Hostname: page-component-76fb5796d-wq484 Total loading time: 0 Render date: 2024-04-26T20:54:07.389Z Has data issue: false hasContentIssue false

Meaning in adjustment to cancer: A model of care

Published online by Cambridge University Press:  19 February 2008

Carrie Lethborg*
Affiliation:
Department of Oncology, St. Vincent's Hospital, Fitzroy, Australia
Sanchia Aranda
Affiliation:
Peter MacCallum Cancer Centre and School of Nursing, University of Melbourne, Melbourne, Australia
David Kissane
Affiliation:
Department of Psychiatry & Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, New York
*
Address correspondence and reprint requests to: Carrie Lethborg, Oncology Department, St. Vincent's Hospital, Fitzroy, Victoria, Australia, 3104. E-mail: carolyn.lethborg@svhm.org.au

Abstract

Objectives:

In the clinical setting of cancer, meaning may well have a central role in the life changes the illness experience brings about. As health care professionals working with people with life-threatening illness, we are exposed to one of the major turning points in life and the ways people confront this transition. Meaning can assist coping by offering a framework, perspective, and counterbalance to the challenge of illness. However, the absence of meaning can be a precursor to profound despair.

Methods:

This article brings together the clinical implications of two studies conducted by the authors that explored the role of meaning in adjustment to cancer, presenting a theoretical understanding of the experience of meaning in cancer and identifying some potential approaches to intervention.

Results:

Our findings point to some specific goals of care as well as a number of therapeutic modalities aimed to meet these goals. We examine four goals of care—acknowledging suffering, encouraging a search for meaning, strengthening connection with others, and ensuring optimal physical care—as foundational in any clinical approach and then examine the key models of therapy that assist the clinician in pursuing these goals.

Significance of results:

Our aim is to create an integrated approach to care provision that locates meaning centrally in any patient's adaptation.

