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Psychological and spiritual interventions to enhance meaning in adults diagnosed with cancer: a systematic review with meta-analysis and meta-regression

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A Correction to this article was published on 21 September 2023

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Abstract

Objective

To summarize the evidence on the effectiveness that psychological and/or spiritual interventions may have to change the levels of meaning, measured with the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp), in adults diagnosed with cancer.

Methods

Systematic review with meta-analysis and meta-regression. CINAHL (via EBSCOhost), Embase, PubMed, PsycINFO (via ProQuest), and the Cochrane Library were searched from inception to 21st October 2022. Manual searches were conducted. Only randomized clinical trials (RCTs) were included. The risk of bias was assessed with the Cochrane Risk of Bias tool 2. The Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach was used to judge the certainty of the evidence.

Results

Eight RCTs were included (N = 1682). Although some individual studies showed positive effects to enhance meaning using mindfulness or dignity therapy, the overall and individual meta-analyses showed a lack of effect of psychological and spiritual interventions in comparison to comparator interventions (MD (95%CI) = −0.19 (−0.45 to 0.06), p = 0.11, Tau2 = 0.0015, I2 = 2%). Publication bias was undetected (Egger’s test = 0.35). Furthermore, no RCTs were judged to have a low risk of bias and the overall certainty of the evidence was judged as low. Meta-regression and subgroups meta-analyses also found possible sources of heterogeneity such as some cancer characteristics, the educational stage, or the religious affiliation.

Conclusions

Despite some RCTs may show promising results following mindfulness or dignity therapy, no effects were observed in the meta-analysis. Moreover, important methodological and clinical concerns precluded us to make sound clinical recommendations with the available evidence.

Open Science Framework DOI Registration

https://doi.org/10.17605/OSF.IO/4YMTK.

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References

  1. Snijders RAH, Brom L, Theunissen M, van den Beuken-van Everdingen MHJ (2023) Update on prevalence of pain in patients with cancer 2022: a systematic literature review and meta-analysis. Cancers 15(3):591

    PubMed  PubMed Central  Google Scholar 

  2. Ma Y, He B, Jiang M, Yang Y, Wang C, Huang C et al (2020) Prevalence and risk factors of cancer-related fatigue: a systematic review and meta-analysis. Int J Nurs Stud 111:103707

    PubMed  Google Scholar 

  3. Almeida SN, Elliott R, Silva ER, Sales CMD (2019) Fear of cancer recurrence: a qualitative systematic review and meta-synthesis of patients’ experiences. Clin Psychol Rev 68:13–24

    PubMed  Google Scholar 

  4. Guan T, Santacroce SJ, Chen DG, Song L (2020) Illness uncertainty, coping, and quality of life among patients with prostate cancer. Psychooncology 29(6):1019–1025

    PubMed  Google Scholar 

  5. Langmuir T, Chu A, Sehabi G, Giguère L, Lamarche J, Boudjatat W et al (2023) A new landscape in illness uncertainty: a systematic review and thematic synthesis of the experience of uncertainty in patients with advanced cancer receiving immunotherapy or targeted therapy. Psychooncology 32(3):356–367

    PubMed  Google Scholar 

  6. Madsen R, Uhrenfeldt L, Birkelund R (2019) Transition experiences during courses of incurable cancer from the perspective of patients. Eur J Oncol Nurs 38:13–20

    PubMed  Google Scholar 

  7. Dornan M, Semple C, Moorhead A (2022) «It’s part of our life now»: a qualitative exploration of the social eating experiences of family members of patients living with head and neck cancer. Support Care Cancer 30(12):10159–10167

    PubMed  PubMed Central  Google Scholar 

  8. Zhu Y, Pei X, Chen X, Li T (2023) Family caregivers’ experiences of caring for advanced cancer patients: a qualitative systematic review and meta-synthesis. Cancer Nurs 46(4):270–283

    PubMed  Google Scholar 

  9. Iskandar AC, Rochmawati E, Wiechula R (2021) Experiences and perspectives of suffering in cancer: a qualitative systematic review. Eur J Oncol Nurs 54:102041

