Aug 2002

Dear Readers: Here's the Article for this Month:

Name of article:

Spirituality and meaning in supportive care: spirituality-and meaning-centered group psychotherapy interventions in advanced cancer.

Author(s):
William Breitbart

Reference:
Support Care Cancer 2002; 10: 272-280

Abstract:
In the environment of Palliative Medicine and particularly in the end-of-life stage, there is ever-increasing evidence that the control of physical and emotional symptoms and the management of psychosocial problems represent only a part of the management of a patient’s suffering.

Concerns related to spiritual and existential suffering are becoming more and more evident which William Breitbart has divided into two parts: faith/religions belief and meaning/spiritual well-being and which can no longer be disregarded by those involved in Palliative Medicine.

Some clinicians/researchers consider that it is necessary to collect and incorporate the "spiritual history" with the "standard medical history"; especially in the case of patients with advanced cancer or other life-threatening diseases. In this way the clinicians are able to understand their patients more fully and obtain indications from the patients themselves on how to address and give due attention to their spirituality.

A study hold in the U.S. showed that 40% of the American public thought it most important to have a doctor who was spiritually in harmony with them if they were dying. It was found that what troubled 50-60% of the people interviewed when they thought about dying was: 1. not to be forgiven by God; 2. not to be reconciled with others and 3. dying while being cut off from God or a higher power.

From studies carried out with cancer patients it emerged that, in America as in Japan, a high percentage of the patients needed help to find hope, peace of mind and spiritual resources. Among the motivations given by the patients requesting "assisted suicide", it was found that in 52% of the cases, there was distress caused by pain and physical symptoms and 47% of the patients referred to loss of meaning in life (National Survey of North American Physicians). From both the physicians’ point of view, as well as the patients’, everything concerns spirituality is of utmost importance for the quality of end-of-life care. According to Puchalski and Romer, spirituality gives a person the possibility to experience transcendent meaning in life. Spirituality has two main components: "faith" and/or "meaning". "Faith" is mostly associated with religion and religions’ belief whereas "meaning" appears to be a more universal concept which can exist in religious and non-religious individuals.

This concept of spirituality is reflected in a widely used measure of spiritual well-being recently developed by the group that elaborated the FACT or FACIT systems that measure quality of life and is called the FACIT Spiritual Well-Being Scale. This tool produces a total score and two subscale scores, one representing Faith and the other Meaning/Peace.

Breitbart’s review also reports a series of studies in literature which investigated the associations between Faith/religiuos belief and/or Meaning/spiritual well-being with health, symptom control and the quality of life of the patients.

Proposals of interventions for spiritual suffering at the "end-of-life" were of great interest.

Among those mentioned psychotherapy techniques were discussed such as talking about life and reviewing life, logotherapy, psychotherapeutic group interventions and, in particular, interventions addressed specifically to existential or spiritual issues and also non-traditional interventions based on yoga, meditation, meditation and the Buddist philosophy that concern theories of self transcendence.

The novel intervention organized by the group of Breitbart, c/o the Memorial Sloan-Kettering Cancer Center is called "Meaning centered Group Psychotherapy" and has the aim of helping advanced cancer patients to maintain or increase a sense of meaning, peace, and purpose of their lives even though they may be approaching death.

Why I chose this Article:

This paper reviews the topics of spirituality and end-of-life care, defines spirituality and suggests measures of spirituality that deal with two of its main components: faith/religious beliefs and meaning/spiritual well-being. Moreover William Breitbart reviews the psychotherapeutic interventions for spiritual suffering and proposes a novel meaning-centered group psychotherapy for advanced cancer patients greatly influenced by the work of Viktor Frankl.

Regards,

Carla Ripamonti, MD
Member of the Board of Directors, IAHPC