Effect of Life Review on Quality of Life in Terminal Patients: A Systematic Review and Meta-Analysis

Flourishing at the end of life

Flourishing is an increasingly common construct employed in the study of human wellbeing. But its appropriateness as a framework of wellbeing at certain stages of life is contested. In this paper, we consider to what extent it is possible for someone to flourish at the end of life. People with terminal illness often experience significant and protracted pain and suffering especially when they opt for treatments that prolong life. Certain aspects of human goods, however, that are plausibly constitutive of flourishing-such as meaning and purpose, deep personal relationships, and character and virtue-can be uniquely realised when life is ending. We argue that there is a qualified sense in which one can flourish at the end of life but that one must make important modifications to the criteria implicit in conventional conceptions of flourishing. We close with a discussion of the empirical assessment of wellbeing at the end of life and explore the possibility of introducing a flourishing measure in palliative care practice.

Clinical application of mindfulness in end-of-life care from the perspective of palliative care professionals: A phenomenological study

BACKGROUND

and Purpose: With mindfulness being increasingly recognized for its potential to address psychological challenges related to advanced or terminal illnesses, palliative care professionals are incorporating mindfulness-based interventions into their practice. However, there is limited understanding of the practical applications of mindfulness in clinical settings, particularly for end-of-life patients. This study explored palliative care professionals' experiences in delivering mindfulness-based therapy to end-of-life patients, thereby aiming to inform the development of effective interventions.

MATERIALS AND METHODS

Semi-structured interviews were conducted with 15 palliative care professionals. Participants were asked to describe their memorable experiences in applying mindfulness in a clinical setting. Data were analyzed following Moustakas's transcendental phenomenology approach.

RESULTS

The interviews produced three themes: clinicians' mindfulness experiences form the cornerstone of their clinical application of mindfulness; creating an optimal healing environment is essential for mindfulness practice; and patient-centric mindfulness guidance should be implemented.

CONCLUSION

This study underscores the critical role of mindfulness in end-of-life care, highlighting its integration into daily life by palliative care professionals. By drawing upon their own mindfulness experiences, palliative care professionals facilitated a therapeutic environment tailored to the unique needs of end-of-life patients. This patient-centered approach not only enhanced the quality of care but also fostered a healing connection rooted in compassion and empathy. The findings advocate for further education and development of mindfulness-based interventions, including group therapies, to support the holistic well-being of patients in collectivist cultures. Future research should further explore the practical applications and benefits of mindfulness in end-of-life care settings.

Death education interventions for people with advanced diseases and/or their family caregivers: A scoping review

BACKGROUND

People with life-threatening diseases and their family caregivers confront psychosocial and spiritual issues caused by the persons' impending death. Reviews of death education interventions in the context of life-threatening diseases are scarce and limited to certain intervention types.

AIMS

This study aims to ascertain existing evidence on death education interventions for the population of adults with advanced diseases and/or their family caregivers and identify gaps for future research.

DESIGN

A scoping review guided by Arksey and O'Malley's framework.

DATA SOURCES

Thirteen electronic databases were searched for experimental and qualitative studies on death education interventions for the advanced disease population and/or their family caregivers between 1 January 1960 and 25 October 2023.

RESULTS

Nine types of interventions were identified in 47 studies, which included 5 qualitative and 42 experimental designs, half of which were pilot and feasibility trials. Most of the studies focused on people with advanced cancer, and only seven investigated caregivers or families/couples. Death-related outcomes were less likely to be assessed relative to psychological outcomes, spiritual well-being, and quality of life. Life review interventions, cognitive-behavior therapy, narrative therapy, and general psychosocial interventions decreased depression and anxiety, but evidence was limited. Factors contributing to the interventions' success included intervention content, which enabled the disclosure of personal experience and death concerns comfortably, trained professionals, and connection to family caregivers.

CONCLUSIONS

This work identified a few potentially effective death education interventions for psychological outcomes for people with advanced cancer or their caregivers. Additional trials are needed to confirm the effectiveness of these interventions.

Meaning of Life Therapy: A Pilot Study of a Novel Psycho-Existential Intervention for Palliative Care in Cancer

Intervention in Palliative Care aims to provide physical, psychosocial, and spiritual relief for patients and family members. Brief interventions with a psycho-existential approach have shown positive responses; however, cultural adaptations are needed. This pilot study aimed to develop the Meaning of Life Therapy (MLT), a novel psycho-existential intervention, rooted in the Dignity Therapy, Life Review, and Meaning-Centered Psychotherapy. MLT was culturally adapted to the Portuguese context to include questions about forgiveness, apology, reconciliation, farewell, and a legacy document, i.e., the Life Letter. Nine PC cancer patients answered a 14-question MLT protocol, intended to help patients find purpose and meaning in life. Eight themes emerged: Family, Preservation of Identity, Life Retrospective, Clinical Situation, Achievements, Socio-Professional Valorization, Forgiveness/Apology/Reconciliation, and Saying Goodbye. MLT has proved its ability to respond to the psycho-existential needs of PC patients. Further studies should be conducted to gain extensive knowledge of the effectiveness of culturally responsive interventions.

