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Dong S, Bray E, Clifton S, McCabe R, Siddall P. A qualitative exploration of the experiences of individuals with spinal cord injury participating in a community-based online intervention to support posttraumatic growth. Disabil Rehabil 2024:1-9. [PMID: 39164999 DOI: 10.1080/09638288.2024.2392035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 07/14/2024] [Accepted: 08/08/2024] [Indexed: 08/22/2024]
Abstract
PURPOSE To date, no evidence-based, community-based online group intervention has been designed specifically to enhance posttraumatic growth (PTG), quality of life (QoL), sense of meaning and purpose, and satisfaction with life following a spinal cord injury (SCI). This qualitative study aims to describe participants' experiences of participating in such a program. METHODS Semi-structured interviews were conducted with 17 people with SCI and analysed using a thematic analysis approach. RESULTS Five major themes were identified: longing for connection; empowerment through education and participation; journeying through common experiences; connecting to the program content; and continuing to contemplate PTG and meaning and purpose. The themes represent how participants were drawn to the program because they longed to connect with others in similar situations. Participants engaged in a shared group process of learning and reflection as well as an individual journey in which they connected with different elements of the program. As a result, PTG was seen as a continuous and individual process that evolved out of shared group processes. CONCLUSIONS This study highlights the importance of addressing psychological needs alongside physical rehabilitation for individuals with SCI. Shared experiences and strength-based approaches can be valuable tools in promoting positive psychological outcomes.
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Affiliation(s)
- Skye Dong
- Melanoma Institute Australia, Sydney, Australia
| | - Emily Bray
- Spinal Cord Injuries Australia, Matraville, Australia
| | - Shane Clifton
- Faculty of Health Sciences, Centre for Disability Research and Policy, The University of Sydney, Sydney, Australia
| | | | - Philip Siddall
- Hammondcare, Sydney, Australia
- Sydney Medical School-Northern, The University of Sydney, Sydney, Australia
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2
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Philipp R, Walbaum C, Vehling S. Psychodynamic psychotherapy in serious physical illness: A systematic literature review of approaches and techniques for the treatment of existential distress and mental disorders. DEATH STUDIES 2024:1-22. [PMID: 38865193 DOI: 10.1080/07481187.2024.2353362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
Individuals with life-limiting physical illness experience lower mental health due to existential distress (e.g., demoralization, death anxiety) and mental disorders (e.g., depression, anxiety). Psychodynamic psychotherapy may be helpful in alleviating such distress by focusing patients' unconscious emotional and relational motivations. There is yet limited knowledge on the application of psychodynamic psychotherapies in this population. We systematically searched electronic databases and analyzed results using meta-ethnography. Of 15,112 identified records, we included 31 qualitative studies applying psychodynamic psychotherapies (n = 69, mean age: 49.3 [SD = 16.9)], 56% female). Psychodynamic treatment in this population can be beneficial when considering modification of the treatment setting to the illness reality, balancing needs for autonomy and separation in light of helplessness and death anxiety, and careful integration of supportive interventions and conflict-oriented interventions (e.g., exploring relational issues that interfere with mourning illness-related loss). We discuss future directions for the development and evaluation of treatments specific to serious physical illness.
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Affiliation(s)
- Rebecca Philipp
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Charlotte Walbaum
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Oncology, Hematology, and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sigrun Vehling
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Oncology, Hematology, and Bone Marrow Transplantation with Section of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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3
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Zhou L, Wu T, Zhong Z, Yi L, Li Y. Acupuncture for painful diabetic peripheral neuropathy: a systematic review and meta-analysis. Front Neurol 2023; 14:1281485. [PMID: 38046594 PMCID: PMC10690617 DOI: 10.3389/fneur.2023.1281485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 11/06/2023] [Indexed: 12/05/2023] Open
Abstract
Background Painful Diabetic Peripheral Neuropathy (PDPN) is a common complication of diabetes, it severely affects the quality of life of patients. Acupuncture has been shown to be effective in the treatment of PDPN. To evaluate the efficacy and safety of acupuncture for pain relief in patients diagnosed with diabetic peripheral neuropathy, we conducted a systematic review and meta-analysis. Method We thoroughly searched specific databases, which included PUBMED, EMBASE, Web of Science, the Cochrane Library, the Chinese Biomedical Literature Database, the Chinese National Knowledge Infrastructure, China Science and Technology Journal Database and the Wanfang Data. All randomized controlled trials of acupuncture therapy for PDPN with pain change scales were included. Included studies were assessed for methodological quality according to the risk of bias from the Cochrane handbook. Meta-analyses were carried out to analyze the outcomes, subgroup analyses, sensitivity analyses, and funnel plot analyses were undertaken. Results This systematic review evaluated a total of 25 trials of acupuncture therapy in combination with conventional treatment, involving a total of 1,561 patients with PDPN. According to the results, among 16 trials using VAS scores with a total of 1,552 patients, 2 acupoint injection trials (MD -2.38, 95% CI: -2.76 to -2.01, p < 0.00001), 12 acupuncture trials (MD -1. 31, 95% CI: -1.60 to -1.02, p < 0.00001) and 2 moxibustion trials showed that acupuncture therapy combined with conventional treatment improved pain better than conventional treatment (MD -2.50, 95% CI: -2.76 to -2.24, p < 0.00001). In the subgroup analysis of the acupuncture group, the results of the 5 trials in which the location of acupuncture was only in the limbs (MD -1.27, 95% CI: -1.54 to -1.01, p < 0.00001) and the 7 trials both in limbs and torso (MD -1.38, 95% CI: -1.81 to -0.95, p < 0.00001) also demonstrated that acupuncture was effective in pain improvement. Conclusion This meta-analysis analyzed the possible efficacy of acupuncture in combination with conventional treatment for pain in diabetic peripheral neuropathy, particularly when acupoints are located in the limbs. However, there are limitations to this meta-analysis and future clinical studies are needed to confirm these findings. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023449447, identifier (CRD42023449447).
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Affiliation(s)
- Luolin Zhou
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Tong Wu
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zhishan Zhong
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Lichen Yi
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yuemei Li
- Department of Rehabilitation, Guangzhou Eighth People’s Hospital, Guangzhou Medical University, Guangzhou, China
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Hyland KA, Oswald LB, Reblin M, Small BJ, Gray JE, Jim HSL, Jacobsen PB. Goals and goal perceptions in patients with advanced stage lung cancer: a mixed methods study. Support Care Cancer 2023; 31:314. [PMID: 37126099 PMCID: PMC10150146 DOI: 10.1007/s00520-023-07745-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 04/10/2023] [Indexed: 05/02/2023]
Abstract
PURPOSE Goals provide insight into what is important to an individual. We describe the development and application of a mixed methods approach to elicit goals and perceptions about goals in patients with advanced cancer. METHODS Patients receiving first-line treatment for advanced lung cancer participated in semi-structured interviews about their goals. Participants self-generated goals, then selected and ranked their three most important goals and provided Likert scale ratings of goal-related perceptions (e.g., attainability, locus of control). Independent raters coded goals into content domains. One month later, participants reported perceived progress toward goals and facilitators of and barriers to progress. RESULTS Participants (N = 75, Mage = 64.5 years, 59% female) identified goals across eight domains: social/role/relationship, everyday/practical, leisure/pleasure, psychological/existential/spiritual, major life changes or achievements, cancer treatment response/disease outcomes, palliative outcomes, and behavioral health improvement. Of all goals identified (N = 352), 72% of patients had at least one social/role/relationship goal, 68% had a leisure/pleasure goal, and 29% had a cancer treatment response goal. On average, participants considered their goals to be attainable, perceived a high degree of control over reaching goals, anticipated making "some" progress in the short term, and perceived a high likelihood of reaching goals in the future. Facilitators of progress included mental fortitude, feeling physically well, and social support. Barriers included cancer-related side effects, practical challenges, and COVID-19. CONCLUSIONS A majority of participant goals focused on meaningful engagement and living well. Goals were largely viewed as attainable and under participants' control. Cancer clinicians may consider how to support patients in working toward valued goals in conjunction with oncology care.
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Affiliation(s)
- Kelly A Hyland
- Duke University, Durham, NC, USA.
- Moffitt Cancer Center, Tampa, FL, USA.
- University of South Florida, Tampa, FL, USA.
| | | | - Maija Reblin
- University of Vermont College of Medicine, Burlington, VT, USA
| | - Brent J Small
- Moffitt Cancer Center, Tampa, FL, USA
- University of South Florida, Tampa, FL, USA
| | | | | | - Paul B Jacobsen
- University of South Florida, Tampa, FL, USA
- Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, USA
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Yager J, Kay J. Purpose in Life: Addressing Transdiagnostic Psychopathologies Concerning Patients' Sense of Purpose. J Nerv Ment Dis 2023; 211:411-418. [PMID: 37094572 DOI: 10.1097/nmd.0000000000001657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
ABSTRACT Having a purpose in life is strongly associated with well-being and quality of life. Some individuals develop their sense of purpose early in life and can sustain lifelong ideals. In contrast, we identify four transdiagnostic syndromes where purpose in life is impaired: 1) deficiencies in generating purpose; 2) loss of purpose due to traumatic events such as catastrophic illnesses or bereavements; 3) conflicts due to crossed purposes; and 4) maladaptive purposes, such as life-limiting single-minded goals, dominating others, or exacting revenge. Several psychotherapies associated with positive and existential psychologies help patients construct, reconstruct, or retain a sense of purpose. However, given the strong links between a sense of purpose and beneficial health and mental health outcomes, the authors suggest that many patients in psychiatric treatment including psychotherapies will benefit from attention to these issues. This article reviews approaches for assessing and addressing purpose in life in psychiatric treatment, to enhance patients' healthy sense of purpose where this characteristic is impaired.
