosed with cancer were identified. The sample of the studies in the review consisted mostly of women, middle-aged and older people diagnosed with advanced cancer. Breast and lung cancer is the most common type of cancer in the articles in this review. The majority of the studies in the review were theoretically influenced by Viktor Frankl's studies and adopted the existential approach in psychotherapy. When the effects of meaning-based interventions were evaluated, it was found that they are highly effective in improving the sense of meaning, quality of life, and spiritual well-being. It was also thought to have relatively positive effects on anxiety, depression, emotional distress, optimism, and hopelessness levels. Because of these effects, it could be said that meaning-focused interventions are a promising approach both in answering the questions of people diagnosed with cancer about meaning and existence and in reducing their emotional distress. On the other hand, new studies using a more rigorous research methodology are needed to make more comprehensive conclusions about meaning-focused interventions.

Anahtar Kelimeler

cancer, meaning, interventions, systematic review

Etik Beyan

It is not a study that requires Ethics Committee approval.

Destekleyen Kurum

This study was supported by TUBITAK 2211-A program.

Kanser tanısı almış kişilere uygulanan anlam temelli müdahale programları: Sistematik bir derleme

Öz

Son yıllarda kanser tanısı almış kişilerin sadece yaşadıkları psikolojik sıkıntıları azaltmayı değil, aynı zamanda kişilerin yaşamdaki anlam kaynaklarını ve değerlerini belirleyerek yaşamlarını zenginleştirmeyi amaçlayan çeşitli anlam temelli müdahale programları geliştirilmiştir. Mevcut çalışmanın amacı, kanser tanısı alan kişilerde doğrudan yaşamda anlam ve amaç bulmaya ve geliştirmeye odaklanan müdahalelerin özelliklerini ve sonuçlarını sistematik olarak incelemektir. Bu kapsamda PsycInfo, MEDLINE, CINAHL Complete, PubMed, Scopus ve Web of Science olmak üzere toplamda altı elektronik veri tabanı kullanılarak sistematik bir alanyazın taraması yapılmıştır. 2000-2022 yılları arasını içerecek şekilde yapılan tarama sonucunda kanser tanısı almış kişiler için anlam yaratmaya ve yaşamda anlam duygusuna odaklanan 14 farklı müdahale programını içeren 20 çalışmaya ulaşılmıştır. Derlemede yer alan araştırmaların örneklemini çoğunlukla kadın, orta yaş ve üzeri olan ve ileri evre kanser tanısı alan kişiler oluşturmuştur. Meme ve akciğer kanseri bu derlemedeki araştırmalarda en çok yer alan kanser türleridir. Derlemeye dâhil edilen çalışmaların çoğunluğunun kuramsal olarak Viktor Frankl’ın çalışmalarından etkilendiği ve psikoterapide varoluşsal yaklaşımı benimsedikleri tespit edilmiştir. Anlam temelli müdahale programlarının etkileri değerlendirildiğinde ise yapılan müdahalelerin kişilerin anlam duygularını, yaşam kalitelerini ve spiritüel iyi oluş düzeylerini iyileştirmede büyük oranda etkili olduğu belirlenmiştir. Ayrıca katılımcıların kaygı, depresyon, duygusal sıkıntı, iyimserlik ve umutsuzluk düzeyleri üzerinde görece olumlu etkileri olduğu görülmüştür. Bu etkilerinden dolayı anlam odaklı müdahalelerin kanser tanısı almış kişilerin hem anlam ve varoluşla ilgili sorularına cevap vermede hem de duygusal sıkıntılarını azaltmada umut verici bir yaklaşım olduğu söylenebilir. Diğer taraftan anlam odaklı müdahalelere ilişkin daha kapsamlı çıkarımlar yapabilmek için daha titiz araştırma yöntemleri kullanan yeni çalışmalara ihtiyaç duyulmaktadır.

Anahtar Kelimeler

kanser, anlam, müdahaleler, sistematik derleme

Etik Beyan

Etik Kurul onayı gerektiren bir çalışma değildir.

Destekleyen Kurum

Bu çalışma TÜBİTAK 2211-A Yurt İçi Doktora Burs programı kapsamında desteklemiştir.