    PubMed  Google Scholar 

  10. Moye J, Jahn A, Norris-Bell R, Herman LI, Gosian J, Naik AD (2020) Making meaning of cancer: a qualitative analysis of oral-digestive cancer survivors’ reflections. J Health Psychol 25(9):1222–1235

    PubMed  Google Scholar 

  11. Gonzalez P, Castañeda SF, Dale J, Medeiros EA, Buelna C, Nuñez A et al (2014) Spiritual well-being and depressive symptoms among cancer survivors. Support Care Cancer 22(9):2393–2400

    PubMed  PubMed Central  Google Scholar 

  12. Smith TB, McCullough ME, Poll J (2003) Religiousness and depression: evidence for a main effect and the moderating influence of stressful life events. Psychol Bull 129(4):614–636

    PubMed  Google Scholar 

  13. Blasco-Belled A, Alsinet C (2022) The architecture of psychological well-being: a network analysis study of the Ryff Psychological Well-Being Scale. Scand J Psychol 63(3):199–207

    PubMed  Google Scholar 

  14. Gomez R, Fisher JW (2003) Domains of spiritual well-being and development and validation of the Spiritual Well-Being Questionnaire. Personal Individ Differ 35(8):1975–1991

    Google Scholar 

  15. Bai M, Lazenby M (2015) A systematic review of associations between spiritual well-being and quality of life at the scale and factor levels in studies among patients with cancer. J Palliat Med 18(3):286–298

    PubMed  PubMed Central  Google Scholar 

  16. Timmins F, Caldeira S (2017) Understanding spirituality and spiritual care in nursing. Nurs Stand 31(22):50–57

    PubMed  Google Scholar 

  17. Cheng Q, Lu W, Duan Y, Li J, Xie J, Chen Y (2023) Spiritual well-being and its association with hope and meaning in life among gastrointestinal cancer patients: a cross-sectional study. Support Care Cancer 31(4):243

    PubMed  Google Scholar 

  18. Park CL (2010) Making sense of the meaning literature: an integrative review of meaning making and its effects on adjustment to stressful life events. Psychol Bull 136(2):257–301

    PubMed  Google Scholar 

  19. Park CL, Van Tongeren DR (2022) Meaning as a framework for integrating positive psychology and the psychology of religiousness and spirituality. In: Handbook of positive psychology, religion, and spirituality. Springer International Publishing, Cham, pp 83–96

    Google Scholar 

  20. Koh SJ, Kang KA, Kim H, Cheon J, Im HS, Lee JH et al (2023) Perceptions of the meaning of life among Korean patients with advanced cancer: a mixed-methods study. Palliat Support Care 21(4):658–669

    PubMed  Google Scholar 

  21. Bobevski I, Kissane DW, Vehling S, Mehnert-Theuerkauf A, Belvederi Murri M, Grassi L (2022) Demoralisation and its link with depression, psychological adjustment and suicidality among cancer patients: a network psychometrics approach. Cancer Med 11(3):815–825

    PubMed  Google Scholar 

  22. Liu X, Liu Z, Cheng Q, Xu N, Liu H, Ying W (2021) Effects of meaning in life and individual characteristics on dignity in patients with advanced cancer in China: a cross-sectional study. Support Care Cancer 29(5):2319–2326

    PubMed  Google Scholar 

  23. Wnuk M, Marcinkowski JT, Fobair P (2012) The relationship of purpose in life and hope in shaping happiness among patients with cancer in Poland. J Psychosoc Oncol 30(4):461–483

    PubMed  Google Scholar 

  24. Peterman AH, Fitchett G, Brady MJ, Hernandez L, Cella D (2002) Measuring spiritual well-being in people with cancer: the functional assessment of chronic illness therapy--Spiritual Well-being Scale (FACIT-Sp). Ann Behav Med 24(1):49–58

    PubMed  Google Scholar 

  25. Austin P, Macdonald J, MacLeod R (2018) Measuring spirituality and religiosity in clinical settings: a scoping review of available instruments. Religions. 9(3):70