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Affiliation(s)
- Joel Yager
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, Colorado
| | - Jerald Kay
- Department of Psychiatry, Boonshoft School of Medicine, Wright State University, Dayton, Ohio
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Tabaei-Aghdaei Z, McColl-Kennedy JR, Coote LV. Goal Setting and Health-Related Outcomes in Chronic Diseases: A Systematic Review and Meta-Analysis of the Literature From 2000 to 2020. Med Care Res Rev 2023; 80:145-164. [PMID: 35904147 DOI: 10.1177/10775587221113228] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Identifying and synthesizing recent empirical research on goal setting among adults with chronic disease is the focus of this article. The article has two phases: Phase 1, a thematic analysis with machine reading of the data and manual thematic analysis, and Phase 2, a quantitative meta-analysis. Qualitative, quantitative, and mixed-method studies are included in Phase 1 (99 papers). Phase 2 includes only quantitative studies (75 papers). Five main themes are identified: (a) the effect of goal characteristics on health-related outcomes, (b) the effect of goal setting on health-related outcomes, (c) the effect of goal achievement on health-related outcomes, (d) goal alignment between patients and health care service providers, and (e) individual and collaborative goal setting of patients and health care service providers. The meta-analysis reveals considerable evidence of an association between goal setting and health-related outcomes.
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Schwartz CE, Biletch E, Stuart RBB, Rapkin BD. Patient life aspirations in the context of Duchenne Muscular Dystrophy: a mixed-methods case–control study. J Patient Rep Outcomes 2022; 6:97. [PMID: 36104592 PMCID: PMC9473464 DOI: 10.1186/s41687-022-00500-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 08/29/2022] [Indexed: 12/30/2022] Open
Abstract
Abstract
Background
Aspirations refer to wishes, ways of defining quality of life (QOL), and life goals. Living with chronic illness likely impacts a person’s life aspirations. Duchenne Muscular Dystrophy (DMD) is an inherited disorder characterized by the inevitable and progressive loss of ambulation and independence. The present cross-sectional case–control study investigated how aspirations differed between people with DMD and a stratified comparison group of nationally representative children/adults.
Methods
A web-based survey was administered October through December 2020. Recruitment was stratified by age group: 8–12, 13–17, and > = 18, reflecting the DMD disability trajectory. Aspirations were measured using qualitative (open-ended) and quantitative (closed-ended) questions. Qualitative prompts asked participants about wishes, how they would define “QOL”; and goals; answers to the prompts were then coded by six trained raters. Quantitative questions included 29 closed-ended goal-delineation items from the QOL Appraisal Profilev2. These data were analyzed using multivariate models adjusting for propensity scores (demographic differences), and testing for the effects of role (patient or comparison), age, and role-by-age interactions.
Results
The study sample of DMD (n = 285) and comparison (n = 292) participants provided open-text data: 577 wishes statements, 283 QOL-definition statements, and 149 goals statements. Inter-rater reliability (kappa = 0.77) reflected good agreement between different raters’ codes. Results suggested that people with DMD have aspirations that differ from their peers in several important ways. Both open-text and closed-ended data in both unadjusted and adjusted analyses generally showed that people with DMD were more focused on intrinsic aspirations such as health, healthcare, and independence than their peers. Compared to non-DMD persons, DMD individuals were much less focused on financial or housing concerns, community contributions, or spiritual growth. With age, patients’ aspirations focused less on extrinsic aspirations such as careers and work and increasingly emphasized emotion-oriented goals. Patients were markedly less likely to give a direct answer to the open-ended goals question.
Conclusion
There were important differences in aspirations between people with DMD and their peers. These findings may be helpful for developing psychosocial interventions.
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8
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Akaishi T. Obsession and Maladaptive Search for Raison D'être: A Condition That May Harm Psychological Wellbeing. Front Psychol 2022; 13:845834. [PMID: 35719547 PMCID: PMC9202496 DOI: 10.3389/fpsyg.2022.845834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 05/05/2022] [Indexed: 11/29/2022] Open
Abstract
Being with raison d’être, or the meaning of living, usually has a positive effect on the psychological wellbeing of humans. The impact of an endeavor or desire to be with raison d’être on human wellbeing remains undetermined. This study investigated the potential impact of an obsession with raison d’être on human psychological wellbeing. A literature review revealed that only a limited number of studies have evaluated the relationship between attitudes toward raison d’être and psychological wellbeing. Some indicate that a pathological obsession with a self-oriented raison d’être, especially when the search is attempted via maladaptive ways, may eventually cause harm and distress to those who are the objects of obsession and the surrounding people. If obsessed people persist to preserve raison d’être in the community, they need to continuously demonstrate the advantage of their existence and differentiation from other members. As conceivable adaptive ways to search for raison d’être, people make efforts to enhance their talents, achieve certifications, be promoted, or dedicate themselves to volunteers. However, if these adaptive ways have failed, some obsessed people may change their processes to maladaptive ways, such as attacking or criticizing other members who are a threat to their satisfaction with raison d’être. Such maladaptive approaches in the community would harm both the obsessed and surrounding members. To date, the negative aspect of desiring for raison d’être has remained largely unevaluated. Research regarding the prevalence of pathologic obsession with raison d’être in the general population, its impact on human wellbeing, and treatability is warranted.
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Affiliation(s)
- Tetsuya Akaishi
- Division of General Internal Medicine, Tohoku University, Sendai, Japan.,Department of Education and Support for Regional Medicine, Tohoku University Hospital, Sendai, Japan
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9
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Chytas V, Costanza A, Mazzola V, Luthy C, Galani V, Bondolfi G, Cedraschi C. Possible Contribution of Meaning in Life in Patients With Chronic Pain and Suicidal Ideation: Observational Study. JMIR Form Res 2022; 6:e35194. [PMID: 35699974 PMCID: PMC9237781 DOI: 10.2196/35194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 03/06/2022] [Accepted: 04/10/2022] [Indexed: 11/13/2022] Open
Abstract
Background Chronic pain is associated with an elevated risk of suicidal ideation (SI). Objective We aimed to examine if the presence or the search for Meaning in Life (MiL) are associated with less SI and explore whether MiL profiles emerge in our cohort. These profiles can be described as high presence–high search, high presence–low search, low presence–low search, and low presence–high search. Methods In this observational study, we recruited 70 patients who were referred to the Multidisciplinary Pain Center of the Geneva University Hospitals and who answered positively to question 9 on the Beck Depression Inventory, 2nd Edition, investigating SI. Patients who agreed to participate in the study were further investigated; they participated in a structured diagnostic interview to screen for psychiatric diagnoses. During this interview, they completed the Meaning in Life Questionnaire and the semistructured Scale for Suicide Ideation (SSI) to assess the characteristics and severity of SI. Results There was a statistically significant correlation between the presence of MiL subscale and the SSI. These 2 scales had a negative and statistically highly significant correlation (R=–.667; P<.001). The results also showed a negative and statistically highly significant correlation between the score of the search for MiL and the SSI (R=–.456; P<.001). The results thus pointed to the presence of MiL as a potential protective factor against the severity of SI, while the search for MiL is also a possible resiliency factor, although to a lesser extent. The profile low presence–low search grouped the vast majority (47%) of the patients; in these patients, the mean SSI score was 14.36 (SD 5.86), much higher compared with that of the other subgroups. Conclusions This study’s results point to MiL as a concept of interest regarding devising psychotherapeutic interventions for chronic pain patients in order to reduce the suicidal risk and more accurately determine patients’ suffering.
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Affiliation(s)
- Vasileios Chytas
- Department of Psychiatry, Service of Liaison Psychiatry and Crisis Intervention, Geneva University Hospitals, Geneva, Switzerland
| | - Alessandra Costanza
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Viridiana Mazzola
- Department of Psychiatry, Service of Liaison Psychiatry and Crisis Intervention, Geneva University Hospitals, Geneva, Switzerland
| | - Christophe Luthy
- Division of General Medical Rehabilitation, Geneva University Hospitals, Geneva, Switzerland
- Department of Geriatrics and Rehabilitation, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Vasiliki Galani
- Department of Psychiatry, Service of Liaison Psychiatry and Crisis Intervention, Geneva University Hospitals, Geneva, Switzerland
| | - Guido Bondolfi
- Department of Psychiatry, Service of Liaison Psychiatry and Crisis Intervention, Geneva University Hospitals, Geneva, Switzerland
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Christine Cedraschi
- Division of General Medical Rehabilitation, Geneva University Hospitals, Geneva, Switzerland
- Department of Geriatrics and Rehabilitation, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Centre, Geneva University Hospitals, Geneva, Switzerland
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10
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Boring BL, Maffly-Kipp J, Mathur VA, Hicks JA. Meaning in Life and Pain: The Differential Effects of Coherence, Purpose, and Mattering on Pain Severity, Frequency, and the Development of Chronic Pain. J Pain Res 2022; 15:299-314. [PMID: 35140515 PMCID: PMC8820455 DOI: 10.2147/jpr.s338691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 01/05/2022] [Indexed: 11/23/2022] Open
Abstract
Objective Meaning in life is consistently associated with better health outcomes across a range of mental and physical domains. However, meaning in life is a complex construct involving three distinct facets: coherence, purpose, and mattering. While these facets have been studied individually in relation to pain, they have not been assessed concurrently to parse out their potential distinct contributions to pain outcomes. We sought to identify the unique relationships of these individual facets of meaning with pain experiences and specify the components associated with pain-related resilience. Methods The associations of coherence, purpose, and mattering with pain outcomes were examined across three studies. Study 1 used data from the Midlife in the United States National Survey to determine associations between facets and the frequency of various recently experienced pains, and the development of chronic pain nine years later. Study 2 cross-sectionally observed the association between facets and recent pain severity in young adults. Using a diary-type approach, Study 3 captured fluctuations of pain severity in relation to the facets across the span of four weeks. Results Coherence was uniquely associated with less headache, backache, joint, and extremities pain frequency in Study 1, over and above purpose and mattering, controlling for other health variables. Coherence was also associated with lower odds of developing chronic pain. In Study 2, coherence was associated with less pain severity and fully mediated the relationship between global meaning in life and pain. Study 3 found that coherence predicted the most unique variance in weekly pain fluctuations. Conclusion Across three studies and timescales, coherence was uniquely associated with fewer and less severe pain experiences over and above purpose and mattering. These findings provide support for the value of coherence as a resilience factor in the context of pain and suggest a potential benefit for coherence-specific interventions in clinical settings.
