| Abstract: |
(create) As we continue to develop our understanding of the needs of palliative care patients, it is becoming more apparent that our present concepts of adequate care must be expanded in their focus beyond simple pain and physical symptom control to include psychiatric, psychosocial, existential, and spiritual domains at the end of life. While such symptoms are indeed distressing to patients with advanced disease, it is clear that symptoms relating to psychological distress and existential concerns are even more prevalent than pain and other physical symptoms. Acknowledging the psychological as well as spiritual domains of end-of-life care has been identified as a priority by both medical professionals as well as by cancer patients themselves. A recent Gallup poll on "Spiritual beliefs and the dying process" demonstrates this. In this poll, 40% of those polled said that if they were dying, it would be "very important" to have a doctor who is spiritually attuned to them. Fifty to sixty percent said their greatest concerns when thinking of their own deaths are d) not being forgiven by God, (2) not reconciling with others, and/or (3) dying when you are removed or cut off from God or a higher power. Clearly, patients are requiring more attention to the existential crisis of meaning that serious illness engenders. As healthcare providers, we often view patients as clusters of syndromes and rush to find symptom relief and reduction. Although this approach may be effective at a purely reductionistic level, it ignores the complexities of the existential crisis that serious illness often engenders. With these issues in mind, our research group wished to develop a psychotherapy intervention for seriously ill cancer patients by acknowledging the importance of such existential crises through addressing the role of meaning and spiritual well-being. This endeavor led us to closely examine the work of Viktor Frankl and his concepts of logotherapy or meaning-based psychotherapy.2 We acknowledge that Frankl's logotherapy was not designed for the treatment of cancer patients or those with life-threatening illness, but we felt that his concepts of meaning and spirituality clearly apply in doing psychotherapy with advanced cancer patients, many of whom seek guidance and help in dealing with issues of sustaining meaning and hope in the context of cancer and possibly death in their lives. Topics discussed in this chapter include the contributions of Viktor Frankl; understanding meaning; the role of spirituality in meaning-making; prior research on psychotherapeutic interventions for meaning; the meaning-centered group psychotherapy for cancer patients; structure of the group; the process of meaning-making within the groups; and preliminary efficacy of the group. (PsycINFO Database Record (c) 2012 APA, all rights reserved). |