    Google Scholar 

  26. Visser A, Garssen B, Vingerhoets A (2010) Spirituality and well-being in cancer patients: a review. Psychooncology 19(6):565–572

    PubMed  Google Scholar 

  27. Balboni TA, VanderWeele TJ, Doan-Soares SD, Long KNG, Ferrell BR, Fitchett G et al (2022) Spirituality in serious illness and health. JAMA. 328(2):184–197

    PubMed  Google Scholar 

  28. Murphy PE, Canada AL, Fitchett G, Stein K, Portier K, Crammer C et al (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). Psychooncology 19(3):264–272

    PubMed  Google Scholar 

  29. Xiao J, Chow KM, Choi KC, Ng SNM, Huang C, Ding J et al (2022) Effects of family-oriented dignity therapy on dignity, depression and spiritual well-being of patients with lung cancer undergoing chemotherapy: a randomised controlled trial. Int J Nurs Studs 129:104217

    Google Scholar 

  30. Carlson LE, Tamagawa R, Stephen J, Drysdale E, Zhong L, Speca M (2016) Randomized-controlled trial of mindfulness-based cancer recovery versus supportive expressive group therapy among distressed breast cancer survivors (MINDSET): long-term follow-up results. Psychooncologys 25(7):750–759

    Google Scholar 

  31. Chen J, Yan J, Wang C, Wang Y, Wu Y, Hu R (2021) Effects and satisfaction of dignity therapy among patients with hematologic neoplasms in the Chinese cultural context: a randomized controlled trial. Support Care Cancer 29(11):6819–6829

    PubMed  Google Scholar 

  32. Lim M, Ang B, Lam C, Loh E, Zainuddin S, Capelle D et al (2021) The effect of 5-min mindfulness of love on suffering and spiritual quality of life of palliative care patients: a randomized controlled study. Eur J Cancer Care (Engl) 30(5):e13456

    PubMed  Google Scholar 

  33. Cook EL, Silverman MJ (2013) Effects of music therapy on spirituality with patients on a medical oncology/hematology unit: a mixed-methods approach. Arts Psychother 40(2):239–244

    Google Scholar 

  34. Jafari N, Farajzadegan Z, Zamani A, Bahrami F, Emami H, Loghmani A, et al. Spiritual therapy to improve the spiritual well-being of iranian women with breast cancer: a randomized controlled trial. Evid Based Complement Alternat Med [Internet]. 2013;2013((Jafari N., n_jafari@med.mui.ac.ir; Farajzadegan Z., farajzadegan@med.mui.ac.ir; Zamani A., zamani@med.mui.ac.ir; Loghmani A., a_loghmani@residents.mui.ac.ir) Community Medicine Department, School of Medicine, Isfahan University of Medical Sciences, Hezar Jerib Street, Isfahan, Iran). Disponible en: https://www.embase.com/search/results?subaction=viewrecord&id=L369831433&from=export

  35. Wise M, Marchand LR, Roberts LJ, Chih MY (2018) Suffering in advanced cancer: a randomized control trial of a narrative intervention. J Palliat Meds 21(2):200–207

    Google Scholar 

  36. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD et al (2021) The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 372:n71

    PubMed  PubMed Central  Google Scholar 

  37. Beller EM, Glasziou PP, Altman DG, Hopewell S, Bastian H, Chalmers I et al (2013) PRISMA for Abstracts: reporting systematic reviews in journal and conference abstracts. PLoS Med 10(4):e1001419

    PubMed  PubMed Central  Google Scholar 

  38. Richardson WS, Wilson MC, Nishikawa J, Hayward RS (1995) The well-built clinical question: a key to evidence-based decisions. ACP J Club 123(3):A12–A13

    CAS  PubMed  Google Scholar 

  39. Ílvia Caldeira S, Timmins F (2017) Implementing spiritual care interventions. Nurs Stand 31(34):54–60

    PubMed  Google Scholar 

  40. Hodges LJ, Walker J, Kleiboer AM, Ramirez AJ, Richardson A, Velikova G et al (2011) What is a psychological intervention? A metareview and practical proposal. Psychooncology 20(5):470–478