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Affiliation(s)
- Brandon L Boring
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, 77843, USA
- Correspondence: Brandon L Boring, Department of Psychological and Brain Sciences, Texas A&M University, 4235 TAMU, College Station, TX, 77843, USA, Email
| | - Joseph Maffly-Kipp
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, 77843, USA
| | - Vani A Mathur
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, 77843, USA
- Institute for Neuroscience, Texas A&M University, College Station, TX, 77843, USA
| | - Joshua A Hicks
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, 77843, USA
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11
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Xu RH, Dong D. Patient-Proxy Agreement Regarding Health-Related Quality of Life in Survivors with Lymphoma: A Propensity-Score Matching Analysis. Cancers (Basel) 2022; 14:cancers14030607. [PMID: 35158875 PMCID: PMC8833321 DOI: 10.3390/cancers14030607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 01/13/2022] [Accepted: 01/24/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: To assess the difference between lymphoma survivors' self- and proxy-reported health-related quality of life (HRQoL) and its association with socioeconomic and health statuses. Methods: The data used in this study were obtained from a nationwide cross-sectional online survey in 2019. Information about participants' demographics, health status and HRQoL were collected. The propensity-score matching (PSM) method was used to control the effect of potential confounders on selection bias. A chi-squared test, one-way analysis of variance, and multiple linear regression models were used to assess the relationship between HRQoL and response type adjusted to respondents' background characteristics. Results: Out of the total 4400 participants, data of 2350 ones were elicited for analysis after PSM process. Patients' self-reported outcomes indicated a slightly better physical, role and emotional functioning than proxy-reported outcomes. Regression analysis showed that patients, who were older, unemployed, and who received surgery, were more likely to report a lower HRQoL. Further analysis demonstrated that proxy-reported patients who had completed treatment were more likely to report a higher HRQoL than those who were being treated. Conclusions: Our study demonstrates that the agreement between self- and proxy-reported HRQoL is low in patients with lymphoma and the heterogeneities of HRQoL among patients with different types of aggressive NHL (Non-Hodgkin's lymphoma) is large. Differences in self- and proxy-reported HRQoL should be considered by oncologists when selecting and deciding the optimal care plan for lymphoma survivors.
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Affiliation(s)
- Richard Huan Xu
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China;
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Dong Dong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
- Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen 518000, China
- Correspondence:
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12
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Wang W, Ma W. Construction of a Meaning Effectiveness Model: A new interpretation of meaning in life. NEW IDEAS IN PSYCHOLOGY 2021. [DOI: 10.1016/j.newideapsych.2021.100876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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13
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Böhmer MC, la Cour P, Schnell T. A Randomized controlled trial of the Sources of Meaning Card Method: A new meaning-oriented approach predicts depression, anxiety, pain acceptance, and crisis of meaning in chronic pain patients. PAIN MEDICINE 2021; 23:314-325. [PMID: 34730813 DOI: 10.1093/pm/pnab321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 07/25/2021] [Accepted: 08/24/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Although considered the first-line psychological treatment of chronic pain, cognitive behavioural therapy has recently been criticized as being too limited, insufficient, and sometimes ineffective in the treatment of chronic pain patients. Moreover, important existential perspectives are sparsely or not at all integrated into CBT. We therefore propose to complement chronic pain treatment with a meaning-based intervention, the Sources of Meaning Card Method (SoMeCaM). This study tested its efficacy. DESIGN A randomized controlled trial was conducted with 42 chronic pain patients, comparing an intervention group (standard care and participation in the SoMeCaM, a meaning-oriented approach) with a control group (standard care). We evaluated both groups at baseline, 1 (t1) and 2 months (t2) after the intervention. The primary outcome assessed was pain acceptance, while depression, anxiety, pain intensity, pain medication, satisfaction with life, meaningfulness, and crisis of meaning were examined as secondary outcomes. RESULTS Comparisons within and between groups showed significant treatment effects at t1. Higher increases in pain acceptance and decreases in anxiety, depression and crisis of meaning were observed in the intervention group. Improvements in pain acceptance and anxiety persisted until t2, when pain intensity was also lower. Effect sizes at t2 were medium to large. CONCLUSION Our preliminary work demonstrates the importance of the existential perspective in chronic pain therapy.
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Affiliation(s)
- Miriam C Böhmer
- Department of Orthopaedics and Trauma Surgery, Musculoskeletal University Center Munich (MUM), University Hospital, LMU Munich, Munich, Germany.,Institute of Psychology, University of Bern, Bern, Switzerland
| | - Peter la Cour
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Tatjana Schnell
- Institute of Psychology, Leopold-Franzens University, Innsbruck, Austria.,MF Norwegian School of Theology, Religion and Society, Oslo, Norway
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14
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Lovell M, Corbett M, Dong S, Siddall P. Spiritual Well-Being in People Living with Persistent Non-Cancer and Cancer-Related Pain. PAIN MEDICINE 2021; 22:1345-1352. [PMID: 33296472 DOI: 10.1093/pm/pnaa414] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Existential and spiritual factors are known to play an important role in how people cope with disability and life-threatening illnesses such as cancer. However, comparatively little is known about the impact of pain on factors such as meaning and purpose in one's life and their potential roles in coping with pain. OBJECTIVES The aim of this study was to determine spiritual well-being scores in people with persistent pain and to compare these with people with cancer and healthy controls. METHODS We assessed 132 people with chronic pain, 74 people with cancer (49 with pain and 25 without pain) and 68 control participants using standardised measures of pain-related variables including pain intensity, physical function, mood and cognitions. Spiritual well-being was also assessed using a validated and widely used questionnaire, the Functional Assessment of Chronic Illness Therapy - Spirituality Scale (FACIT-Sp). RESULTS Spiritual well-being scores were significantly lower in people with persistent pain when compared with controls and were no different when compared with people with cancer, including those who had cancer and pain. In addition, low levels of meaning and purpose were significant predictors of depression, anxiety, and stress across all groups. CONCLUSION The findings demonstrate that persistent pain is associated with spiritual distress that is equal to those observed in people who have cancer. Furthermore, those who have higher levels of meaning and purpose are less likely to develop mood dysfunction when experiencing pain, indicating they may have a protective role.
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Affiliation(s)
- Melanie Lovell
- Department of Palliative & Supportive Care, Greenwich Hospital, HammondCare, Sydney, Australia.,Sydney Medical School - Northern, University of Sydney, Sydney, NSW, Australia
| | - Mandy Corbett
- Department of Pain Management, Greenwich Hospital, HammondCare, Sydney, Australia
| | - Skye Dong
- Department of Pain Management, Greenwich Hospital, HammondCare, Sydney, Australia
| | - Philip Siddall
- Sydney Medical School - Northern, University of Sydney, Sydney, NSW, Australia.,Department of Pain Management, Greenwich Hospital, HammondCare, Sydney, Australia.,Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, NSW, Australia
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15
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Costanza A, Chytas V, Piguet V, Luthy C, Mazzola V, Bondolfi G, Cedraschi C. Meaning in Life Among Patients With Chronic Pain and Suicidal Ideation: Mixed Methods Study. JMIR Form Res 2021; 5:e29365. [PMID: 34003136 PMCID: PMC8214181 DOI: 10.2196/29365] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 05/06/2021] [Accepted: 05/16/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Patients with chronic pain have elevated risk of suicidal ideation and behavior, including suicide attempts and completed suicides. In most studies, associations between chronic pain and suicidal ideation/suicidal behavior are robust even after adjusting for the effect of sociodemographics and psychiatric comorbidity. However, to refine the risk profile of these patients, further exploration of other possible risk and protective factors is necessary. OBJECTIVE There is a common clinical observation that experiencing chronic pain often requires a revision of life goals and expectations, and hence, it impacts the existential domain including one's perception of the meaning in life (MiL). This study aimed to characterize the main domains that constitute the personal MiL, including the "presence of" and "search for" constructs, in a group of patients with chronic pain and suicidal ideation. METHODS Seventy participants were enlisted by ongoing recruitment through a larger project anchored in daily clinical practice at the Multidisciplinary Pain Center of the Geneva University Hospitals. It was an observational mixed method study. Data were recorded through both validated quantitative questionnaires and qualitative open-ended questions. RESULTS The total sample consisted of 70 patients. Responses to questionnaires showed a depressive episode in 68 (97%) patients and anxious disorders in 25 (36%) patients. With a score threshold for positive MiL of 24, the mean score for the "presence of" construct was 20.13 (SD 8.23), and 63% (44/70) of respondents had a score <24. The mean score for the "search for" construct was lower at 18.14 (SD 8.64), and 70% (49/70) of respondents had a score <24. The "presence of" and "search for" constructs were significantly positively correlated (R=0.402; P=.001). An open question addressed the "presence of" construct by inviting the respondents to cite domains they consider as providing meaning in their life at the present time. All patients responded to this question, citing one or more domains. The three main dimensions that emerged from content analysis of this qualitative section were as follows: the domain of relationships, the domain of personal activities, and pain and its consequences on MiL. CONCLUSIONS The study results provide insights into patients with chronic pain and suicidal ideation, including the domains that provide them with meaning in their lives and the impact of pain on these domains with regard to suicidal ideation. The main clinical implications concern both prevention and supportive/psychotherapeutic interventions. They are based on a narrative approach aiming to explore with the patients the content of their suffering and the MiL domains that they could identify to mitigate it, in order to restructure/reinforce these domains and thus possibly reduce suicidal ideation. Specifically, a focus on maintaining the domains of interpersonal relationships and personal activities can allow patients to ultimately escape the biopsychosocial vicious cycle of chronic pain-induced deep moral suffering.
