Hostname: page-component-7479d7b7d-k7p5g Total loading time: 0 Render date: 2024-07-11T05:59:33.301Z Has data issue: false hasContentIssue false
  • English
  • Français

Comprehension and acceptance of the Meaning-Centered Psychotherapy with a Puerto Rican patient diagnosed with advanced cancer: A case study

Published online by Cambridge University Press:  27 November 2019

Normarie Torres-Blasco Open the ORCID record for Normarie Torres-Blasco [Opens in a new window] ,
Eida Castro ,
Iris Crespo-Martín ,
Karina Gonzalez ,
Emely Perez Ramirez ,
Olga Garduño  and
Rosario Costas-Muñiz
Normarie Torres-Blasco*
Affiliation:
Ponce Health Sciences University
Eida Castro
Affiliation:
Ponce Health Sciences University
Iris Crespo-Martín
Affiliation:
Universidad Int. Cataluna
Karina Gonzalez
Affiliation:
Ponce Health Sciences University
Emely Perez Ramirez
Affiliation:
Universidad de Puerto Rico
Olga Garduño
Affiliation:
Memorial Sloan Kettering Cancer Center
Rosario Costas-Muñiz
Affiliation:
Memorial Sloan Kettering Cancer Center
*
Author for correspondence: Normarie Torres-Blasco, PhD, MS, Ponce Health Sciences University, Psychology, Psychology, Ponce, 00732-7004. E-mail: ntorres13@stu.psm.edu
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Meaning-centered psychotherapy (MCP) is a structured psychotherapeutic intervention that aims to improve existential and spiritual well-being in patients with advanced cancer. To validate it, several efficacy studies with predominantly non-Hispanic white patients have been done. Puerto Ricans residing on the island are a largely overlooked segment of the US Latinx population. They have a strong national identity and are embedded in a collectivist culture which shares the Spanish language, cultural traditions, and an emphasis on familism, a cultural factor that values the role of the family in ensuring the well-being of its members.

Objective

The purpose of this study is to present a case study focused on a Puerto Rican advanced cancer patient who underwent MCP to assess the comprehension and acceptance of the MCP intervention.

Method

We used a mixed-methods study design that included the taking of ethnographic notes, and pre- and post-test assessments of the scores the patient received on all the measures (using validated scales). The ethnographic notes were analyzed to determine the participant's comprehension and acceptance of the MCP intervention. Content analysis was performed on the ethnographic notes by three independent coders using a deductive coding approach. Pre- and post-interview assessments were conducted to explore changes in distress, spiritual well-being, and self-perceived quality of life.

Results

A Latino patient with stage III cancer, low income, and low literacy skills showed low comprehension of the concepts of meaning, the finite, legacy, and moderate comprehension and acceptance of the concepts of the search for hope, purpose in life, connecting with life, courage, life's limitations, and sources of meaning. However, the patient showed high comprehension of death and dying (i.e., meaningful death). The patient showed low acceptance of death and dying concepts and high acceptance of the integration of family members into the therapy.

Significance of Results

Additional studies are needed to address cultural themes and to improve the comprehensibility and acceptance of the manual's content and the central MCP concepts. The findings suggest that MCP has the potential of being a feasible form of psychotherapy for Latinx patients suffering from distress, low spiritual well-being, and low self-perceived QOL.

Keywords

cancerLatinxHispanicexistentialmeaningtherapyquality of lifedistressspiritual well-being
Type
Case Report
Information
Palliative & Supportive Care , Volume 18 , Issue 1 , February 2020 , pp. 103 - 109
Copyright
Copyright © Cambridge University Press 2019