Kaynakça

• Bowlby J (1982). Attachment. Basic Books.
• Breitbart, W., Rosenfeld, B., Gibson, C., Pessin, H., Poppito, S., Nelson, C., Tomarken, A., Timm, A. K., Berg, A., Jacobson, C., Sorger, B., Abbey, J. ve Olden, M. (2010). Meaning-centered group psychotherapy for patients with advanced cancer: A pilot randomized controlled trial. Psycho-oncology, 19(1), 21-28.
• Breitbart, W., Poppito, S., Rosenfeld, B., Vickers, A. J., Li, Y., Abbey, J., Olden, M., Pessin, H., Lichtenthal, W., Sjoberg, D. ve Cassileth, B. R. (2012). Pilot randomized controlled trial of individual meaning-centered psychotherapy for patients with advanced cancer. Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology, 30(12), 1304-1309.
• Breitbart, W., Rosenfeld, B., Pessin, H., Applebaum, A., Kulikowski, J. ve Lichtenthal, W. G. (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.
• Breitbart, W., Pessin, H., Rosenfeld, B., Applebaum, A. J., Lichtenthal, W. G., Li, Y., Saracino, R. M., Marziliano, A. M., Masterson, M., Tobias, K. ve Fenn, N. (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.
• Blow, A. J., Swiecicki, P., Haan, P., Osuch, J. R., Symonds, L. L., Smith, S. S., ... ve Boivin, M. J. (2011). The emotional journey of women experiencing a breast abnormality. Qualitative Health Research, 21(10), 1316-1334.
• Ching, S. S., Martinson, I. M. ve Wong, T. K. (2009). Reframing: Psychological adjustment of Chinese women at the beginning of the breast cancer experience. Qualitative Health Research, 19(3), 339-351.
• Chochinov, H. M., Kristjanson, L. J., Breitbart, W., McClement, S., Hack, T. F., Hassard, T. ve Harlos, M. (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.
• Creamer, M., Burgess, P., & Pattison, P. (1992). Reaction to trauma: a cognitive processing model. Journal of Abnormal Psychology, 101(3), 452.
• da Ponte, G., Ouakinin, S., Santo, J. E., Ohunakin, A., Prata, D., Amorim, I., Gameiro, Z., Dos Santos, E. S. ve Breitbart, W. (2021). Meaning-centered group psychotherapy in Portuguese cancer patients: A pilot exploratory trial. Palliative & Supportive Care, 19(4), 464-473.
• Gagnon, P., Fillion, L., Robitaille, M. A., Girard, M., Tardif, F., Cochrane, J. P., ... ve Breitbart, W. (2015). A cognitive–existential intervention to improve existential and global quality of life in cancer patients: A pilot study. Palliative & Supportive care, 13(4), 981-990.
• Henry, M., Cohen, S. R., Lee, V., Sauthier, P., Provencher, D., Drouin, P., Gauthier, P., Gotlieb, W., Lau, S., Drummond, N., Gilbert, L., Stanimir, G., Sturgeon, J., Chasen, M., Mitchell, J., Huang, L. N., Ferland, M.-K. ve Mayo, N. (2010). The Meaning-Making intervention (MMi) appears to increase meaning in life in advanced ovarian cancer: A randomized controlled pilot study. Psycho-oncology, 19(12), 1340-1347.
• Holtmaat, K., Van der Spek, N., Lissenberg-Witte, B. I., Cuijpers, P. ve Verdonck-de Leeuw, I. M. (2019). Positive mental health among cancer survivors: overlap in psychological well-being, personal meaning, and posttraumatic growth. Supportive Care in Cancer, 27(2), 443-450.
• Farhadi, M., Reisi-Dehkordi, N., Kalantari, M. ve Zargham-Boroujeni, A. (2014). Efficacy of group meaning centered hope therapy of cancer patients and their families on patients’ quality of life. Iranian Journal of Nursing and Midwifery Research, 19(3), 290-294.
• Frankl, V.E. (1948/1986). Man’s search for meaning. Simon and Schuster
• Fraguell-Hernando, C., Limonero, J. T. ve Gil, F. (2020). Psychological intervention in patients with advanced cancer at home through Individual Meaning-Centered Psychotherapy-Palliative Care: A pilot study. Supportive Care in Cancer, 28(10), 4803-4811.
• Janoff-Bulman, R. (1992). Shattered assumptions: Towards a new psychology of trauma. Free Press.