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Affiliation(s)
- Alessandra Costanza
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Vasileios Chytas
- Division of Clinical Pharmacology & Toxicology, Multidisciplinary Pain Centre, Geneva University Hospitals, Geneva, Switzerland.,Department of Psychiatry, Service of Liaison Psychiatry and Crisis Intervention, Geneva University Hospitals, Geneva, Switzerland
| | - Valérie Piguet
- Division of Clinical Pharmacology & Toxicology, Multidisciplinary Pain Centre, Geneva University Hospitals, Geneva, Switzerland
| | - Christophe Luthy
- Division of General Medical Rehabilitation, Geneva University Hospitals, Geneva, Switzerland.,Department of Geriatrics and Rehabilitation, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Viridiana Mazzola
- Department of Psychiatry, Service of Liaison Psychiatry and Crisis Intervention, Geneva University Hospitals, Geneva, Switzerland
| | - Guido Bondolfi
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Department of Psychiatry, Service of Liaison Psychiatry and Crisis Intervention, Geneva University Hospitals, Geneva, Switzerland
| | - Christine Cedraschi
- Division of Clinical Pharmacology & Toxicology, Multidisciplinary Pain Centre, Geneva University Hospitals, Geneva, Switzerland.,Division of General Medical Rehabilitation, Geneva University Hospitals, Geneva, Switzerland.,Department of Geriatrics and Rehabilitation, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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16
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Steineck A, Barton KS, Bradford MC, Yi-Frazier JP, Rosenberg AR. Tincture of Time: The Evolution of Goals in Adolescents and Young Adults with Cancer. J Adolesc Young Adult Oncol 2021; 10:703-710. [PMID: 33960833 DOI: 10.1089/jayao.2020.0223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: A diagnosis of cancer often derails an individual's goals. The purpose of this mixed-methods analysis was to describe the evolution of adolescent and young adult (AYA)-reported goals in the year after a diagnosis of new or advanced cancer. Methods: As part of the Promoting Resilience in Stress Management (PRISM) phase 2 randomized controlled trial, AYAs with cancer (ages 12-25 years) were asked at baseline, 6 months, and 12 months: "Please give an example of a goal you hope to accomplish over the next month/year." We used content analysis to categorize goals as follows: life milestones, physical health, mental/emotional health, cancer specific, and hobbies/interests. We summarized goal categories at each time point: for the entire cohort, by baseline diagnosis status (new vs. advanced cancer), treatment status (on-therapy vs. off-therapy), and baseline health-related quality of life (high vs. low). Results: Eighty-six participants completed the study and were included in the analysis (control: n = 41, PRISM: n = 45); 69 reported their goals at 6 months, and 54 at 12 months. Participants submitted a total of 169 goals at baseline, 148 at 6 months, and 126 at 12 months. At baseline, cancer-specific goals were most common for the short-term (35%), whereas milestone goals were most common for the long-term (46%). At 6 months, milestone goals were most common in both short- (38%) and long-term (51%) categories. A similar pattern was seen at 12 months. Conclusion: AYAs' goals change over the first year of their cancer experience, with a shift in short-term goals from cancer-specific goals at baseline to milestone goals at later time points. ClinicalTrials.gov (NCT02340884).
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Affiliation(s)
- Angela Steineck
- Center for Cancer and Blood Disorders Center, Seattle Children's Hospital, Seattle, Washington, USA.,Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA.,Palliative Care and Resilience Research Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA.,Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA
| | - Krysta S Barton
- Palliative Care and Resilience Research Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA.,Biostatistics Epidemiology and Analytics for Research (BEAR) Core, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Miranda C Bradford
- Palliative Care and Resilience Research Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA.,Biostatistics Epidemiology and Analytics for Research (BEAR) Core, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Joyce P Yi-Frazier
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA.,Palliative Care and Resilience Research Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA.,Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA
| | - Abby R Rosenberg
- Center for Cancer and Blood Disorders Center, Seattle Children's Hospital, Seattle, Washington, USA.,Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington, USA.,Palliative Care and Resilience Research Lab, Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, Washington, USA.,Cambia Palliative Care Center of Excellence, University of Washington, Seattle, Washington, USA
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Costanza A, Chytas V, Mazzola V, Piguet V, Desmeules J, Bondolfi G, Cedraschi C. The Role of Demoralization and Meaning in Life (DEMIL) in Influencing Suicidal Ideation Among Patients Affected by Chronic Pain: Protocol of a Single-Center, Observational, Case-Control Study. JMIR Res Protoc 2020; 9:e24882. [PMID: 33144275 PMCID: PMC7728536 DOI: 10.2196/24882] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/03/2020] [Accepted: 11/03/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Chronic pain is a significant risk factor for suicidal ideation (SI) and suicidal behavior (SB), including a 20%-40% prevalence rate of SI, a prevalence between 5% and 14% of suicide attempts, and a doubled risk of death by suicide in patients with chronic pain compared to controls. In most studies, associations between chronic pain and suicidality are robust, even after adjusting for the effect of sociodemographics and psychiatric comorbidity, and particularly for depressive conditions. A number of specific conditions that can modulate suicidality risk in patients with chronic pain have been investigated, but there is a need for their more specific characterization. Numerous recent studies have shown that demoralization and meaning in life (MiL) constructs affect suicidality as risk and protective factors, respectively. These constructs have been mainly investigated in patients with somatic illness and in community-dwelling individuals who may present with SI or SB independently of a psychiatric diagnosis of depression. However, a paucity of studies investigated them in suicidal patients affected by chronic pain. OBJECTIVE The primary objective of this project is to investigate the relationship between demoralization and MiL on SI risk in patients with chronic pain. The secondary objectives are (1) to test whether demoralization can occur independently of depression in patients with chronic pain and SI, (2) to examine whether the expected association between demoralization and SI may be explained by a sole dimension of demoralization: hopelessness, (3) to examine whether the presence of MiL, but not the search for MiL, is associated with less SI, and (4) to explore whether previously described MiL profiles (ie, high presence-high search, high presence-low search, moderate presence-moderate search, low presence-low search, and low presence-high search) emerge in our cohort. METHODS This project is a single-center, observational, case-control study-the Demoralization and Meaning in Life (DEMiL) study-conducted by the Division of Clinical Pharmacology and Toxicology, the Multidisciplinary Pain Centre, and the Service of Liaison Psychiatry and Crisis Intervention at the Geneva University Hospitals. Self- and hetero-administered questionnaires were conducted among patients and controls, matched by age and gender. The Ethics Committee of the Canton of Geneva approved the scientific utilization of collected data (project No. 2017-02138; decision dated January 25, 2018). Data have been analyzed with SPSS, version 23.0, software (IBM Corp). RESULTS From March 1, 2018, to November 30, 2019, 70 patients and 70 controls were enrolled. Statistical analyses are still in progress and are expected to be finalized in November 2020. To date, we did not observe any unfavorable event for which a causal relationship with the collection of health-related personal data could be ruled out. Results of this study are expected to form the basis for possible prevention and psychotherapeutic interventions oriented toward demoralization and MiL constructs for suicidal patients with chronic pain. CONCLUSIONS The interest in exploring demoralization and MiL in chronic pain patients with SI arises from the common clinical observation that experiencing chronic pain often requires a revision of one's life goals and expectations. Hence, the impact of chronic pain is not limited to patients' biopsychosocial functioning, but it affects the existential domain as well. The major clinical implications in suicidal patients with chronic pain consist in trying to (1) delineate a more precise and individualized suicide risk profile, (2) improve detection and prevention strategies by investigating SI also in individuals who do not present with a clinically diagnosed depression, and (3) enhance the panel of interventions by broadening supportive or psychotherapeutic actions, taking into consideration the existential condition of a person who suffers and strives to deal with his or her suffering. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/24882.
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Affiliation(s)
- Alessandra Costanza
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of Psychiatry, Santi Antonio e Biagio e Cesare Arrigo Hospital, Alessandria, Italy
| | - Vasileios Chytas
- Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Center, Geneva University Hospitals, Geneva, Switzerland
| | - Viridiana Mazzola
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of Psychiatry, Service of Liaison Psychiatry and Crisis Intervention, Geneva University Hospitals, Geneva, Switzerland
| | - Valérie Piguet
- Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Center, Geneva University Hospitals, Geneva, Switzerland
| | - Jules Desmeules
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Center, Geneva University Hospitals, Geneva, Switzerland
| | - Guido Bondolfi
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Department of Psychiatry, Service of Liaison Psychiatry and Crisis Intervention, Geneva University Hospitals, Geneva, Switzerland
| | - Christine Cedraschi
- Department of Psychiatry, Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Center, Geneva University Hospitals, Geneva, Switzerland
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18
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Sanders JJ, Miller K, Desai M, Geerse OP, Paladino J, Kavanagh J, Lakin JR, Neville BA, Block SD, Fromme EK, Bernacki R. Measuring Goal-Concordant Care: Results and Reflections From Secondary Analysis of a Trial to Improve Serious Illness Communication. J Pain Symptom Manage 2020; 60:889-897.e2. [PMID: 32599148 DOI: 10.1016/j.jpainsymman.2020.06.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 06/05/2020] [Accepted: 06/14/2020] [Indexed: 01/17/2023]
Abstract
CONTEXT Many consider goal-concordant care (GCC) to be the most important of advance care planning and palliative care. Researchers face significant challenges in attempting to measure this outcome. We conducted a randomized controlled trial to assess the effects of a system-level intervention to improve serious illness communication on GCC and other outcomes. OBJECTIVES To describe our measurement approach to GCC, present findings from a post-hoc analysis of trial data, and discuss lessons learned about measuring GCC. METHODS Using trial data collected to measure GCC, we analyzed ratings and rankings from a nonvalidated survey of patient priorities in the setting of advanced cancer, the Life Priorities Scale, and compared outcomes with correlative measures. RESULTS Participants commonly rated several predetermined and literature-derived priorities as important but did so in ways that were commonly incongruent with rankings. Ratings were frequently stable over time; rankings less so. Rankings are more likely to help assess the degree to which care is goal concordant but may be best augmented by corollary measures that signal achievement of a given priority. CONCLUSION Measuring GCC remains a fundamental challenge to palliative care researchers. Ratings attest to the fact that many things matter to patients; however, rankings can better determine what matters most. Insights gained from our experience may guide future research aiming to use this outcome to assess the effect of intervention to improve serious illness care.
