EXISTENTIAL HEALING AT THE END OF LIFE: A CULTURALLY ADAPTED INTERVENTION FOR TURKISH WOMEN WITH ADVANCED CANCER

Öz

This quasi experimental study assessed the effectiveness of a 12 week Existential Based Cognitive Therapy (EBCT) program for women with metastatic cancer in Türkiye. Sixty participants were allocated to either the intervention or waitlist control group. The intervention integrated meaning centered exercises, symbolic expression, self compassion, and acceptance strategies within culturally congruent therapeutic frameworks. Outcomes were evaluated using validated Turkish versions of the Ryff Psychological Well Being Scale, FACIT Sp 12, and Beck Hopelessness Scale at baseline, mid intervention, and post intervention. Results showed that the EBCT group experienced statistically and clinically significant improvements across all outcome measures—particularly in autonomy, purpose in life, spiritual meaning, and reductions in hopelessness—while the control group displayed no meaningful change. Thematic analysis of anonymized session reflections provided illustrative context for participants’ experiences, highlighting culturally embedded meanings of illness, gendered caregiving roles, and spiritual coping frameworks. Findings suggest that EBCT, when culturally adapted to integrate existential themes with local meaning systems, can promote psychological and spiritual well being among women confronting life limiting illness. This study contributes to death studies literature by demonstrating how existentially grounded psychosocial interventions may support adaptive functioning in non Western settings confronting the existential challenges of advanced cancer.

Anahtar Kelimeler

• psycho-oncology
• existential therapy
• advanced cancer
• ; culture
• Turkish women
• spirituality

YAŞAM SONUNDA VAROLUŞSAL İYİLEŞME: İLERİ EVRE KANSERLİ TÜRK KADINLAR İÇİN KÜLTÜREL OLARAK UYARLANMIŞ BİR MÜDAHALE

Öz

Bu yarı deneysel çalışma, Türkiye'de metastatik kanserli kadınlar için 12 haftalık Varoluşsal Temelli Bilişsel Terapi (EBCT) programının etkinliğini değerlendirdi. Altmış katılımcı, müdahale grubu veya bekleme listesi kontrol grubuna ayrıldı. Müdahale, kültürel açıdan uygun terapötik çerçeveler içinde anlam odaklı egzersizler, sembolik ifade, öz şefkat ve kabul stratejilerini birleştirdi. Sonuçlar, Ryff Psikolojik İyi Olma Ölçeği, FACIT Sp 12 ve Beck Umutsuzluk Ölçeği'nin doğrulanmış Türkçe versiyonları kullanılarak başlangıçta, müdahalenin ortasında ve müdahale sonrasında değerlendirildi. Sonuçlar, EBCT grubunun tüm sonuç ölçümlerinde, özellikle özerklik, yaşam amacı, manevi anlam ve umutsuzlukta azalma açısından istatistiksel ve klinik olarak anlamlı iyileşmeler yaşadığını gösterirken, kontrol grubunda anlamlı bir değişiklik görülmedi. Anonimleştirilmiş seans yansımalarının tematik analizi, katılımcıların deneyimlerine açıklayıcı bir bağlam sağladı ve hastalığın kültürel olarak yerleşik anlamlarını, cinsiyete dayalı bakım rollerini ve manevi başa çıkma çerçevelerini vurguladı. Bulgular, EBCT'nin, varoluşsal temaları yerel anlam sistemleriyle bütünleştirmek için kültürel olarak uyarlanması durumunda, yaşamı sınırlayan hastalıklarla karşı karşıya olan kadınlar arasında psikolojik ve manevi refahı teşvik edebileceğini göstermektedir. Bu çalışma, varoluşsal temelli psikososyal müdahalelerin, ileri evre kanserin varoluşsal zorluklarıyla karşı karşıya olan Batı dışı ortamlarda uyumsal işlevselliği nasıl destekleyebileceğini göstererek ölüm çalışmaları literatürüne katkıda bulunmaktadır.

