The Construction Of The Meaning Making Intervention And The Effect Of Its Application On Terminal Ill Cancer Patients

[Aim]Searching for meaning is a persistent, changing and individual process through one’s life and one may encounter frustration in the process, especially when one faces suffering or death.Encountering the pain cancer brings and impossible cure for cancer, advanced cancer patients usually feel the approach of death, often encounter frustration for the meaning of life.To supply references for improving the quality of life on the spiritual level through improving the sense of meaning of life and reducing the anxiety, depression, moreover the psychological pain for advanced cancer patients, we constructed the localization meaning making intervention (MMi) by literature analysis,clinical observation,understanding the searching for meaning for domestic advanced cancer patients and panel meeting.And then evaluate the effect of the intervention.[Methods]1. The Qualitative studyWe selected "Hermeneutics" as our research methodology which is one of the qualitative methods in order to understand the searching for meaning pathways for advanced cancer patients (30) who were selected according to Inclusion criteria in a traditional Chinese medicine department general ward from a three level of first-class hospital in Shanghai from April1,2012to June15,2012. We constructed the model for searching for meaning for cancer patients thourgh literature analysis as one of the important of the principle of "Hermeneutics". The model includes seven categories which are "cancer attribution, construing benefits from loss, creation and action, hope, love, spiritual belief or faith and self-identity" for searching for meaning pathways. And then we formulated the interview outline according to that.2. The construction of interventionThe localized meaning making intervention final draft for advanced cancer patients was formed by constructing the first draft of the intervention using literature "content analysis" combined with the clinical observation, revising that according to the results of qualitative study further and taking panel meeting method to revise that lastly.3. The intervention study Randomized Control Test was used in the intervention study part. We selected the eligible advanced cancer patients who were in a traditional Chinese medicine department general ward from a three level of first-class hospital in Shanghai from July1,2012to December31,2012firstly, and then they were randomized divided into intervention group (18) and Control group (20). The intervention group patients accepted ordinary care and at the same time the localized meaning making intervention and the control group patients accepted ordinary care only. The effects were evaluated by many scales before the intervention and24hours after the completion of the intervention for the intervention and control group.[Findings]1. The findings for qualitative study(1) Sixteen themes and thirteen sub-themes relating to searching for meaning pathways emerged. We classify those themes to seven categories for searching for meaning pathways wich are cancer attribution(self factors, the medical service factors and environmental factors), construing benefits from loss (appreciate the true meaning of the life and downward comparison), creation and action (way of doing things, making fun and settleling care), hope (treatmen trust and hospice care), love (love and to be loved), self-identity (be strong and tolerance) and spiritual belief or faith (religious belief and personal faith)(table2-2)(2) Six themes and ten sub-themes relating to frustrations in the process of searching for meaning for them emerged. The themes and sub-themes include self factors (burden, worry, fear and self sealing), economic burden, changes of life, treatment related(great side effects, communication problems and difficult seeking of medical treatment), lack of support (unfortunate marriage, low attention from society and the lack of information) and cancer discrimination (figure2-1)2. The literature analysis and the intervention formed(1) The literature analysis:The literatures about meaning intervention mainly distributed about the past six years (2006-2012).The interventions can be summarized as two types which are"one-to-one"model and group model. The interventions of one-to-one"model include Meaning-making Interventions, individual Meaning-Centered Psychotherapy and life review. The interventions of group model include Meaning-centered Group Psychotherapy and logotherapy. We analysed the above interventions systematicly according to the inclusion criteria of the intervention objects, the intervention meatures, intervenor, implementation steps, evaluation indexs, evaluation time, intervention effects and the advantages and limitations for the intervention. The sysmetic analysis of that and clinical observation are the basis of the construction of the localized meaning making intervention.(2) The localized meaning making intervention for advanced cancer patient:The researcher herself carries that; Specific intervention contents for the intervention are three takes which are "Acknowledge the Present","Life Review" and "Live the Present for the Future" according to the completion order and will be finished by the patients with the help of the researcher; The tasks will be divided three times to complete, and each task intervals are1-2days and all the tasks will be controlled with in6days to accomplish; The three scales of "Numeric Rating Scales of Suffering, NRSS","Hospital Anxiety and Depression Scale, HADS" and "Meaning in Life Scale for Advanced Cancer Patients, MiLS" were adopted to evaluate the effect of the interventions within24hours after the interventions were finished.3. The evaluation for the intervention effectiveness(1) t-test:Parallel comparison results show that:The scores for the mental pain digital, depression dimension, the meaning of life and satisfaction dimension, suffering tolerance and death acceptation dimension between the two groups existed statistical significances (P<O.05). Namely, after the intervention, the intervention group patients’psychological pain decreased, depression level was reduced, the meaning of life and satisfaction ascended, suffering tolerance and death acceptation ability were enhanced compared with the control group patients (table4-3);Two groups of their own cross-references results show that: Before and after the intervention, the scores for mental pain digital, anxiety depression scale, depression dimension, the meaning of life scale, the meaning of life and satisfaction dimensions, suffering toleration and death acceptation dimension had statistical significances (P<0.05) for the intervention group. Namely, after the intervention, psychological pain degree and anxiety depression level was reduced and the overall level for sense of meaning, the meaning of life and satisfaction, suffering tolerance and death acceptance level increased for the intervention group (table4-4). Before and after the intervention, only the will to search for meaning dimension score had statistical significances for the control group (P<0.05). Namely, after the intervention (usual care), the will to search for meaning was higher, while the other scales all had no statistical significances before and after the intervention usual care) for the control group (P>0.05)(table4-5) (2) ANCOVA:The changes of adjusted mean for scores of the mental pain digital, the meaning of life scale and suffering toleration which is one dimension of the meaning of life scale before and after the intervention had statistical significances between control group and intervention group (P<0.05). That is the mental pain which was eased, the sense of meaning of life which was promoted and the ability of suffering toleration which was enhanced for the intervention group compared with the control after the intervention.There were no statistical significances for any of the rest scale between the two group (P>0.05)[Conclusions]1. The domestic cancer patients can search for meaning thourgh many ways and also can encounter many frustrations. It’s very important to identify the frustions to formulate the domestic meaning making intervention for advanced cancer patients.2. The domestic meaning making intervention can reduce the degree of mental pain, could not have made sure the effect for improve the anxiety and depreesion mood and can promote the sense of meaning of life and can enhance the ablity to bear suffering which is a dimension of scale for meaning of life especially. The intervention has a good acceptance and clinical feasibility for advanced cancer patients.3. The meaning making intervention is an important spiritual need for advanced cancer patients. And it is necessary to train related personnel to carry out the clinical research on meaning making intervention and conduct the clinical practice of meaning making intervention for advanced cancer patients.