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Affiliation(s)
- Justin J Sanders
- Harvard Medical School, Boston, MA, USA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA; Ariadne Labs, Brigham and Women's Hospital and Harvard T. H. Chan School of Public Health, Boston, MA, USA; Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
| | - Kate Miller
- Ariadne Labs, Brigham and Women's Hospital and Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Meghna Desai
- Ariadne Labs, Brigham and Women's Hospital and Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Olaf P Geerse
- Ariadne Labs, Brigham and Women's Hospital and Harvard T. H. Chan School of Public Health, Boston, MA, USA; Department of Pulmonary Diseases, Academic Medical Center, Amsterdam, The Netherlands
| | - Joanna Paladino
- Harvard Medical School, Boston, MA, USA; Ariadne Labs, Brigham and Women's Hospital and Harvard T. H. Chan School of Public Health, Boston, MA, USA; Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Jane Kavanagh
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA; Ariadne Labs, Brigham and Women's Hospital and Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Joshua R Lakin
- Harvard Medical School, Boston, MA, USA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA; Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Bridget A Neville
- Ariadne Labs, Brigham and Women's Hospital and Harvard T. H. Chan School of Public Health, Boston, MA, USA
| | - Susan D Block
- Harvard Medical School, Boston, MA, USA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA; Ariadne Labs, Brigham and Women's Hospital and Harvard T. H. Chan School of Public Health, Boston, MA, USA; Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA; Department of Psychiatry, Brigham and Women's Hospital, Boston, MA, USA
| | - Erik K Fromme
- Harvard Medical School, Boston, MA, USA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA; Ariadne Labs, Brigham and Women's Hospital and Harvard T. H. Chan School of Public Health, Boston, MA, USA; Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Rachelle Bernacki
- Harvard Medical School, Boston, MA, USA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA; Ariadne Labs, Brigham and Women's Hospital and Harvard T. H. Chan School of Public Health, Boston, MA, USA; Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
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19
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Szcześniak M, Świątek AH, Cieślak M, Świdurska D. Disease Acceptance and Eudemonic Well-Being Among Adults With Physical Disabilities: The Mediator Effect of Meaning in Life. Front Psychol 2020; 11:525560. [PMID: 33192766 PMCID: PMC7643024 DOI: 10.3389/fpsyg.2020.525560] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 08/26/2020] [Indexed: 12/15/2022] Open
Abstract
The acceptance of disability is recognized as one of the most frequently mentioned factors that plays a particularly significant role in subjective well-being. However, so far, only a very small amount of research has been undertaken to clarify how and why acceptance of illness relates to eudemonic well-being. Hence, comprehension of the direct and indirect effects underlying this relationship seems essential for interventions that increase the recovery of people with impairments and enhance their quality of life. The current research was aimed at investigating the association between acceptance of illness, meaning in life, and eudemonic well-being, as well as the possible mediatory effect of meaning in life on the relationship between acceptance of illness and well-being. The sample consisted of 102 participants (71% women) aged between 20 and 64 years. The respondents had a range of different impairments (e.g., cerebral palsy, neurological disorders, spinal muscular atrophy, and sight defects). The Acceptance of Illness Scale, the Meaning in Life Questionnaire, and the Ryff Scales of Psychological Well-Being were used. It was confirmed that acceptance of illness correlated positively and significantly with the presence of meaning, self-acceptance, positive relations, environmental mastery, personal growth, general well-being, cohesion, flexibility, communication, and family satisfaction. The presence of meaning mediated the relationship between acceptance of illness and general well-being with its four other dimensions: self-acceptance, environmental mastery, purpose in life, and personal growth. Conversely, the search for meaning did not have any mediatory effect on this relationship.
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Affiliation(s)
| | - Agata H Świątek
- Institute of Psychology, University of Szczecin, Szczecin, Poland
| | | | - Daria Świdurska
- Institute of Psychology, University of Szczecin, Szczecin, Poland
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20
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Hoskote M, Le G, Cherian R, Zeiger R, Sarkar U. Cancer patient perspectives on survivorship goals from the Smart Patients online community. Support Care Cancer 2020; 29:2375-2384. [PMID: 32918605 DOI: 10.1007/s00520-020-05734-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Cancer impacts individuals' life goals. Recent cancer care guidelines recommend discussing life goals as part of patient-provider communication. The goal of this study was to understand patients' attitudes toward goal sharing with their cancer care providers. PATIENTS AND METHODS Semi-structured questionnaires were conducted via email with cancer patients and survivors (n = 39) on an online social network called Smart Patients. Participants answered open-ended questions about their life goals. They then completed a survey regarding their attitudes toward goal sharing with healthcare providers. The study team used an integrated inductive-deductive qualitative analysis to identify conceptual themes. RESULTS Participants listed goals related to improving physical activity, control, enjoyment/leisure, and inner strength while reducing pain, anxiety, fear of recurrence, and uncertainty. Most of these goals were life goals rather than goals specifically related to medical care. Across all goals, there was a focus on returning to normality. Our findings show that 87% of participants expect their cancer specialist to discuss their treatment preferences and goals regularly with them. However, participants were reluctant to share their goals with their providers. Respondents felt that their providers did not have an interest in their life goals or time to address them in addition to their medical treatment. CONCLUSION Even though cancer patient-provider communication guidelines advocate for discussions around life goals, participants in this study expressed reluctance to share life goals with providers. Further efforts to align expectations of patients and providers may facilitate adherence to cancer communication guidelines about life goals. IMPLICATIONS FOR CANCER SURVIVORS Cancer survivors should be aware that discussing life goals is part of recommended communication with their cancer care teams.
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Affiliation(s)
- Mekhala Hoskote
- Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, Center for Vulnerable Populations, University of California San Francisco, 1001 Potrero Avenue, Box 1364, San Francisco, CA, USA
| | - Gem Le
- Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, Center for Vulnerable Populations, University of California San Francisco, 1001 Potrero Avenue, Box 1364, San Francisco, CA, USA
| | - Roy Cherian
- Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, Center for Vulnerable Populations, University of California San Francisco, 1001 Potrero Avenue, Box 1364, San Francisco, CA, USA
| | | | - Urmimala Sarkar
- Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, Center for Vulnerable Populations, University of California San Francisco, 1001 Potrero Avenue, Box 1364, San Francisco, CA, USA.
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21
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Ax AK, Johansson B, Carlsson M, Nordin K, Börjeson S. Exercise: A positive feature on functioning in daily life during cancer treatment - Experiences from the Phys-Can study. Eur J Oncol Nurs 2019; 44:101713. [PMID: 31877511 DOI: 10.1016/j.ejon.2019.101713] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 12/05/2019] [Accepted: 12/09/2019] [Indexed: 12/22/2022]
Abstract
PURPOSE Impaired functioning due to cancer treatment is a challenge for daily life. Exercise during treatment can improve functioning. However, research describing experiences of how exercise affects activities of daily life is limited. We aimed to explore how individuals with cancer receiving curative treatment and participating in an exercise intervention experienced their functioning in daily life. METHODS Twenty-one participants were recruited from Phys-Can, an exercise intervention study. Semi-structured interviews were conducted after the intervention had finished, and data was analysed using thematic analysis. RESULTS Two main themes evolved: "Striving to maintain a normal life in a new context" and "Struggling with impairments from side effects of cancer treatment". The supervised group exercise proved popular, and participants reported positive effects on physical and psychological functioning, as well as social and informative support from other participants. Participants struggled with impaired cognitive and physical functioning and exhaustion. They strove to maintain a normal life by adjusting their activities. CONCLUSIONS Perceived physical and psychological benefits from exercise during cancer treatment suggest that exercise should be a part of cancer rehabilitation to facilitate activities and participation in daily life. Striving to maintain a normal life during cancer treatment is vital, and adjustments are needed to maintain activities and participation in daily life. Cancer nurses should motivate patients to engage in physical activity and encourage the introduction of exercise as part of their rehabilitation. They could also support patients in making adjustments to maintain functioning in daily life.
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Affiliation(s)
- Anna-Karin Ax
- Department of Oncology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
| | - Birgitta Johansson
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden; Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
| | - Maria Carlsson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden.
| | - Karin Nordin
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden; Department of Public Health, Sport and Nutrition, University of Agder, Kristiansand, Norway.
| | - Sussanne Börjeson
- Department of Oncology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
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Radomski MV, Swenson KK, Anheluk M, Zola J, Kreiger R, Rabusch S, Halsten J, Kath K, Carroll G, Zust BL. The feasibility of a purpose-renewal intervention after treatment for early stage breast cancer: A brief report. J Psychosoc Oncol 2019; 38:501-509. [DOI: 10.1080/07347332.2019.1692990] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | | | - Mattie Anheluk
- Courage Kenny Rehabilitation Institute, Minneapolis, Minnesota, USA
| | - Joette Zola
- Courage Kenny Rehabilitation Institute, Minneapolis, Minnesota, USA
| | - Rob Kreiger
- Courage Kenny Research Center, Minneapolis, Minnesota, USA
| | - Stacey Rabusch
- Courage Kenny Research Center, Minneapolis, Minnesota, USA
| | - Jerry Halsten
- Courage Kenny Rehabilitation Institute, Minneapolis, Minnesota, USA
| | - Kristina Kath
- Courage Kenny Research Center, Minneapolis, Minnesota, USA
| | - Ginger Carroll
- Courage Kenny Research Center, Minneapolis, Minnesota, USA
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Almeida VM, Carvalho C, Pereira MG. The contribution of purpose in life to psychological morbidity and quality of life in chronic pain patients. PSYCHOL HEALTH MED 2019; 25:160-170. [PMID: 31522538 DOI: 10.1080/13548506.2019.1665189] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Chronic pain is a cause of morbidity, interference with daily functioning, decreased health and quality of life. Purpose in life acts as a protective factor and mitigates these consequences. This cross-sectional study aimed to determine whether purpose in life contributed to psychological morbidity and quality of life in patients with chronic pain by controlling psychological variables related to health (pain severity and interference, pain perceptions, pain catastrophizing and coping). The sample included 103 patients diagnosed with chronic pain. Results showed that purpose in life independently contributed to psychological morbidity and to mental quality of life, but not to physical quality of life, after controlling for pain-related variables. Results showed the relevance of purpose in life to identify patients at risk of developing psychological morbidity and decreased quality of life, suggestting the need to intervene in chronic pain, specifically on purpose in life, to prevent psychological morbidity and promote quality of life, in this population.