Anahtar Kelimeler

• psiko-onkoloji; varoluşsal terapi; ileri evre kanser; kültür; Türk kadınları; maneviyat
• psiko-onkoloji
• varoluşsal terapi
• ileri evre kanser
• kültür

Kaynakça

1. World Health Organization. World Cancer Report. Geneva: WHO Press; 2025.
2. Gallicchio L, Devasia TP, Tonorezos E, Mollica MA, Mariotto AB. Estimation of the number of individuals living with metastatic cancer in the United States. J Natl Cancer Inst. 2022;114(11):1476-1483. doi:10.1093/jnci/djac158.
3. Türkiye Halk Sağlığı Genel Müdürlüğü. Kanser İstatistikleri 2020. Ankara: Sağlık Bakanlığı Yayınları; 2020.
4. Drew EM, Schoenberg NE. Deconstructing fatalism: ethnographic perspectives on women's decision making about cancer prevention and treatment. Med Anthropol Q. 2011;25(2):164-182. doi:10.1111/j.1548-1387.2010.01136.x.
5. Ryff CD, Singer BH. Know thyself and become what you are: a eudaimonic approach to psychological well-being. J Happiness Stud. 2008;9(1):13-39. doi:10.1007/s10902-006-9019-0
6. Greer JA, Park ER, Prigerson HG, Safren SA. Tailoring cognitive-behavioral therapy to treat anxiety comorbid with advanced cancer. J Cogn Psychother. 2010;24(4):294-313. doi:10.1891/0889-8391.24.4.294.
7. Yalom ID. Existential Psychotherapy. New York: Basic Books; 1980.
8. May R. The Discovery of Being: Writings in Existential Psychology. New York: Norton; 1983.