• Jim, H. S., Richardson, S. A., Golden-Kreutz, D. M. ve Andersen, B. L. (2006). Strategies used in coping with a cancer diagnosis predict meaning in life for survivors. Health Psychology, 25(6), 753.
• Kernan, W. D. ve Lepore, S. J. (2009). Searching for and making meaning after breast cancer: Prevalence, patterns, and negative affect. Social Science & Medicine, 68(6), 1176-1182.
• Kang, K. A., Han, S. J., Lim, Y. S. ve Kim, S. J. (2019). Meaning-centered interventions for patients with advanced or terminal cancer: A meta-analysis. Cancer Nursing, 42(4), 332-340.
• Kissane, D. W., Lethborg, C., Brooker, J., Hempton, C., Burney, S., Michael, N., Staples, M., Osicka, T., Sulistio, M., Shapiro, J. ve Hiscock, H. (2019). Meaning and Purpose (MaP) therapy II: Feasibility and acceptability from a pilot study in advanced cancer. Palliative & Supportive Care, 17(1), 21-28.
• Kreitler, S. (2019). Psycho-oncology for the clinician: the patient behind the disease. Springer.
• Krok, D. ve Telka, E. (2018). Meaning in life in cancer patients: relationships with illness perception and global meaning changes. Health Psychology Report, 6(2), 171-182.
• Lee, V. (2008). The existential plight of cancer: meaning making as a concrete approach to the intangible search for meaning. Supportive Care in Cancer, 16(7), 779-785.
• Lee, V., Cohen, S. R., Edgar, L., Laizner, A. M. ve Gagnon, A. J. (2006). Meaning-making and psychological adjustment to cancer: Development of an intervention and pilot results. Oncology Nursing Forum, 33(2), 291-302.
• Lee, V., Robin Cohen, S., Edgar, L., Laizner, A. M. ve Gagnon, A. J. (2006). Meaning-making intervention during breast or colorectal cancer treatment improves self-esteem, optimism, and self-efficacy. Social Science & Medicine, 62(12), 3133-3145. LeMay, K. ve Wilson, K. G. (2008). Treatment of existential distress in life threatening illness: a review of manualized interventions. Clinical Psychology Review, 28(3), 472-493.
• Levin, T. ve Kissane, D. W. (2006). Psychooncology: The state of its development in 2006. The European Journal of Psychiatry, 20(3), 183-197.
• Lindemalm, C., Granstam-Björneklett, H., Bergkvist, L., Ojutkangas, M. L. ve Strang, P. (2012). Existential aspects are neglected in the evaluation of support-intervention in breast cancer patients. Acta Oncologica, 51(6), 807-809.
• Lo, C., Hales, S., Jung, J., Chiu, A., Panday, T., Rydall, A., Nissim, R., Malfitano, C., Petricone-Westwood, D., Zimmermann, C. ve Rodin, G. (2014). Managing Cancer And Living Meaningfully (CALM): Phase 2 trial of a brief individual psychotherapy for patients with advanced cancer. Palliative Medicine, 28(3), 234-242.
• Mehnert, A., Koranyi, S., Philipp, R., Scheffold, K., Kriston, L., Lehmann-Laue, A., Engelmann, D., Vehling, S., Eisenecker, C., Oechsle, K., Schulz-Kindermann, F., Rodin, G. ve Härter, M. (2020). Efficacy of the Managing Cancer and Living Meaningfully (CALM) individual psychotherapy for patients with advanced cancer: A single-blind randomized controlled trial. Psycho-oncology, 29(11), 1895-1904.
• Mitchell, S. A. (1988). Relational concepts in psychoanalysis: An integration. Harvard University Press.
• Mohabbat-Bahar, S., Golzari, M., Moradi-Joo, M. ve Akbari, M. E. (2014). Efficacy of group logotherapy on decreasing anxiety in women with breast cancer. Iranian Journal of Cancer Prevention, 7(3), 165-170.
• Moher, D., Liberati, A., Tetzlaff, J., Altman, D. G. ve PRISMA Group*. (2009). Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Annals of Internal Medicine, 151(4), 264-269.
• Moher, D., Shamseer, L., Clarke, M., Ghersi, D., Liberati, A., Petticrew, M., ... ve Stewart, L. A. (2015). Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Systematic Reviews, 4(1), 1-9.
• Mok, E., Lau, K., Lai, T. ve Ching, S. (2012). The meaning of life intervention for patients with advanced-stage cancer: Development and pilot study. Oncology nursing forum, 39(6), E480-E488.