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

Almanza, MJJ, Rosario, JI and Pérez, S (2008) Traducción, adaptación y validación del Termómetro de Distrés en una muestra de pacientes mexicanos con cáncer. Revista De Sanidad Militar 62(5), 209–17.Google Scholar
Anastasia, EA and Bridges, AJ (2015) Understanding service utilization disparities and depression in Latinos: the role of fatalismo. Journal of Immigrant and Minority Health 17(6), 1758–1764.CrossRefGoogle ScholarPubMed
Ashing-Giwa, KT, Padilla, GV, Bohorquez, DE, Tejero, JS and Garcia, M (2006) Understanding the breast cancer experience of Latina women. Journal of Psychosocial Oncology 24(3), 19–52.CrossRefGoogle ScholarPubMed
Baez, A and Hernandez, D (2001) Complementary spiritual beliefs in the Latino community: the interface with psychotherapy. American Journal of Orthopsychiatry 71, 408–415. https://doi.org/10.1037/0002-9432.71.4.408CrossRefGoogle ScholarPubMed
Barbour, RS (2001) Checklists for improving rigour in qualitative research: a case of the tail wagging the dog? BMJ 322(7294), 1115–1117.CrossRefGoogle ScholarPubMed
Bernal, G, Jiménez-Chafey, MI and Domenech Rodríguez, MM (2009) Cultural adaptation of treatments: A resource for considering culture in evidence-based practice. Professional Psychology: Research and Practice 40(4), 361.CrossRefGoogle Scholar
Bishaw, A, Fontenot, K Poverty: 2012 and 2013. American Community Survey Office: The U.S. Census Bureau. Available at https://www.census.gov/content/dam/Census/library/publications/2014/acs/acsbr13-01.pdfGoogle Scholar
Breitbart, W, Poppito, S, Rosenfeld, B, Vickers, AJ, Li, Y, Abbey, J, Olden, M, Pessin, H, Lichtenthal, W, Sjoberg, D and Cassileth, BR (2012) Pilot randomized controlled trial of individual meaning-centered psychotherapy for patients with advanced cancer. Journal of Clinical Oncology 30(12), 1304.CrossRefGoogle ScholarPubMed
Breitbart, W, Rosenfeld, B, Gibson, C, Pessin, H, Poppito, S, Nelson, C, Tomarken, A, Timm, AK, Berg, A, Jacobson, C and Sorger, B (2010) Meaning-centered group psychotherapy for patients with advanced cancer: a pilot randomized controlled trial. Psycho-Oncology 19(1), 21–28.CrossRefGoogle ScholarPubMed
Breitbart, W, Rosenfeld, B, Pessin, H, Applebaum, A, Kulikowski, J and Lichtenthal, WG (2015) Meaning-centered group psychotherapy: an effective intervention for improving psychological well-being in patients with advanced cancer. Journal of Clinical Oncology 33(7), 749.CrossRefGoogle ScholarPubMed
Campesino, M and Schwartz, GE (2006) Spirituality among Latinas/os implications of culture in conceptualization and measurement. Advances in Nursing Science 29(1), 69.CrossRefGoogle Scholar
Comas-Díaz, L (2006) Latino healing: The integration of ethnic psychology into psychotherapy. Psychotherapy: Theory, Research, Practice, Training 43, 436–453. https://doi.org/10.1037/0033-3204.43.4.436CrossRefGoogle ScholarPubMed
Costas-Muñiz, R, Garduño-Ortega, O, González, J, Rocha, X, Breitbart, W and Gany, F (2016) Cultural and linguistic adaptation of meaning-centered psychotherapy for Spanish-speaking Latino cancer patients. Meaning-Centered Psychotherapy in the Cancer Setting: Finding Meaning and Hope in the Face of Suffering, 134.Google Scholar
Crimmins, EM, Garcia, K and Kim, JK (2010) Are international differences in health similar to international differences in life-expectancy? International Differences in Mortality at Older Ages: Dimensions and Sources 66–101.Google Scholar
Dapueto, JJ, Francolino, C, Servente, L, Chang, CH, Gotta, I, Levin, R and del Carmen Abreu, M (2003) Evaluation of the Functional Assessment of Cancer Therapy-General (FACT-G) Spanish Version 4 in South America: classic psychometric and item response theory analyses. Health and Quality of Life Outcomes 1(1), 32.CrossRefGoogle ScholarPubMed
Deck, AF (ed.) (2017) Frontiers of Hispanic Theology in the United States. Eugene, OR: Wipf and Stock Publishers.Google Scholar