Exploring Audio Recording in Terminally Ill Patients Receiving Hospice Care: "Stories for Life Charity" Model

Stories for Life is a UK charity that provides a free and confidential service for terminally ill patients to audio record their "life story." Patients are given a copy of the recording and, if they wish, can then pass a copy on to their family/friends. This study explored how a group of terminally ill patients, receiving hospice care, experienced the process of making a voice recording of their biographies. Interviews were conducted with 5 terminally ill patients and 1 family member. Study participants found that talking to a trained volunteer provided a neutral, nonjudgmental interviewer. Patients reported a feeling of catharsis while telling their story as well as being able to reflect on significant life events. However, it was challenging to convey difficult emotions while also being mindful of protecting family who may listen to the recording. Although there was some uncertainty about how the recording would be perceived by listeners, leaving a voice-recorded life account was felt to be beneficial for immediate family members, as well as maintaining a meaningful connection with future generations. Overall, recording an audio biography in terminal illness can allow patients a space for reflection and a meaningful connection with their families.

Effects of a WeChat-Based Life Review Program for Patients With Digestive System Cancer: 3-Arm Parallel Randomized Controlled Trial

Background

Patients with digestive system cancer often experience psychospiritual distress. Life review is an evidence-based psychological intervention for patients with cancer, but the effects of digital life review programs are unclear, especially for patients with digestive system cancer.

Objective

We examined the effects of a WeChat-based life review program on the psychospiritual well-being of patients with digestive system cancer.

Methods

This study was a 3-arm parallel randomized controlled trial. Eligible patients with digestive system cancer were recruited from a university hospital in Fujian, China. They were randomized to a life review group and 2 control groups. All participants received routine care, and the life review group also received the 4-week WeChat-based life review program. Control group 1 also received a 4-week program of friendly visiting. Anxiety, depression, hope, and self-transcendence were measured at baseline and 2 days, 1 month, and 6 months after the intervention.

Results

A total of 150 participants were randomly allocated to the WeChat-based life review group (n=50), control group 1 (n=50), or control group 2 (n=50). The overall dropout rate was 10% (15/150), and 92% (46/50) of participants in the the life review group completed the intervention. Significant interaction effects for time and group membership were found for anxiety (P<.001), depression (P<.001), hope (P<.001), and self-transcendence (P<.001) at all follow-up time points. For anxiety and depression, the scores did not differ significantly between the life review group and control group 1 on day 2 (P=.80 for anxiety, P=.51 for depression), but the scores were significantly lower in the life review group at month 1 and month 6 (P=.02 for anxiety at both months 1 and 6; P=.003 and P<.001 for depression at months 1 and 6, respectively). Significant increases in hope and self-transcendence were revealed in the life review group compared to control group participants at all follow-up sessions.

Conclusions

The WeChat-based life review program was effective in reducing anxiety and depressive symptoms and in improving the level of hope and self-transcendence among patients with digestive system cancer. Though friendly visiting can also help to relieve anxiety, its effects are short-term.

Trial Registration

Chinese Clinical Trial Registry ChiCTR-IOR-17011998; https://tinyurl.com/5acycpd4

Spiritual Care for Individuals with Cancer: The Importance of Life Review as a Tool for Promoting Spiritual Well-Being

OBJECTIVE

To discuss spirituality in the context of cancer, focusing on the use of life review as a tool to help promote spiritual well-being among individuals with cancer.

DATA SOURCES

Literature regarding spirituality and life review of the author in cancer care provided the foundation for this article.

CONCLUSION

Reliance on spirituality as an untapped supportive resource may surprise patients and their families when dealing with a diagnosis of cancer. Coming to terms with advancing disease can be a time of internal and spiritual growth. It is important that all members of the health care team make efforts to understand that spirituality is part of the journey that the person with advanced cancer is going through and that life review is one way to promote spiritual well-being among patients with advanced cancer.

IMPLICATIONS FOR NURSING PRACTICE

Nurses are ideally placed to provide spiritual care. Using life review, nurses can assist individuals coming to terms with their diagnosis and can positively impact spiritual and psychosocial well-being.