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Meaning and Purpose (MaP) therapy in advanced cancer patients: a randomised controlled trial

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Abstract

Purpose

We aimed to examine the efficacy of Meaning and Purpose (MaP) Therapy in promoting posttraumatic growth and meaningful life attitudes (choices and goal seeking) in people living with advanced cancer.

Methods

Patients with a prognosis ≥ 1 year were stratified across two sites and randomised to receive MaP therapy and regular oncology/palliative care (Intervention) or usual care (Control). They completed measures at baseline (t0), post-intervention (12 weeks, t1) and 12 weeks later (t2). Our primary outcome was posttraumatic growth (PTGI); secondary outcome measures included life attitudes (LAPR), spiritual wellbeing (FACIT-Sp), anxiety, demoralization and depression. Trial Registration Number: ACTRN12618001751268, 7 January 2019.

Results

We consented 107 from 404 eligible patients (26.5%) and randomised 55 to MaP Invention (35 completing t1, 25 t2) and 52 to Control (32 completing t1, 25 t2). Fidelity of the intervention was sustained. PTGI mean scores were significantly higher post-intervention on analysis by covariance (Cohen’s d = 0.7 at t1 & d = 0.5 at t2). Secondary measures were significant, including LAPR (d = 0.4) and FACIT-Sp (meaning subscale d = 0.4; total d = 0.4). Participants completing six sessions achieved more noteworthy effect sizes.

Conclusion

This brief, structured individual intervention shows promise for sustaining sense of coherence, meaning and choices in life despite living with advanced cancer.

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Data availability

Data can be obtained from the study statistician, Dr Irene Bobevski; email irene.bobevski@monash.edu. Schematic MaP Therapy summary sheets and Fidelity coding checklists are attached as an Appendix with the Supplementary data. The therapy manual can be obtained from Prof David Kissane, email david.kissane@monash.edu or Dr Carrie Lethborg, email carrie@hyperphonic.com.

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Acknowledgements

We thank our therapists and referring clinicians: Yoland Antill, Richard Chye, Jo Fleisher, Rachel Henwood, Lebecca Jelicic, Pauley Kessel, Anna Laverty-Wilson, Lara Lipton, Paulina Mech, Natasha Michael, Veronica O’Shaughnessy, Christopher Pene, Davinia Seah, Michelle White and Celeste Whiteman.

Funding

We acknowledge with gratitude the support of the Charles Curran Foundation at St Vincent’s Hospital Sydney and the Doreen Johnson Oncology Research Grant from the Cabrini Foundation, awarded to David Kissane.

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Authors and Affiliations

  1. School of Medicine, University of Notre Dame Australia, Sydney, Australia

    David W. Kissane, Irene Bobevski, Jane Appleton, Natasha Michael & Richard Chye

  2. Departments of Palliative Care, Cabrini Health, Melbourne, Australia

    David W. Kissane, Genevieve Murphy & Natasha Michael

  3. Department of Palliative Care, St Vincent’s Hospital Sydney, Sydney, Australia

    David W. Kissane, Jane Appleton, Anna Laverty-Wilson & Richard Chye

  4. School of Clinical Sciences, Monash Health and Monash University, Melbourne, Australia

    David W. Kissane, Irene Bobevski, Genevieve Murphy, Pauley Kessel & Natasha Michael

  5. Centre for Rural Health, University of Tasmania, Launceston, Australia

    Carrie Lethborg

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  1. David W. Kissane
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  2. Irene Bobevski
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Contributions

Conceptualization, design, funding, and analysis by DK, IB, NM, RC; recruitment and data collection by JA, GM; therapy and supervision by ALW, PK, DK; statistical analysis by IB; therapy manual development by CL, DK; first draft by DK, IB; Review of manuscript by all.

Corresponding author

Correspondence to David W. Kissane.

Ethics declarations

Ethical approval

In line with principles of the Declaration of Helsinki, ethical approval was given by the Human Research Ethics Committees of both institutions: Cabrini HREC 15-17-09-18; St Vincent’s HREC:2019/STE00014-SVH19/181. Written informed consent was obtained from all participants.

Competing interests

The authors have no relevant financial or non-financial duality of interests to disclose.

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Kissane, D.W., Bobevski, I., Appleton, J. et al. Meaning and Purpose (MaP) therapy in advanced cancer patients: a randomised controlled trial. Support Care Cancer 31, 734 (2023). https://doi.org/10.1007/s00520-023-08189-1

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