Power of the past: Life review therapy in palliative cancer care

Chapter 1 contains the general introduction of this thesis. It provides an overview of the epidemiology and treatment of cancer and palliative care, and the challenges this disease and its treatment puts on patients and their informal caregivers. Also, life review therapy is introduced, the intervention “Dear Memories” is described, and the main aim and the hypotheses of this dissertation are presented. The main aim of this dissertation is to obtain insight in the efficacy of the structured Life Review Therapy combined with memory specificity training (LRT-MST), named ‘’Dear Memories’’ among incurably ill cancer patients. Chapter 2 presents the study protocol of the randomized controlled trial (RCT) to assess the efficacy of LRT-MST in incurably ill cancer patients and their spouses. Spouses will not receive LRT themselves, but because it was expected that patients will talk about their memories during the intervention period with their spouses, it was hypothesized that LRT may have a positive effect on them as well. Chapter 3 describes a study on the psychometric characteristics of the primary outcome measure in in the RCT: the North-western Ego-integrity Scale (NEIS). It is a questionnaire on ego-integrity (the experience of wholeness and meaning in life, even in spite of negative experiences) and despair (the experience of regret about the life one has led, and feelings of sadness, failure and hopelessness) among cancer patients. It was concluded that the NEIS has good psychometric characteristics to assess ego-integrity and despair among cancer patients. Chapter 4 presents the results of the multicentre randomized controlled trial investigating the efficacy of LRT-MST among incurably ill cancer patients. A total of 107 patients were randomized to the intervention group (LRT-MST; n=55) or waiting-list control group (n=52). Linear mixed models (intention to treat) showed that the course of ego-integrity (not despair) improved significantly over time (p=.007) in the intervention group compared to the waiting-list control group, with moderate, but statistically not significant, effect sizes at T1 (ES=.42) and T2 (ES=.48). This study showed that LRT-MST seems effective to improve ego-integrity among cancer patients in palliative care. Chapter 5 includes the outcomes of a qualitative study which provided more in-depth knowledge on motivation to start with LRT-MST, experiences with LRT-MST, and perceived outcomes of LRT-MST in incurably ill cancer patients. Semi-structured interviews were conducted with 20 cancer patients in palliative care who participated in the RCT. The results of this study are important to further tailor LRT-MST and for development or improvement of other psychological interventions targeting cancer patients in palliative care. Chapter 6 investigated whether Life Review Therapy and Memory Specificity Training (LRT-MST) targeting incurably ill cancer patients, may also have a beneficial effect on caregiving burden, symptoms of anxiety and depression, and posttraumatic growth of the informal caregivers. Many caregivers experienced symptoms of anxiety (56%) and depression (30%). LRT-MST did not improve symptoms of depression and anxiety, negative aspects of caregiver burden or post-traumatic growth. LRT-MST may have a protective effect on self-esteem of informal caregivers (positive aspect of caregiver burden). Chapter 7 provides a general discussion putting the findings of the studies conducted in this dissertation in broader perspective. Also, strengths, limitations, implications for clinical practice and recommendations for future research are provided

Convergent validity.

<p>Convergent validity.</p

Demographic characteristics of participants.

<p>Demographic characteristics of participants.</p

Confirmatory Factor Analysis of the Northwestern Ego-integrity Scale, correlated factors were assumed.

<p>Confirmatory Factor Analysis of the Northwestern Ego-integrity Scale, correlated factors were assumed.</p

A randomized controlled trial on the efficacy of life review therapy targeting incurably ill cancer patients: do their informal caregivers benefit?

Purpose: Investigate whether Life Review Therapy and Memory Specificity Training (LRT-MST) targeting incurably ill cancer patients may also have a beneficial effect on caregiving burden, symptoms of anxiety and depression, and posttraumatic growth of the informal caregivers. Methods: Data was collected in the context of a randomized controlled trial (RCT) (secondary analyses) on the effect of LRT-MST among incurably cancer patients. Informal caregivers of participating patients were asked to complete outcome measures at baseline (T0), post-intervention (T1), and 1-month follow-up (T2): caregiver burden (caregivers reaction assessment scale (CRA)), symptoms of anxiety and depression (hospital anxiety and depression scale), and posttraumatic growth (posttraumatic growth inventory). Linear mixed models (intention to treat) were used to assess group differences in changes over time. Effect size and independent samples t tests were used to assess group differences at T1 and T2. Results: In total, 64 caregivers participated. At baseline, 56% of the caregivers experienced anxiety and 30% depression. No significant effect was found on these symptoms nor on posttraumatic growth or most aspects of caregiver burden. There was a significant effect of LRT-MST on the course of self-esteem (subscale CRA) (p = 0.013). Effect size was moderate post-intervention (ES = − 0.38, p = 0.23) and at 3-month follow-up (ES = 0.53, p = 0.083). Conclusions: Many caregivers of incurably ill cancer patients experience symptoms of anxiety and depression. LRT-MST does not improve symptoms of depression and anxiety, negative aspects of caregiver burden, or posttraumatic growth. LRT-MST may have a protective effect on self-esteem of informal caregivers (positive aspect of caregiver burden). Trial registration number: Netherlands Trial Register (NTR 2256), registered on 23-3-2010

L'Auto-vélo : automobilisme, cyclisme, athlétisme, yachting, aérostation, escrime, hippisme / dir. Henri Desgranges

20 octobre 19101910/10/20 (A11,N3657)

The efficacy of Life Review Therapy combined with Memory Specificity Training (LRT-MST) targeting cancer patients in palliative care : A randomized controlled trial

BACKGROUND: The aim of this study was to evaluate the efficacy of an intervention combining Life Review Therapy (LRT) and Memory Specificity Training (MST) (LRT-MST) to improve ego-integrity and despair among cancer patients in palliative care. METHODS: In this multicentre randomized controlled trial, cancer patients in palliative care were randomized to the intervention group (LRT-MST; n = 55) or waiting-list control group (n = 52). LRT-MST is a 4-session home-based psychological intervention that aims to retrieve specific positive memories, to re-evaluate life events and to reconstruct the story of a patient's life, including the diagnosis of incurable cancer. Outcome measures were ego-integrity and despair (NEIS), psychological distress, anxiety and depression (HADS), quality of life (EORTC QLQ-C15-PAL), and specificity of the autobiographical memory (AMT). NEIS, HADS and EORTC QLQ-C15-PAL were assessed at baseline (T0), 1 month later (post-treatment; T1), and at 1 month follow-up (T2). AMT was assessed at T0 and T1. Linear mixed models (intention to treat) were used to assess group differences in changes over time. Independent samples t-tests were used to assess group differences at T0, T1, and T2, and effect sizes (ES) were calculated at T1 and T2. RESULTS: The course of ego-integrity (not despair) improved significantly over time (p = .007) in the intervention group compared to the waiting-list control group, with moderate, but insignificant, effect sizes at T1 (ES = .42) and T2 (ES = .48). Compliance rate was 69% and total dropout rate was 28%, both primarily related to disease progression and death. CONCLUSIONS: LRT-MST seems effective among cancer patients in palliative care to improve the course of ego-integrity