• Park, C. L. (2010). Making sense of the meaning literature: an integrative review of meaning making and its effects on adjustment to stressful life events. Psychological Bulletin, 136(2), 257-301.
• Park, C. L., Currier, J. M., Harris, J. I. ve Slattery, J. M. (2017). Trauma, meaning, and spirituality: Translating research into clinical practice. American Psychological Association.
• Park, C. L. ve Folkman, S. (1997). Meaning in the context of stress and coping. Review of General Psychology, 1(2), 115-144.
• Park, C. L., Pustejovsky, J. E., Trevino, K., Sherman, A. C., Esposito, C., Berendsen, M. ve Salsman, J. M. (2019). Effects of psychosocial interventions on meaning and purpose in adults with cancer: A systematic review and meta‐analysis. Cancer, 125(14), 2383-2393.
• Quílez-Bielsa, E., Barrado-Moreno, V., Lastra Del Prado, R., Arbonés-Mainar, J. M., Sebastian-Sanchez, M. ve Ventura-Faci, T. (2021). An adaptation of meaning-centered psychotherapy integrating “essential care”: A pilot study. Palliative & Supportive Care, 1-9.
• Rodin, G., Lo, C., Rydall, A., Shnall, J., Malfitano, C., Chiu, A., Panday, T., Watt, S., An, E., Nissim, R., Li, M., Zimmermann, C. ve Hales, S. (2018). Managing Cancer and Living Meaningfully (CALM): A randomized controlled trial of a psychological ıntervention for patients with advanced cancer. Journal of Clinical Oncology, 36(23), 2422-2432.
• Ryu, J. S., Choi, S. W., Yun, S. S., Koo, B. H., Choi, I. S., Kim, S. J., Park, J. S., Seok, J. H. ve Yoon, D. S. (2018). Preliminary findings on the effectiveness of meaning-centered psychotherapy in patients with pancreatobiliary cancer. Yonsei Medical journal, 59(9), 1107-1114.
• Seligman, M. E., Steen, T. A., Park, N. ve Peterson, C. (2005). Positive psychology progress: empirical validation of interventions. American Psychologist, 60(5), 410-421.
• Spiegel D (1993) Living Beyond Limits: New Hope and Help for Facing Life Threatening Illness. New York: Times Books
• van der Spek, N., Vos, J., van Uden-Kraan, C. F., Breitbart, W., Cuijpers, P., Holtmaat, K., Witte, B. I., Tollenaar, R. A. E. M. ve Verdonck-de Leeuw, I. M. (2017). Efficacy of meaning-centered group psychotherapy for cancer survivors: A randomized controlled trial. Psychological Medicine, 47(11), 1990-2001.
• van der Spek, N., Vos, J., van Uden-Kraan, C. F., Breitbart, W., Tollenaar, R. A., Cuijpers, P. ve Verdonck-de Leeuw, I. M. (2013). Meaning making in cancer survivors: a focus group study. PLoS One, 8(9), e76089.
• Vehling, S., Lehmann, C., Oechsle, K., Bokemeyer, C., Krüll, A., Koch, U. ve Mehnert, A. (2011). Global meaning and meaning-related life attitudes: Exploring their role in predicting depression, anxiety, and demoralization in cancer patients. Supportive Care in Cancer, 19(4), 513-520.
• Vos, J. (2016). Working with meaning in life in mental health care: A systematic literature review of the practices and effectiveness of meaning-centred therapies. Clinical Perspectives on Meaning, 59-87.
• Wagner, C. D., Johns, S., Brown, L. F., Hanna, N. ve Bigatti, S. M. (2016). Acceptability and feasibility of a meaning-based ıntervention for patients with advanced cancer and their spouses: A pilot study. The American Journal of Hospice & Palliative Care, 33(6), 546-554.
• Winger, J. G., Adams, R. N. ve Mosher, C. E. (2016). Relations of meaning in life and sense of coherence to distress in cancer patients: A meta‐analysis. Psycho‐oncology, 25(1), 2-10.
• Wong, P. T. (2010). Meaning therapy: An integrative and positive existential psychotherapy. Journal of Contemporary Psychotherapy, 40(2), 85-93.
• Yalom, I. D. (1980). Existential psychotherapy. Basic Books
• Zhou, Y. ve Xu, W. (2019). the mediator effect of meaning in life in the relationship between self-acceptance and psychological wellbeing among gastrointestinal cancer patients. Psychology, Health & Medicine, 24(6), 725-731.