9. Frankl VE. Man’s Search for Meaning. Boston: Beacon Press; 1959.
10. Neff K. Self-compassion: An alternative conceptualization of a healthy attitude toward oneself. Self Identity. 2003;2(2):85–101. doi:10.1080/15298860309032
11. Vos J, Craig M, Cooper M. Existential therapies: a meta-analysis of their effects on psychological outcomes. J Consult Clin Psychol. 2015;83(1):115-128. doi:10.1037/a0037167
12. Hayes SC, Strosahl KD, Wilson KG. Acceptance and commitment therapy: the process and practice of mindful change. 2nd ed. New York: Guilford Press; 2012.
13. Wong PT. Meaning-making and the positive psychology of death acceptance. Int J Exist Psychol Psychother. 2012;4(1):1-14.
14. Vehling S, Kissane DW. Existential distress in cancer: alleviating suffering from fundamental loss and change. Psychooncology. 2018;27(11):2525-2530. doi:10.1002/pon.4872.
15. Chochinov HM, Hack T, Hassard T, Kristjanson LJ, McClement S, Harlos M. Dignity therapy: a novel psychotherapeutic intervention for patients near the end of life. J Clin Oncol. 2005;23(24):5520-5525. doi: 10.1200/JCO.2005.08.391
16. Ando M, Morita T, Akechi T, et al. Efficacy of short-term life review interviews on the spiritual well-being of terminally ill cancer patients. J Pain Symptom Manage. 2010;39(6):993-1002. doi:10.1016/j.jpainsymman.2009.11.320
17. Küçük L, Kocaman N. Spirituality and its relationship with illness perception and treatment compliance in Turkish cancer patients. Int J Caring Sci. 2018;11(3):1673-1681.
18. Çınar D, Kutlu FY. Psychosocial care needs of Turkish breast cancer patients during the chemotherapy process. Eur J Breast Health. 2017;13(4):190-195.
19. Yıldırım N, Erci B, Özdemir S. Spirituality in cancer patients. J Relig Health. 2015;54(3):794-804.
20. Akın A. The scales of psychological well-being: a study of validity and reliability. Educ Sci Theory Pract. 2008;8(3):741-750.
21. Aktürk Ü, Erci B, Araz M. Functional evaluation of treatment of chronic disease: Validity and reliability of the Turkish version of the Spiritual Well-Being Scale. Palliative & Supportive Care. 2017;15(6):684–692. doi:10.1017/S1478951517000013.
22. Durak A, Palabıyıkoğlu R. Beck Umutsuzluk Ölçeği’nin geçerlik ve güvenirlik çalışması. Kriz Derg. 1994;2(2):311-319. doi:10.1501/Kriz_0000000071
23. Jacobson NS, Truax P. Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol. 1991;59(1):12-19. doi:10.1037//0022-006x.59.1.12
24. Savaş E. Kadın hastalarda beden imgesi ve feminenlik kimliği: onkoloji bağlamında psikososyal değerlendirme. Psikol Yaz. 2022;25(48):31-42.
25. Akyüz A, Şahiner G, Seven M. Depression, self-esteem, body image and quality of life in Turkish women with gynecological cancer. Asian Pac J Cancer Prev. 2008;9(3):505-510.
26. Gilligan C. In a Different Voice: Psychological Theory and Women’s Development. Cambridge: Harvard University Press; 1982.
27. Fredrickson BL, Roberts TA. Objectification theory: toward understanding women’s lived experiences and mental health risks. Psychol Women Q. 1997;21(2):173-206. doi: 10.1111/j.1471-6402.1997.tb00108.x
28. Tandoğan Ö, Korkmaz Z. Navigating motherhood with one breast: a descriptive phenomenological study of body image, social stigma and resilience during active chemotherapy. Eur J Obstet Gynecol Reprod Biol. 2026;321:114984. doi:10.1016/j.ejogrb.2026.114984
29. Ahmadi F, Erbil P, Ahmadi N, Cetrez ÖA. Religion, culture and meaning-making coping: A study among cancer patients in Turkey. J Relig Health. 2019;58(4):1115–1124. doi:10.1007/s10943-018-0646-7.
30. Jim HS, Small B, Faul LA, Franzen J, Apte S, Jacobsen PB. Fatigue, depression, sleep, and activity during chemotherapy: daily and intraday variation and relationships among symptom changes. Ann Behav Med. 2011;42(3):321-333. doi:10.1007/s12160-011-9294-9.
31. Henry M, Gonzalez BD, Small BJ, et al. Variability in sleep disturbance and its relationship with quality of life in cancer patients. Psychooncology. 2014;23(10):1100-1108.
32. Park CL. Meaning making and its effects on psychological adjustment to stressful life events: a review of literature. J Behav Med. 2013;36(2):241-259.
33. Breitbart W. Reframing hope: meaning-centered care for patients near the end of life. J Palliat Med. 2003;6(6):979-988. doi:10.1089/109662103322654901.
34. Mohr DC, Spring B, Freedland KE, Beckner V, Areán P, Hollon SD, et al. The selection and design of control conditions for randomized controlled trials of psychological interventions. Psychother Psychosom. 2009;78(5):275-284. doi:10.1159/000228248.
35. Cuijpers P, van Straten A, Andersson G, van Oppen P. Psychotherapy for depression in adults: a meta-analysis of comparative outcome studies. J Consult Clin Psychol. 2008;76(6):909-922. doi:10.1037/a0013075.
36. Hall S, Goddard C, Speck PW, Martin P, Higginson IJ. “It makes you feel that somebody is out there caring”: a qualitative study of intervention and control participants' perceptions of the benefits of taking part in an evaluation of dignity therapy for people with advanced cancer. J Pain Symptom Manage. 2013;45(4):712-725. doi:10.1016/j.jpainsymman.2012.03.009.
37. Puchalski CM, Vitillo R, Hull SK, Reller N. Improving the spiritual dimension of whole person care: reaching national and international consensus. J Palliat Med. 2014;17(6):642-656. doi:10.1089/jpm.2014.9427.
38. Abu-Raiya H, Pargament KI, Mahoney A. Examining the psychometric properties of the Islamic Religiosity Scale among Muslims in the United States. Psychol Relig Spiritual. 2015;7(2):130-141.