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Affiliation(s)
| | - Cátia Carvalho
- School of Psychology, University of Minho, Braga, Portugal
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Affiliation(s)
- Svetlana Savina
- Department of Out-Patient, Medical Center Hippocrates, Russian Federation
| | - Boris Zaydiner
- Regional Cancer Center, Rostov-on-Don, Russian Federation
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Rokach A, Rosenstreich E, Brill S, Goor Aryeh I. People with Chronic Pain and Caregivers: Experiencing Loneliness and Coping with It. CURRENT PSYCHOLOGY 2018. [DOI: 10.1007/s12144-017-9571-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Neville S, Adams J, Montayre J, Larmer P, Garrett N, Stephens C, Alpass F. Loneliness in Men 60 Years and Over: The Association With Purpose in Life. Am J Mens Health 2018; 12:730-739. [PMID: 29458295 PMCID: PMC6131432 DOI: 10.1177/1557988318758807] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Loneliness as a consequence of getting older negatively impacts on the health and
well-being of men as they age. Having a purpose in life may mitigate loneliness and
therefore positively impact on health and well-being. Limited research into loneliness and
purpose in life has been undertaken in older men. This study seeks to understand the
relationship between loneliness and purpose in life in a group of older men. Using data
from a cross-sectional survey of 614 men aged 60 years and over living in New Zealand,
bivariate and multivariate analyses were undertaken to examine the relationship between
loneliness and purpose in life using a range of demographic, health, and social connection
variables. Bivariate analysis revealed that being unpartnered and having low socioeconomic
status, limited social networks, low levels of participation, and mental health issues
were associated with loneliness. Multivariate analysis showed that having poor mental
health and lower purpose in life were indicators of loneliness. Consequently, improving
mental health and purpose in life are likely to reduce loneliness in at-risk older men. As
older men are a heterogeneous group from a variety of sociocultural and ethnic
backgrounds, a multidimensional approach to any intervention initiatives needs to
occur.
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Affiliation(s)
- Stephen Neville
- 1 Department of Nursing, Auckland University of Technology, Auckland, New Zealand
| | - Jeffery Adams
- 2 SHORE & Whariki Research Centre, Massey University, Auckland, New Zealand
| | - Jed Montayre
- 1 Department of Nursing, Auckland University of Technology, Auckland, New Zealand
| | - Peter Larmer
- 3 School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Nick Garrett
- 4 Department of Biostatistics and Epidemiology, Auckland University of Technology, Auckland, New Zealand
| | - Christine Stephens
- 5 School of Psychology, Massey University, Palmerston North, New Zealand
| | - Fiona Alpass
- 5 School of Psychology, Massey University, Palmerston North, New Zealand
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Burd KA, Burrow AL. Conceptualizing similarities and differences between purpose in life and self-affirmation. SOCIAL AND PERSONALITY PSYCHOLOGY COMPASS 2017. [DOI: 10.1111/spc3.12366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Dose A, Hubbard J, Mansfield A, McCabe P, Krecke C, Sloan J. Feasibility and Acceptability of a Dignity Therapy/Life Plan Intervention for Patients With Advanced Cancer. Oncol Nurs Forum 2017; 44:E194-E202. [DOI: 10.1188/17.onf.e194-e202] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Dose AM, Rhudy LM. Perspectives of newly diagnosed advanced cancer patients receiving dignity therapy during cancer treatment. Support Care Cancer 2017; 26:187-195. [PMID: 28733697 DOI: 10.1007/s00520-017-3833-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Accepted: 07/10/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Dignity therapy is a psychosocial intervention that has been used primarily at the end of life to improve quality of life and other patient outcomes, but many individuals are unable to complete it due to health decline and death. The purpose of this study was to identify what individuals with advanced pancreatic or lung cancer with limited life expectancy, undergoing active cancer treatment describe during the dignity therapy intervention as important to them when not immediately facing end of life. METHODS Twenty patients undergoing chemotherapy for advanced cancer participated in a dignity therapy intervention study. Initial interviews were analyzed using descriptive content analysis. RESULTS Family provided the overall context and background for emerging themes of defining events, accomplishments, and God's plan, which led to lessons learned, and resulted in messages of hope. Interviews were often autobiographical in nature and contained much reminiscence, consistent with dignity therapy's intent. Few participants spoke about their cancer diagnoses during the interview. CONCLUSIONS This study adds unique insight into the use of dignity therapy for those still receiving active cancer treatment, different from work by others in which it was offered only at end of life. As part of supportive care, clinicians need to validate the importance of family to those with advanced cancer and to provide opportunities for patients to share what they have learned throughout life and to impart messages of hope to those closest to them.
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Affiliation(s)
- Ann Marie Dose
- Department of Nursing, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Lori M Rhudy
- Department of Nursing, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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Kang D, Kim IR, Choi EK, Yoon JH, Lee SK, Lee JE, Nam SJ, Han W, Noh DY, Cho J. Who are happy survivors? Physical, psychosocial, and spiritual factors associated with happiness of breast cancer survivors during the transition from cancer patient to survivor. Psychooncology 2017; 26:1922-1928. [DOI: 10.1002/pon.4408] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Revised: 01/14/2017] [Accepted: 02/18/2017] [Indexed: 01/20/2023]
Affiliation(s)
- Danbee Kang
- Department of Health Sciences and Technology, SAIHST; Sungkyunkwan University; Seoul South Korea
| | - Im-Ryung Kim
- Cancer Education Center, Samsung Comprehensive Cancer Center, Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul South Korea
| | - Eun-Kyung Choi
- Cancer Education Center, Samsung Comprehensive Cancer Center, Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul South Korea
| | - Jung Hee Yoon
- Cancer Education Center, Samsung Comprehensive Cancer Center, Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul South Korea
| | - Se-Kyung Lee
- Department of Surgery, Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul South Korea
| | - Jeong Eon Lee
- Department of Health Sciences and Technology, SAIHST; Sungkyunkwan University; Seoul South Korea
- Department of Surgery, Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul South Korea
| | - Seok Jin Nam
- Department of Surgery, Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul South Korea
| | - Wonshik Han
- Department of Surgery and Cancer Research Institute; Seoul National University College of Medicine; Seoul South Korea
| | - Dong-Young Noh
- Department of Surgery and Cancer Research Institute; Seoul National University College of Medicine; Seoul South Korea
| | - Juhee Cho
- Department of Health Sciences and Technology, SAIHST; Sungkyunkwan University; Seoul South Korea
- Cancer Education Center, Samsung Comprehensive Cancer Center, Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul South Korea
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Abstract
BACKGROUND Breast cancer is the most common cancer among women worldwide, and spiritual fulfillment such as experiencing meaning in life plays an important role in coping with the disease. OBJECTIVE The objectives of this study were to explore and understand Chinese breast cancer survivors' perspective on meaning in life. METHODS This study used Grounded Theory; 23 participants were recruited using convenience sampling, purposive sampling, and theoretical sampling. Semistructured interviews were conducted, and the data were analyzed using open coding, axial coding, and selective coding. RESULTS A core category emerged as "satisfaction with my life" to explain Chinese breast cancer survivors' perspective of meaning in life, and 4 subcategories described the core category including (1) living a healthy and peaceful life, (2) having a good relationship with others, (3) achieving purpose in life, and (4) fulfilling responsibility. CONCLUSION Chinese breast cancer survivors value physical health as well as spiritual fulfillment. The experience of adapting to life with cancer, having a good relationship with others, pursuing life goals, and fulfilling responsibility consists of a satisfying life, which makes life more meaningful. IMPLICATIONS FOR PRACTICE Health providers should pay more attention to survivors' experience of meaning in life and help them enhance meaning in life and improve their quality of life through building good relationship with others, achieving purpose in life, and fulfilling responsibility for family and society.
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Chun S, Heo J, Lee S, Kim J. Leisure-Related Predictors on a Sense of Purpose in Life among Older Adults with Cancer. ACTIVITIES, ADAPTATION & AGING 2016. [DOI: 10.1080/01924788.2016.1199517] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Objective Experiencing pain not only affects patients' biopsychosocial functioning but also the existential domain. Attention to the existential, in addition to the biopsychosocial domains, might thus be important in chronic pain care. Therefore, we investigated: (a) how satisfied patients were with the attention of their practitioners to the impact of pain on biological, psychological, social, and existential life domains, and (b) how satisfaction with each domain was related to patient functioning. Method Pain patients ( N = 163) were questioned on their satisfaction with the attention of their practitioners to biological, psychological, social, and existential life domains, and on pain intensity, pain disability, life satisfaction, and depressive symptoms. Results Patients reported low satisfaction with the attention of their practitioners to the social and existential domains. Satisfaction with each domain was negatively related with pain intensity, pain disability, and depressive symptoms and positively related with life satisfaction. Only satisfaction with the existential domain was able to predict all functional outcomes above and beyond all other satisfaction variables modeled simultaneously. Conclusions Patients reported not feeling satisfied with the attention to the social and existential life domains. Furthermore, practitioners' attention to the existential domain seems highly important for patient functioning. Openness to existential concerns of pain patients might thus be an important aspect of chronic pain care.
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Affiliation(s)
- Jessie Dezutter
- 1 Faculty of Psychology and Educational Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Martin Offenbaecher
- 2 Institute of General Medicine, Ludwig-Maximilians University of Munich, Munich, Germany
| | | | - Siebrecht Vanhooren
- 1 Faculty of Psychology and Educational Sciences, KU Leuven - University of Leuven, Leuven, Belgium
| | - Evalyne Thauvoye
- 1 Faculty of Psychology and Educational Sciences, KU Leuven - University of Leuven, Leuven, Belgium
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Khoramirad A, Mousavi M, Dadkhahtehrani T, Pourmarzi D. Relationship Between Sleep Quality and Spiritual Well-Being/Religious Activities in Muslim Women with Breast Cancer. JOURNAL OF RELIGION AND HEALTH 2015; 54:2276-2285. [PMID: 25487182 DOI: 10.1007/s10943-014-9978-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
For determining relationship between quality of sleep and spiritual well-being/religious activities in Muslim women with breast cancer (WBC), we conducted a cross-sectional study on 80 WBC who presented at all chemotherapy clinics in Qom, Iran, in 2012. We used Pittsburgh Sleep Quality Index (PSQI), spiritual well-being scale (SWBS), and religious activities (RA) questionnaire. Global PSQI score and its seven components score were not significantly correlated with total score of SWBS and its two subscales. Global PSQI score was not significantly correlated with total score of RA questionnaire (P = 0.278), but its "sleep latency" (r = 0.235, P = 0.044) and "use of sleep medications" (r = 0.237, P = 0.040) components were significantly correlated with total score of RA. Global PSQI was significantly correlated with "I don't get much personal strength and support from my God," "I believe there is some real purpose for my life" questions in SWBS, and "Attendance in mosque or religious places" subscale of RA.