Dolan, JP (1994) Hispanic Catholic culture in the US: Issues and Concerns, Vol. 3. University of Notre Dame Press.Google Scholar
Domenech Rodríguez, MM, Baumann, AA, Vázquez, AL, Amador-Buenabad, NG, Franceschi Rivera, N, Ortiz-Pons, N and Parra-Cardona, JR (2018) Scaling out evidence-based interventions outside the US mainland: social justice or Trojan Horse? Journal of Latina/o Psychology 6(4), 329.CrossRefGoogle Scholar
Ellis, J, Cobb, M, O'Connor, T, Dunn, L, Irving, G and Lloyd-Williams, M (2015) The meaning of suffering in patients with advanced progressive cancer. Chronic Illness 11(3), 198–209.CrossRefGoogle ScholarPubMed
Elo, S and Kyngäs, H (2008) The qualitative content analysis process. Journal of Advanced Nursing 62(1), 107–115.CrossRefGoogle ScholarPubMed
Ettema, EJ, Derksen, LD and van Leeuwen, E (2010) Existential loneliness and end-of-life care: A systematic review. Theoretical Medicine and Bioethics 31(2), 141–169.CrossRefGoogle ScholarPubMed
Falicov, CJ (2014) Religion, spirituality, and traditional healing practices. In Falicov, CJ (ed), Latino Families in Therapy, 2nd Edn. New York, NY: Guilford Press, pp. 195–219.Google Scholar
Fraguell, C, Castillo, MS, Limonero, JT and Gil, F (2016) Modelo de psicoterapia centrada en el sentido/compasión para pacientes de cáncer con enfermedad avanzada. Psicooncología 13, 11. https://doi.org/10.5209/rev_PSIC.2016.v13.n1.52192Google Scholar
Frankl, VE (1984) Man's Search for Meaning. New York: Touchstone.Google Scholar
Gellis, ZD, McGinty, J, Horowitz, A, Bruce, M and Misener, E (2007) Problem-solving therapy for late-life depression in home care: a randomized field trial. American Journal of Geriatric Psychiatry 15(11), 968–978. https://doi.org/10.1097%2FJGP.0b013e3180cc2bd7CrossRefGoogle ScholarPubMed
Holland, JC and Bultz, BD (2007) The NCCN guideline for distress management: a case for making distress the sixth vital sign. Journal of the National Comprehensive Cancer Network 5(1), 3–7.CrossRefGoogle ScholarPubMed
Hunter-Hernández, M, Costas-Muñíz, R and Gany, F (2015) Missed opportunity: spirituality as a bridge to resilience in Latinos with cancer. Journal of Religion and Health 54(6), 2367–75.CrossRefGoogle ScholarPubMed
Jimenez, DE, Cook, B, Bartels, SJ and Alegría, M (2012) Disparities in mental health service use of racial and ethnic minority elderly adults. Journal of the American Geriatrics Society 61(1), 18–25.CrossRefGoogle ScholarPubMed
Kessler, RC, Berglund, PA, Bruce, ML, Koch, JR, Laska, EM, Leaf, PJ, Manderscheid, RW, Rosenheck, RA, Walters, EE and Wang, PS (2001) The prevalence and correlates of untreated serious mental illness. Health Services Research 36(6 Pt 1), 987.Google ScholarPubMed
Lee, MS, Tyson, DM, Gonzalez, BD, Small, BJ, Lechner, SC, Antoni, MH, Vinard, A, Krause, M, Meade, C and Jacobsen, PB (2018) Anxiety and depression in Spanish-speaking Latina cancer patients prior to starting chemotherapy. Psycho-Oncology 27(1), 333–338. https://doi.org/10.1002/pon.4462CrossRefGoogle ScholarPubMed
Mayring, P (2015) Qualitative content analysis: Theoretical background and procedures. In Approaches to Qualitative Research in Mathematics Education. Dordrecht: Springer, pp. 365–380.Google Scholar
Moadel, A, Morgan, C, Fatone, A, Grennan, J, Carter, J, Laruffa, G, Skummy, A and Dutcher, J (1999) Seeking meaning and hope: self-reported spiritual and existential needs among an ethnically-diverse cancer patient population. Psycho-Oncology 8(5), 378–385.3.0.CO;2-A>CrossRefGoogle ScholarPubMed
Morales, LS, Lara, M, Kington, RS, Valdez, RO and Escarce, JJ (2002) Socioeconomic, cultural, and behavioral factors affecting Hispanic health outcomes. Journal of Health Care for the Poor and Underserved 13(4), 477.CrossRefGoogle ScholarPubMed
Murphy, PE, Canada, AL, Fitchett, G, Stein, K, Portier, K, Crammer, C and Peterman, AH (2010) An examination of the 3-factor model and structural invariance across racial/ethnic groups for the FACIT-Sp: A report from the American Cancer Society's Study of Cancer Survivors-II (SCS-II). Psycho-Oncology 19, 264–272.CrossRefGoogle Scholar
