Adjustment Disorder, Non-metastatic Cancer
Conditions
Keywords
Creating meaning, Therapy, Cancer, Oncology, Existential, Spirituality, Quality of life, QOL, Psycho-oncology, French-canadian, Cognitive therapy, Existentialism
Brief summary
The purpose of this study is to test the efficacy of a cognitive-existential intervention (using either an individual or a group format) to improve the existential and global quality of life of patients as compared to usual care in a population of adult non-metastatic cancer patients.
Detailed description
People diagnosed with cancer must learn to cope with loss of meaning and empowerment which compromises quality of life. Questions regarding Why me?, along with universal existential concerns about death, search for meaning, and sense of control over one's life, often constitute the principal source of overall suffering. Since there is no single and identifiable cause for cancer, those existential questions are commonly observed among patients who demand specific interventions to properly address this central issue. The existential approach can be used to help patients find meaning in the midst of a crisis. It addresses a central issue of survivorship in cancer. The conceptual model explains the relation between being exposed to a stressful and traumatic life event such as cancer and the risk of progressing toward adjustment difficulties which compromises quality of life and existential integrity. Cancer constitutes a major stressor involving significant losses that confronts the person's beliefs system. A set of therapeutic strategies can help to cope with this inevitable challenge: 1) cognitive-behavioral strategies; 2) direct existential intervention; and 3) social support through supportive-expressive strategies. Adjustment first involves cognitive reframing of the perception of the situation (situational meaning). Cognitive reframing also contributes to a readjustment of personal beliefs and values (global meaning and existential dimension). Existential strategies enable to further this process by including cognitive (beliefs, sense of coherence, expectations), motivational (choice, goal setting, and goal driving) and affective dimensions. The expressive-supportive strategy promotes active listening and non-judgmental support to encourage expression of emotions. The use of these active coping strategies (meaning-based) to the threatened-life challenge enables optimization of existential and global quality of life, as opposed to employing passive strategies such as avoidance.
Interventions
OTHERCognitive-existential intervention
Over the past 2 years we developed a 12-week cognitive-existential intervention consisting of 12 modules. The first three modules essentially involve cognitive and behavioral techniques proposing reinforcement of the use of active behavioral (e.g., relaxation, activation) and emotional (cognitive reframing) strategies. This content comes from classical cognitive-behavioral techniques. The next 3 modules, inspired by empirically-tested interventions further explore emotional strategies. The last six modules specifically address the existential dimension. They are adapted from logotherapy techniques, which are also empirically-based, and have been adapted to a French-Canadian culture by our team. They aim to improve meaning-based and emotional coping strategies.
OTHERUsual care
This group receive the usual treatment only.
Sponsors
Laval University
Centre de recherche en cancérologie de l'Université Laval
Canadian Cancer Society (CCS)
Maison Michel-Sarrazin
CHU de Quebec-Universite Laval
Study design
Allocation
RANDOMIZED
Intervention model
FACTORIAL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Be of 18 years of age or more; * Speak French; * Have received a diagnosis of non-metastatic cancer; * Be available to participate in the program of 12 weekly group or individual sessions.
Exclusion criteria
* Depressive mood (score greater than 10 on the Hospital Anxiety and Depression Scale depressive subscale) that could interfere with the intervention. Since we specifically target the existential dimension and it might temporarily provoke questioning in patients, high psychological distress must first be addressed using other approaches. * Diagnosis of metastatic cancer or diagnosis of non-metastatic cancer with a usually fast-growing and unpredictable course, making it unlikely to adhere to the intervention (e.g., pancreatic cancer, acute leukemia, glioblastoma).
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Existential quality of life | T0: Pre-intervention | At every time frame, we use two questionnaires to measure the primary outcome: 1. The McGill Quality of Life Questionnaire (MQOL): 16 items plus a single-item global scale. 2. Spiritual well-being (FACIT-SP): The FACIT-SP is a sub-scale of the FACT-G (Functional Assessment of Cancer Therapy-General) and a French version of the FACIT-SP, FACIT-Spiritual well-being scale. This questionnaire has two sub-scales: Meaning/Peace (8 items) and Faith (4 items). |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Global quality of life | T0: Pre-intervention | To measure the secondary outcome, The McGill Quality of Life Questionnaire (MQOL) is use at every time frames. |
Countries
Canada
Outcome results
None listed