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Affiliation(s)
- Ashraf Khoramirad
- Research Center for Medicine and Religion, Qom University of Medical Sciences, Qom, Iran.
| | - Maryam Mousavi
- School of Nursing and Midwifery, Rasht Islamic Azad University, Rasht, Iran.
| | - Tahmineh Dadkhahtehrani
- Department of Midwifery, School of Nursing and Midwifery, Qom University of Medical Sciences, Qom, Iran.
| | - Davoud Pourmarzi
- Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, Iran.
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Hullmann SE, Robb SL, Rand KL. Life goals in patients with cancer: a systematic review of the literature. Psychooncology 2015; 25:387-99. [PMID: 25990641 DOI: 10.1002/pon.3852] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Revised: 03/16/2015] [Accepted: 04/14/2015] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Purposes of this systematic review of life goal research in cancer patients were to (1) identify life goal characteristics and processes being examined, (2) describe instruments used to assess life goal constructs, (3) identify theoretical models being used to guide research, and (4) summarize what is known about the impact of the cancer experience on life goal characteristics, processes, and psychological outcomes. METHODS We conducted this systematic review using MEDLINE, PubMed, CINAHL, and PsycINFO databases. Inclusion criteria were as follows: (1) published between 1993 and 2014, (2) English language, (3) cancer patient population, and (4) original research articles that assessed life goal characteristics and/or goal processes. One hundred ninety-seven articles were screened and 27 included in the final review. RESULTS Seven life goal characteristics and seven life goal processes were identified, and less than half of studies investigated associations between goal characteristics and processes. Conceptual definitions were not provided for about half of the identified life goal constructs. Studies used both validated and author-developed instruments to assess goal constructs. Twenty-four different theoretical models were identified, with self-regulation theory most frequently cited. Overall, the literature suggests that cancer impacts patients' life goal characteristics and processes, and life goal disturbance is related to poorer psychological outcomes. CONCLUSIONS The impact of the cancer experience on life goals is an important and emerging area of research that would benefit from conceptual and theoretical clarity and measurement consistency.
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Affiliation(s)
| | - Sheri L Robb
- School of Nursing, Indiana University, Indianapolis, IN, USA
| | - Kevin L Rand
- Indiana University-Purdue University Indianapolis, Indianapolis, IN, USA
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Dezutter J, Luyckx K, Wachholtz A. Meaning in life in chronic pain patients over time: associations with pain experience and psychological well-being. J Behav Med 2015; 38:384-96. [PMID: 25537924 PMCID: PMC4454349 DOI: 10.1007/s10865-014-9614-1] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 12/10/2014] [Indexed: 12/16/2022]
Abstract
We explored the relationship between meaning in life and adjustment to chronic pain in a three-wave, 2 year, longitudinal study of 273 Belgian chronic pain patients. We examined the directionality of the relationships among the meaning in life dimensions (Presence of Meaning and Search for Meaning) and indicators of adjustment (depressive symptoms, life satisfaction, pain intensity, and pain medication use). We found that Presence of Meaning was an important predictor of well-being. Secondly, we used a typological methodology to distinguish meaning in life profiles, and the relationship of individual meaning in life profiles with indicators of adjustment. Five meaning in life profiles emerged: High Presence High Search, High Presence Low Search, Moderate Presence Moderate Search, Low Presence Low Search, and Low Presence High Search. Each meaning in life profile was associated with a unique adjustment outcome. Profiles that scored high on Presence of Meaning showed more optimal adjustment. The profiles showed little change over time and did not moderate the development of adjustment indicators, except for life satisfaction. Practical implications and suggestions for future research are discussed.
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Affiliation(s)
- Jessie Dezutter
- Research Group Clinical Psychology, Faculty of Psychology and Education Sciences, KU Leuven, Tiensestraat 102, Postbox 3722, 3000 Louvain, Belgium,
| | - Koen Luyckx
- Research Group School and Developmental Psychology, Faculty of Psychology and Education Sciences, KU Leuven, Tiensestraat 102, Postbox 3722, 3000 Louvain, Belgium,
| | - Amy Wachholtz
- Department of Psychiatry, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA 01655, USA,
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Dezutter J, Casalin S, Wachholtz A, Luyckx K, Hekking J, Vandewiele W. Meaning in life: an important factor for the psychological well-being of chronically ill patients? Rehabil Psychol 2014; 58:334-41. [PMID: 24295525 DOI: 10.1037/a0034393] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE This study aimed to investigate 2 dimensions of meaning in life--Presence of Meaning (i.e., the perception of your life as significant, purposeful, and valuable) and Search for Meaning (i.e., the strength, intensity, and activity of people's efforts to establish or increase their understanding of the meaning in their lives)--and their role for the well-being of chronically ill patients. RESEARCH DESIGN A sample of 481 chronically ill patients (M = 50 years, SD = 7.26) completed measures on meaning in life, life satisfaction, optimism, and acceptance. We hypothesized that Presence of Meaning and Search for Meaning will have specific relations with all 3 aspects of well-being. RESULTS Cluster analysis was used to examine meaning in life profiles. RESULTS supported 4 distinguishable profiles (High Presence High Search, Low Presence High Search, High Presence Low Search, and Low Presence Low Search) with specific patterns in relation to well-being and acceptance. Specifically, the 2 profiles in which meaning is present showed higher levels of well-being and acceptance, whereas the profiles in which meaning is absent are characterized by lower levels. Furthermore, the results provided some clarification on the nature of the Search for Meaning process by distinguishing between adaptive (the High Presence High Search cluster) and maladaptive (the Low Presence High Search cluster) searching for meaning in life. CONCLUSIONS The present study provides an initial glimpse in how meaning in life may be related to the well-being of chronically ill patients and the acceptance of their condition. Clinical implications are discussed.
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Affiliation(s)
- Jessie Dezutter
- Faculty of Psychology and Educational Sciences, Research Group Clinical Psychology, University of Leuven
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Scheffold K, Mehnert A, Müller V, Koch U, Härter M, Vehling S. Sources of meaning in cancer patients - influences on global meaning, anxiety and depression in a longitudinal study. Eur J Cancer Care (Engl) 2013; 23:472-80. [DOI: 10.1111/ecc.12152] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2013] [Indexed: 11/29/2022]
Affiliation(s)
- K. Scheffold
- Department of Medical Psychology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - A. Mehnert
- Department of Medical Psychology and Medical Sociology; University Medical Center Leipzig; Leipzig Germany
| | - V. Müller
- University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - U. Koch
- University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - M. Härter
- University Medical Center Hamburg-Eppendorf; Hamburg Germany
| | - S. Vehling
- Department of Medical Psychology; University Medical Center Hamburg-Eppendorf; Hamburg Germany
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Thornton LM, Levin AO, Dorfman CS, Godiwala N, Heitzmann C, Andersen BL. Emotions and social relationships for breast and gynecologic patients: a qualitative study of coping with recurrence. Psychooncology 2013; 23:382-9. [PMID: 24123502 DOI: 10.1002/pon.3429] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Revised: 09/05/2013] [Accepted: 09/16/2013] [Indexed: 11/08/2022]
Abstract
BACKGROUND In contrast to the large literature on patients' coping with an initial diagnosis of cancer, there have been few quantitative or qualitative studies of patients coping with recurrence. A qualitative study was undertaken to aid in the development of a tailored intervention for these patients. METHODS Individuals (N=35) receiving follow-up care for recurrent breast or gynecologic cancer at a university-affiliated cancer center participated in an individual or a group interview. Transcripts of interviews were analyzed using a coding format with two areas of emphasis. First, we focused on patients' emotions, as there is specificity between emotions and the corresponding ways in which individuals choose to manage them. Secondly, we considered the patients' social environments and relationships, as they too appear key in the adjustment to, and survival from, cancer. RESULTS Patients identified notable differences in their responses to an initial diagnosis of cancer and their current ones to recurrence, including the following: (i) depressive symptoms being problematic; (ii) with the passing years and the women's own aging, there is shrinkage in the size of social networks; and (iii) additional losses come from social support erosion, arising from a) intentional distancing by social contacts, b) friends and family not understanding that cancer recurrence is a chronic illness, and/or c) patients stemming their support requests across time. CONCLUSION The contribution of these findings to the selection of intervention strategies is discussed.
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Affiliation(s)
- Lisa M Thornton
- Department of Psychology, The Ohio State University, Columbus, OH, USA
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Kuenemund A, Zwick S, Doering BK, Conrad N, Rief W, Exner C. Decline in attainability of communion and agency life goals over 2 years following acquired brain injury and the impact on subjective well-being. Neuropsychol Rehabil 2013; 23:678-97. [DOI: 10.1080/09602011.2013.801779] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Marino P, Luis Sagaon T, Laetitia M, Anne-Gaelle LCS. Sex Differences in the Return-to-Work Process of Cancer Survivors 2 Years After Diagnosis: Results From a Large French Population-Based Sample. J Clin Oncol 2013; 31:1277-84. [DOI: 10.1200/jco.2011.38.5401] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To investigate the effects of clinical, sociodemographic, and occupational factors on time to return to work (RTW) during the 2 years after cancer diagnosis and to analyze whether sex differences exist. Patients and Methods This study was based on a French national cross-sectional survey involving 4,270 cancer survivors. Time to RTW was estimated through the duration of sick leave of 801 cancer survivors younger than 58 years who were employed during the 2-year survey. Multivariate analysis of the RTW after sick leave was performed using a Weibull accelerated failure time model. Results We found some sex differences in the RTW process. Older men returned to work more slowly than older women (P = .013), whereas married men returned to work much faster than married women (P = .019). Duration dependence was also sex-specific. In men, the time spent on sick leave was independent of the probability of returning to work, whereas in women, this duration dependence was positive (P < .001). For both men and women, clinical factors including chemotherapy, adverse effects, and cancer severity were found to delay RTW (P = .035, P = .001, and P < .001, respectively). Survivors investing most strongly in their personal lives also delayed their RTW (P = .006), as did those with a permanent work contract (P = .042). The factor found to accelerate RTW was a higher educational level (P = .014). Conclusion The RTW process 2 years after cancer diagnosis differed between men and women. A better knowledge of this process should help the national implementation of more cost-effective strategies for managing the RTW of cancer survivors.
