Department of Psychiatry and Mental Health, Centro Hospitalar Barreiro-Montijo, EPE, Barreiro, Portugal.
Medical School of Lisbon, University of Lisbon, Lisbon, Portugal.
Palliat Support Care. 2021 Aug;19(4):464-473. doi: 10.1017/S1478951521000602.
To describe the feasibility of a meaning-centered group psychotherapy (MCGP) adaptation in a sample of Portuguese cancer patients.
The study was carried out according to four steps: 1st - Transcultural adaptation and validation (focus groups); 2nd - Preliminary study with MCGP original version (to test its feasibility); 3rd - Adaptation of MCGP original version to a 4-session version (and internal pilot study); and 4th - Pilot exploratory trial (MCGP-4 session version), implemented between January 1, 2018 and December 31, 2019. Inclusion criteria were >18 years, psychological complaints, and difficulty to adapt to cancer. Allocation was according to participants' preference: MCGP vs. care as usual (CAU). Primary outcomes were: MCGP adapted version improved quality of life (QoL) and spiritual well-being; secondary outcomes were improvement of depression, anxiety, and distress. Assessments were done at baseline (T1) and 1 month after (T2), with self-report socio-demographic and clinical questionnaires, Distress Thermometer (DT), McGill Quality of Life Questionnaire (MQOL), Functional Assessment of Chronic Illness Therapy - Spiritual Well-Being Scale (FACIT-Sp-12), Hospital Anxiety and Depression Scale, and its subscales (HADS - HADS-D, HADS-A).
In the 1st step, and through focus groups, the manual was reformulated and tested. The preliminary study (2nd step) with MCGP original version showed a high number of dropouts which could jeopardize the study and, after reframing the sessions content, MCGP was adapted to a 4-session version, and its feasibility was tested by an internal pilot study (3rd step). The pilot exploratory trial (4th step) had 91 participants. Most socio-demographic and clinical characteristics between the groups (51: MCGP; 40: CAU) had no statistically significant differences. A comparison between the two groups at T2 showed that the MCGP group scored significantly higher in the general (U = 552.00, P < 0.001), and existential (U = 727.50, P = 0.018) domains and total score (U = 717.50, P = 0.015) of QoL, and CAU presented statistical higher levels in DT (U = 608.50, P = 0.001). Comparing the groups between T1 and T2, the MCGP group had a statistically significant improvement in the general (Z = -3.67, P < 0.001) and psychosocial (Z = -2.89, P = 0.004) domains and total score (Z = -2.71, P = 0.007) of QoL, and a statistically significant decrease in DT (Z = -2.40, P = 0.016). In terms of group effects, the MCGP group presented increased general (b = 1.42, P < 0.001, η2p = 0.179), and support (b = 0.80, P = 0.045, η2p = 0.048) domains and total score (b = 0.81, P = 0.013, η2p = 0.073) of QoL (small to elevated dimensions), and decreased levels of depression (b = -1.14, P = 0.044, η2p = 0.048), and distress (b = -1.38, P = 0.001, η2p = 0.127) (small to medium dimensions), compared with CAU. At T2, participants who attended ≥3 sessions (n = 38) had a statistically significant higher score in the general domain (U = 130.50, P = 0.009) of QoL, comparing with those who attended 1 or 2 sessions (n = 13).
This study supports the benefits of an MCGP adapted version in improving QoL and psychologic well-being. More studies are necessary to address the limitations of this pilot exploratory trial, as its small sample size.
描述一种以意义为中心的团体心理治疗（MCGP）适应葡萄牙癌症患者样本的可行性。
该研究按照以下四个步骤进行：1. 文化翻译和验证（焦点小组）；2. MCGP 原始版本的初步研究（测试其可行性）；3. 改编为 4 节版本（和内部试点研究）；4. 探索性试验（MCGP-4 节版本），于 2018 年 1 月 1 日至 2019 年 12 月 31 日实施。纳入标准为 >18 岁，有心理困扰和难以适应癌症。根据参与者的偏好进行分配：MCGP 与常规护理（CAU）。主要结果是 MCGP 改编版本提高了生活质量（QoL）和精神幸福感；次要结果是改善抑郁、焦虑和困扰。评估在基线（T1）和 1 个月后（T2）进行，使用自我报告的社会人口统计学和临床问卷、痛苦温度计（DT）、McGill 生活质量问卷（MQOL）、慢性疾病治疗的功能评估-精神幸福感量表（FACIT-Sp-12）、医院焦虑和抑郁量表及其子量表（HADS-HADS-D、HADS-A）。
在第 1 步中，通过焦点小组对手册进行了重新制定和测试。对 MCGP 原始版本的初步研究（第 2 步）显示出较高的脱落率，这可能会影响研究，在重新构建会话内容后，MCGP 被改编为 4 节版本，并通过内部试点研究对其可行性进行了测试（第 3 步）。探索性试验（第 4 步）有 91 名参与者。两组之间的大多数社会人口统计学和临床特征（51：MCGP；40：CAU）没有统计学上的显著差异。两组在 T2 时的比较显示，MCGP 组在一般（U = 552.00，P < 0.001）和存在（U = 727.50，P = 0.018）领域以及总分（U = 717.50，P = 0.015）的 QoL 得分显著更高，而 CAU 在 DT（U = 608.50，P = 0.001）中表现出统计学上更高的水平。在 T1 和 T2 之间比较两组，MCGP 组在一般（Z = -3.67，P < 0.001）和心理社会（Z = -2.89，P = 0.004）领域以及总分（Z = -2.71，P = 0.007）的 QoL 有统计学显著改善，DT（Z = -2.40，P = 0.016）有统计学显著下降。就组间效应而言，MCGP 组表现出一般（b = 1.42，P < 0.001，η2p = 0.179）和支持（b = 0.80，P = 0.045，η2p = 0.048）领域以及总分（b = 0.81，P = 0.013，η2p = 0.073）的 QoL（小到高维度）的增加，以及抑郁（b = -1.14，P = 0.044，η2p = 0.048）和困扰（b = -1.38，P = 0.001，η2p = 0.127）水平的降低（小到中维度），与 CAU 相比。在 T2 时，与参加 1 或 2 次会议的参与者（n = 13）相比，参加 ≥3 次会议的参与者（n = 38）的 QoL 一般领域得分有统计学显著提高（U = 130.50，P = 0.009）。
这项研究支持 MCGP 改编版本在提高生活质量和心理幸福感方面的益处。需要更多的研究来解决这项探索性试验的局限性，因为其样本量较小。