    PubMed  Google Scholar 

  41. Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I et al (2019) RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 366:l4898

    PubMed  Google Scholar 

  42. Hoffmann TC, Glasziou PP, Boutron I, Milne R, Perera R, Moher D et al (2014) Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ 348:g1687

    PubMed  Google Scholar 

  43. Schünemann H, Brożek J, Guyatt G, Oxman A (eds) (2013) GRADE handbook for grading quality of evidence and strength of recommendations. The GRADE Working Group Disponible en: Available from http://guidelinedevelopment.org/handbook

    Google Scholar 

  44. Balduzzi S, Rücker G, Schwarzer G (2019) How to perform a meta-analysis with R: a practical tutorial. Evid Based Ment Health 22(4):153–160

    PubMed  PubMed Central  Google Scholar 

  45. Viechtbauer W (2010) Conducting meta-analyses in R with the metafor package. J Stat Softw 36(3):1–48

    Google Scholar 

  46. Harrer M, Cuijpers P, Furukawa T, Ebert DD (2019) Dmetar: Companion R package for the guide “doing meta-analysis in R”. In: R package version 0.0.9000 Disponible en: http://dmetar.protectlab.org/

    Google Scholar 

  47. Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Routledge, New York, NY, p 567

    Google Scholar 

  48. Olver IN, Dutney A (2012) A randomized, blinded study of the impact of intercessory prayer on spiritual well-being in patients with cancer. Altern Ther Health Med 18(5):18–27

    PubMed  Google Scholar 

  49. Schünemann H, Brożek J, Guyatt G, Oxman A (eds) GRADE handbook for grading quality of evidence and strength of recommendations. Updated October 2013. [Internet]. In: The GRADE Working Group; 2013 Disponible en: Available from http://guidelinedevelopment.org/handbook

  50. Carlson LE, Speca M (2010) Mindfulness-based cancer recovery: a step-by-step MBSR approach to help you cope with treatment and reclaim your life. New Harbinger, Oakville, CA

    Google Scholar 

  51. García-Vivar C (2022) The use and misuse of the concept of cancer survivor. Cancer Nurs 45(6):419–420

    PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Departamento de Fisioterapia, Facultad de Enfermería, Fisioterapia y Podología, Universidad de Sevilla, c/Avicena s/n, Sevilla, Spain

    Javier Martinez-Calderon

  2. CTS 1110: Uncertainty, Mindfulness, Self, and Spirituality (UMMS) Research Group, Andalusia, Spain

    Javier Martinez-Calderon, Cristina García-Muñoz & Alberto Marcos Heredia-Rizo

  3. Universidad Loyola de Andalucía, Avda. de las Universidades s/n, 41704 Sevilla, Sevilla, Spain

    Cristina García-Muñoz

  4. Departamento de Personalidad, Evaluación y Tratamiento Psicológicos, Universidad de Sevilla, 41018, Sevilla, Spain

    Francisco Javier Cano-García

  5. Instituto de Biomedicina de Sevilla, IBiS, Departamento de Fisioterapia, Universidad de Sevilla, Sevilla, Spain

    Alberto Marcos Heredia-Rizo

Authors
  1. Javier Martinez-Calderon
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  3. Francisco Javier Cano-García
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Contributions

JMC designed the study; JMC, CGM, FJC, and AMHR developed the different analyses; JMC wrote the main manuscript. All authors reviewed and approved the final version of this work.

Corresponding author

Correspondence to Cristina García-Muñoz.

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This is a systematic review and thus, this statement is not applicable.

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The original version of this article was revised. The authors detected a minor error related to the written information in the “Certainty of the evidence (GRADE)” subsection of Results as well as Supplementary Material 28.

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Martinez-Calderon, J., García-Muñoz, C., Cano-García, F.J. et al. Psychological and spiritual interventions to enhance meaning in adults diagnosed with cancer: a systematic review with meta-analysis and meta-regression. Support Care Cancer 31, 523 (2023). https://doi.org/10.1007/s00520-023-07986-y

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