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Affiliation(s)
- Patricia Marino
- Patricia Marino, Institut Paoli-Calmettes; Patricia Marino, Luis Sagaon Teyssier, Laetitia Malavolti, and Anne-Gaelle Le Corroller-Soriano, L'Institut National de la Santé et de la Recherche Médicale INSERM, Unité Mixte de Recherche (UMR) 912; Patricia Marino, Luis Sagaon Teyssier, and Anne-Gaelle Le Corroller-Soriano, Aix Marseille Université, INSERM UMR S912; Institut de la Recherche pour le développement; and Luis Sagaon Teyssier, Observatoir Régional de la Santé Provence-Alpes-Cote d'Azur Marseilles,
| | - Teyssier Luis Sagaon
- Patricia Marino, Institut Paoli-Calmettes; Patricia Marino, Luis Sagaon Teyssier, Laetitia Malavolti, and Anne-Gaelle Le Corroller-Soriano, L'Institut National de la Santé et de la Recherche Médicale INSERM, Unité Mixte de Recherche (UMR) 912; Patricia Marino, Luis Sagaon Teyssier, and Anne-Gaelle Le Corroller-Soriano, Aix Marseille Université, INSERM UMR S912; Institut de la Recherche pour le développement; and Luis Sagaon Teyssier, Observatoir Régional de la Santé Provence-Alpes-Cote d'Azur Marseilles,
| | - Malavolti Laetitia
- Patricia Marino, Institut Paoli-Calmettes; Patricia Marino, Luis Sagaon Teyssier, Laetitia Malavolti, and Anne-Gaelle Le Corroller-Soriano, L'Institut National de la Santé et de la Recherche Médicale INSERM, Unité Mixte de Recherche (UMR) 912; Patricia Marino, Luis Sagaon Teyssier, and Anne-Gaelle Le Corroller-Soriano, Aix Marseille Université, INSERM UMR S912; Institut de la Recherche pour le développement; and Luis Sagaon Teyssier, Observatoir Régional de la Santé Provence-Alpes-Cote d'Azur Marseilles,
| | - Le Corroller-Soriano Anne-Gaelle
- Patricia Marino, Institut Paoli-Calmettes; Patricia Marino, Luis Sagaon Teyssier, Laetitia Malavolti, and Anne-Gaelle Le Corroller-Soriano, L'Institut National de la Santé et de la Recherche Médicale INSERM, Unité Mixte de Recherche (UMR) 912; Patricia Marino, Luis Sagaon Teyssier, and Anne-Gaelle Le Corroller-Soriano, Aix Marseille Université, INSERM UMR S912; Institut de la Recherche pour le développement; and Luis Sagaon Teyssier, Observatoir Régional de la Santé Provence-Alpes-Cote d'Azur Marseilles,
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Time perception of cancer patients without evidence of disease and advanced cancer patients in a palliative, end-of-life-care setting. Cancer Nurs 2012; 34:453-63. [PMID: 21558853 DOI: 10.1097/ncc.0b013e31820f4eb7] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Time perception may be an important factor influencing distress of cancer patients. However, no comparative studies have been performed for cancer patients without evidence of disease and advanced cancer patients in the palliative, end-of-life-care setting. OBJECTIVE The objectives of the study were to assess time perception in disease-free and advanced cancer patients and examine the relation of time perception with patients' distress. METHODS A descriptive research design was used. Ninety-six disease-free and 63 advanced cancer patients filled out Cottle's Circle Test to assess time coherence and time dominance, Cottle's Line Test to assess temporal extension and Bayes' question on speed of time, the European Organisation for Research-and-Treatment of Cancer QOL-Questionnaire version 2.0, Beck's Depression Inventory for primary care, and Beck's Hopelessness-Scale. RESULTS In patients without evidence of disease, future dominance was most often observed, whereas in advanced cancer patients, the present was the dominant time segment. In both groups, a focus on the past was associated with distress. In contrast with patients without evidence of disease, advanced cancer patients perceived time as moving slowly, and this was correlated with distress. CONCLUSIONS The time perception of cancer patients without evidence of disease and advanced cancer patients is significantly different and is related to distress. IMPLICATIONS FOR PRACTICE The observed relation between a focus on the past and distress gives room for interventions of nurses and other healthcare professionals. Specific attention is needed for differences between cancer patients without evidence of disease and advanced cancer patients.
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Cebeci F, Yangın HB, Tekeli A. Life experiences of women with breast cancer in south western Turkey: a qualitative study. Eur J Oncol Nurs 2011; 16:406-12. [PMID: 22000551 DOI: 10.1016/j.ejon.2011.09.003] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 08/18/2011] [Accepted: 09/14/2011] [Indexed: 10/16/2022]
Abstract
PURPOSE This qualitative study explores the experience of women living with breast cancer. METHODS The study was conducted among eight women with ongoing breast cancer chemotherapy treatment, which occurred in an ambulatory unit. The data were collected using semi-structured and in-depth individual interviews. All interviews were tape-recorded, and the results were obtained by analysing the content of the recorded data. RESULTS Three major themes related to the experiences of women living with breast cancer were identified. They are as follows: (1) needs (the need for spouse and family support, the need to worship, and the need to receive and share information), (2) living with losses (loss of the breast and of one's hair), and (3) changes (changes in one's normal life, change in self-perception, changes in the perception of the value of health, and a greater appreciation for life). CONCLUSIONS This study was conducted to increase awareness concerning women's perceptions of their care and various needs during breast cancer treatment. The results of this study challenge health care providers and educators to be more aware of the difficulties that women face when living with breast cancer.
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Affiliation(s)
- Fatma Cebeci
- Antalya School of Health, Akdeniz University, 07058 Campus/Antalya, Turkey.
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Lepore SJ, Buzaglo JS, Lieberman MA, Golant M, Davey A. Standard versus prosocial online support groups for distressed breast cancer survivors: a randomized controlled trial. BMC Cancer 2011; 11:379. [PMID: 21867502 PMCID: PMC3201039 DOI: 10.1186/1471-2407-11-379] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Accepted: 08/25/2011] [Indexed: 11/10/2022] Open
Abstract
Background The Internet can increase access to psychosocial care for breast cancer survivors through online support groups. This study will test a novel prosocial online group that emphasizes both opportunities for getting and giving help. Based on the helper therapy principle, it is hypothesized that the addition of structured helping opportunities and coaching on how to help others online will increase the psychological benefits of a standard online group. Methods/Design A two-armed randomized controlled trial with pretest and posttest. Non-metastatic breast cancer survivors with elevated psychological distress will be randomized to either a standard facilitated online group or to a prosocial facilitated online group, which combines online exchanges of support with structured helping opportunities (blogging, breast cancer outreach) and coaching on how best to give support to others. Validated and reliable measures will be administered to women approximately one month before and after the interventions. Self-esteem, positive affect, and sense of belonging will be tested as potential mediators of the primary outcomes of depressive/anxious symptoms and sense of purpose in life. Discussion This study will test an innovative approach to maximizing the psychological benefits of cancer online support groups. The theory-based prosocial online support group intervention model is sustainable, because it can be implemented by private non-profit or other organizations, such as cancer centers, which mostly offer face-to-face support groups with limited patient reach. Trial Registration ClinicalTrials.gov: NCT01396174
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Affiliation(s)
- Stephen J Lepore
- Temple University, Department of Public Health, 1301 Cecil B. Moore Ave., 9th Floor Ritter Annex, Philadelphia, PA 19122, USA.
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Sherman AC, Simonton S. Effects of personal meaning among patients in primary and specialized care: associations with psychosocial and physical outcomes. Psychol Health 2011; 27:475-90. [PMID: 21722041 DOI: 10.1080/08870446.2011.592983] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Personal meaning is thought to serve as an important resource among individuals adapting to the demands of illness. However, some work in this area has been marked by vague conceptualization, or use of assessment instruments that are confounded by well-being. This investigation evaluated relationships between psychosocial and physical outcomes and one theoretically important dimension of attained global meaning - perceptions of life purpose and commitment. Study 1 evaluated 175 patients followed in a primary care gynaecological practice. Study 2 assessed 104 cancer patients in a specialized stem cell transplantation centre. In both samples, personal meaning was concurrently associated with reduced emotional distress, enhanced coping efficacy, and closer intimate relationships, after controlling for social desirability bias and relevant demographic and medical covariates. Associations with lower distress and improved coping efficacy remained significant after additionally controlling for other psychosocial resource variables (i.e. social support, religiousness, emotional control). Personal meaning appears to be independently related to concurrent psychosocial adjustment in a range of medical settings.
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Affiliation(s)
- Allen C Sherman
- Behavioral Medicine, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
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Patient centeredness in terminologies: Coverage of health assets concepts in the International Classification of Nursing Practice. J Biomed Inform 2010; 43:805-11. [DOI: 10.1016/j.jbi.2010.04.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2010] [Revised: 04/29/2010] [Accepted: 04/30/2010] [Indexed: 11/19/2022]
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Geffen JR. Integrative Oncology for the Whole Person: A Multidimensional Approach to Cancer Care. Integr Cancer Ther 2010; 9:105-21. [DOI: 10.1177/1534735409355172] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Today, more than ever before, millions of people are seeking an approach to medicine and health care that is more comprehensive, more holistic and integrative, and more compassionate and sensitive to their needs as a whole person. This is particularly true for those dealing with cancer. Changing patient demographics, heightened consumer demand for complementary and alternative medicine (CAM) products and services, advances in medical science and technology, expanding access to the Internet and health information, and other factors have contributed to a wave of transformation that is unprecedented in its impact on the entire health care system. These trends have fueled the emerging fields of integrative medicine and oncology, which are growing rapidly. As these fields continue to evolve, they will move beyond the present integrative model to a broader vision of whole-person, multidimensional care that will more fully and coherently address and embrace all dimensions of the human experience. This article describes 6 major driving forces behind the wave of transformation presently under way in medicine and health care. It provides a brief, historical overview of integrative medicine and oncology and summarizes the present status of these emerging fields. It discusses the future of integrative medicine and oncology, including a multidimensional approach to care, and highlights 5 key elements that underlie this approach. Finally, it describes The Seven Levels of Healing — a model of multidimensional care—and concludes with a discussion of 3 important challenges and opportunities for medicine and health care that lie on the horizon.
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