Type
Review Articles
Copyright
Copyright © Cambridge University Press 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Benzein, E. & Saveman, B.I. (1998). One step towards the understanding of hope: A concept analysis. International Journal of Nursing Studies, 35, 322329.CrossRefGoogle Scholar
Blanchard, E.B., Buckley, T.C., Hickling, E.J., et al. (1998). Posttraumatic stress disorder and comorbid major depression: Is the correlation an illusion? Journal of Anxiety Disorders, 12, 2137.CrossRefGoogle ScholarPubMed
Blinderman, C.D. & Cherny, N.I. (2005). Existential issues do not necessarily result in existential suffering: Lessons from cancer patients in Israel. Palliative Medicine, 19, 371380.CrossRefGoogle Scholar
Breitbart, W., Gibson, C., Poppito, S.R., et al. (2004). Psychotherapeutic interventions at the end of life: A focus on meaning and spirituality. Canadian Journal of Psychiatry, 49, 366372.CrossRefGoogle ScholarPubMed
Brett, D. (2001). Eating the Underworld. A Memoir in Three Voices. Milsons Point: Random House.Google Scholar
Bruner, E.M. (1986). Ethnography as narrative. In The Anthropology of Experience, Bruner, E. & Turner, V. (eds.), pp. 139155. Illinois: University of Illinois Press.Google Scholar
Bruner, J. (1987). Life as narrative. Social Research, 54, 1132.Google Scholar
Carlick, A., & Biley, F.C. (2004). Thoughts on the therapeutic use of narrative in the promotion of coping in cancer care. European Journal of Cancer, 12, 308317.CrossRefGoogle Scholar
Cassem, E.D. (2000). Care and management of the patient at the end of life. In Handbook of Psychiatry in Palliative Medicine, Chochinov, H.M. & Breitbart, W. (eds.), pp. 1323. Oxford: Oxford University Press.Google Scholar
Chochinov, H. (2002). Dignity-conserving care—A new model for palliative care: Helping the patient feel valued . JAMA, 287, 22532260.CrossRefGoogle ScholarPubMed
Clarke, D. (2003). Faith and hope. Australasian Psychiatry, 11, 164168.CrossRefGoogle Scholar
Cobb, S. (1976). Social support as a moderator of life stress, Psychosomatic Society Presidential Address–1976. Psychosomatic Medicine, 38, 300314.CrossRefGoogle Scholar
Dessaix, R. (2000). Interview by Professor Martin Tattersall. Paper presented at the 5th World Congress of Psycho-Oncology, Melbourne.Google Scholar
Ferrell, B. (1998). The family. In Oxford Textbook of Palliative Medicine (2nd ed.), Mac Donald, N. (ed.), pp. 909917. New York: Oxford University Press.Google Scholar
Ferrell, B.R., Ferrell, B.A., & Rhiner, M. (1991). Family factors influencing cancer pain management. Journal of Postgraduate Medicine, 67, 9.Google ScholarPubMed
Folkman, S. (1997). Positive psychological states and coping with severe stress. Social Science & Medicine, 45, 12071221.CrossRefGoogle ScholarPubMed
Folkman, S., Chesney, M., McKusick, L., et al. (1991). Translating coping theory into an intervention. In The social context of coping, Eckenrode, J. (ed.), pp. 239260. New York: Plenum Press.CrossRefGoogle Scholar
Forbes, M.A.R. (1999). Testing a causal model of hope and its antecedents among chronically ill older adults. Dissertation Abstracts International: Section B: The Sciences & Engineering, 59 (8-B).Google Scholar
Frankl, V.E. (1963). Man's Search for Meaning: An Introduction to Logotherapy. New York: Washington Square Press.Google Scholar
Frankl, V.E. (1973). The Doctor and the Soul: From Psychotherapy to Logotherapy. Winston, R.C. (trans.). New York: Vintage Books.Google Scholar
Frankl, V.E. (1985). Man's Search for Meaning. New York: Washington Square Press.Google Scholar
Greenstein, M. & Breitbart, W. (2000). Cancer and the experience of meaning: A group psychotherapy program for people with cancer. American Journal of Psychotherapy, 54, 486500.CrossRefGoogle ScholarPubMed
Gregory, D. (1995). Narratives of suffering in the cancer experience. Dissertation Abstracts International: Section B: The Sciences & Engineering, 56, 170.Google Scholar
Hartman, D. & Zimberoff, M.A. (2003). The existential approach in heart-centred therapies. Journal of Heart-Centred Therapies, 6, 346.Google Scholar
Herth, K. (1990). Fostering hope in terminally-ill people. Journal of Advanced Nursing, 15, 12501259.CrossRefGoogle ScholarPubMed
Holland, J. & Gooen-Piels, J.A. (2000). A psychotherapy approach based on Folkman's meaning-making model: Meaning-seeking. Paper presented at the 5th World Congress of Psycho-Oncology, Melbourne.Google Scholar
Jacobs, J., Ostroff, J., & Steinglass, P. (1998). Family therapy: A systems approach to cancer care. In Psychooncology, Holland, J. (ed.), pp. 9941003. New York: Oxford University Press.Google Scholar
Kissane, D., Clarke, D.M., & Street, A.F. (2001). Demoralization syndrome-A relevant psychiatric diagnosis for palliative care. Journal of Palliative Care, 17, 1221.CrossRefGoogle ScholarPubMed
Kissane, D., McKenzie, M., Bloch, S., et al. (2006). Family focused grief therapy: A randomized controlled trial in palliative care and bereavement. American Journal of Psychiatry, 163, 12081218.CrossRefGoogle Scholar
Kissane, D.W., Bloch, S., McKenzie, M., et al. (1998). Family grief therapy: A preliminary account of a new model to promote healthy family functioning during palliative care and bereavement. Psycho-Oncology, 7, 1425.3.0.CO;2-D>CrossRefGoogle ScholarPubMed
Lawton, J. (1998). Contemporary hospice care: The sequestration of the unbounded body and “dirty dying.” Sociology of Health and Illness, 20, 121143.CrossRefGoogle Scholar
Lethborg, C., Aranda, S., Bloch, S., et al. (2006). The role of meaning in advanced cancer-integrating the constructs of assumptive world, sense of coherence and meaning-based coping. Journal of Psychosocial Oncology, 24, 2742.CrossRefGoogle ScholarPubMed
Mount, B. (1993). Whole person care: Beyond psychosocial and physical needs. American Journal of Hospice and Palliative Care, 10, 2836.CrossRefGoogle ScholarPubMed
Nekolaichuk, C.L. & Bruera, E. (1998). On the nature of hope in palliative care. Journal of Palliative Care, 14, 3642.CrossRefGoogle ScholarPubMed
Pruyser, P.W. (1984). Existential impact of professional exposure to life-threatening terminal illness. Bulletin of the Menninger Clinic, 48, 357367.Google ScholarPubMed
Rousseau, P. (2000). Hope in the terminally ill. Western Journal of Medicine, 173, 117118.CrossRefGoogle ScholarPubMed
Sharf, R.S. (2000). Theories of Psychotherapy & Counseling. Belmont, CA: Wadsworth/Thomson Learning.Google Scholar
Soelle, D. (1975). Suffering Philadelphia, PA: Fortress Press.Google Scholar
Steeves, R. & Kahn, D. (1987). Experience of meaning in suffering. Image—The Journal of Nursing Scholarship, 19, 114116.CrossRefGoogle ScholarPubMed
Storey, P. & Knight, C.F. (1997). UNIPAC Two: Alleviating Psychological and Spiritual Pain in the Terminally Ill. Gainesville, Fl: American Academy of Hospice and Palliative Medicine.Google Scholar
Tillich, P. (1963). The Eternal Now. New York: Charles Scribner.Google Scholar
Tournier, P. (1957). The Meaning of Persons. London: SCM Press.CrossRefGoogle Scholar
Tournier, P. (1965). L'aventure de la vie, Delachaux & Niestlé, Neuchâtel, Hudson, E. (trans.). London: SCM Press.Google Scholar
Younger, J. (1995). The alienation of the sufferer. Advances in Nursing Science, 17, 5372.CrossRefGoogle ScholarPubMed
Zuehlke, T.E. & Watkins, J.T. (1975). The use of psychotherapy with dying patients: An exploratory study. Journal of Clinical Psychology, 31, 729732.3.0.CO;2-G>CrossRefGoogle ScholarPubMed