Pérez, C and Ailshire, JA (2017) Aging in Puerto Rico: A Comparison of Health Status Among Island Puerto Rican and Mainland US Older Adults. Journal of Aging and Health 29(6), 1056–1078.CrossRefGoogle Scholar
Peterman, AH, Fitchett, G, Brady, MJ, Hernandez, L and Cella, D (2002) Measuring spiritual well-being in people with cancer: The Functional Assessment of Chronic Illness Therapy - Spiritual Well-Being scale (FACIT-Sp). Annals of Behavioral Medicine 24(1), 49–58. https://doi.org/10.1207/S15324796ABM2401_06CrossRefGoogle Scholar
Proctor, BD, Semega, JL and Kollar, MA (2016) Income and poverty in the United States: 2015. US Census Bureau, Current Population Reports P60–256.Google Scholar
Pew Research Center (2015) America's Changing Religious Landscape: Christians decline sharply as share of population; unaffiliated and other faiths continue to grow. Religion and Public Life. Washington, DC.Google Scholar
Pew Research Center (2014) The Shifting Religious Identity of Latinos in the United States. Washington, DC: Author. Available at http://www.pewforum.org/2015/05/12/americas-changing-religious-landscape/Google Scholar
Rodriguez, J (2010) Our Lady of Guadalupe: Faith and Empowerment Among Mexican-American Women. Austin, TX: University of Texas Press.Google Scholar
Rubenstein, LV, Jackson-Triche, M, Unützer, J, Miranda, J, Minnium, K, Pearson, ML and Wells, KB (1999) Evidence-based care for depression in managed primary care practices: A collaborative approach shows promise in improving care of depression in a variety of sites. Health Affairs 18(5), 89–105.CrossRefGoogle Scholar
Ruiz, E, Aguirre, RT and Mitschke, DB (2013) What leads non-US-born Latinos to access mental health care? Social Work in Health Care 52(1), 1–19.CrossRefGoogle Scholar
Schwartz, SJ (2007). The applicability of familism to diverse ethnic groups: A preliminary study. The Journal of Social Psychology 147(2), 101–118.CrossRefGoogle ScholarPubMed
Shattell, MM, Hamilton, D, Starr, SS, Jenkins, CJ and Hinderliter, NA (2008) Mental health service needs of a Latino population: A community-based participatory research project. Issues in Mental Health Nursing 29(4), 351–370.CrossRefGoogle ScholarPubMed
Taylor, JAS and Irizarry-Robles, CY (2015) Factores protectores de la depresión en una muestra de adultos mayores en Puerto Rico: autoeficacia, escolaridad y otras variables socio-demográficas. Acta colombiana de psicología 18(1), 125–134.CrossRefGoogle Scholar
Travado, L, Grassi, L, Gil, F, Martins, C, Ventura, C, Bairradas, J and Southern European Psycho-Oncology Study Group (2010) Do spirituality and faith make a difference? Report from the Southern European Psycho-Oncology Study Group. Palliative & Supportive Care 8(4), 405–413.CrossRefGoogle ScholarPubMed
Uebelacker, LA, Marootian, BA, Pirraglia, PA, Primack, J, Tigue, PM, Haggarty, R, Velazquez, L, Bowdoin, JJ, Kalibatseva, Z and Miller, IW (2012) Barriers and facilitators of treatment for depression in a Latino community: A focus group study. Community Mental Health Journal 48(1), 114–126.CrossRefGoogle Scholar
Vargas, SM, Cabassa, LJ, Nicasio, A, De La Cruz, AA, Jackson, E, Rosario, M, Guarnaccia, PJ and Lewis-Fernández, R (2015) Toward a cultural adaptation of pharmacotherapy: Latino views of depression and antidepressant therapy. Transcultural Psychiatry 52(2), 244–273.CrossRefGoogle Scholar
Wang, T, Molassiotis, A, Chung, B and Tan, JY (2018). Unmet care needs of advanced cancer patients and their informal caregivers: a systematic review. BMC Palliative Care 17(1), 96. https://doi.org/10.1186/s12904-018-0346-9CrossRefGoogle ScholarPubMed
World Health Organization (2012) Report on health systems in Puerto Rico. Available at http://www.who.int/mental_health/evidence/puerto_rico_whoaims_report.pdf?ua=1Google Scholar