To develop a mindfulness-based palliative psychotherapy to address psychoexistential suffering in palliative care.
Conceptualization:
First, a theory of suffering was formulated by merging 2 models of suffering from 2 thematic analyses of 20 palliative care patients and 15 informal caregivers. Second, the results from a secondary thematic analysis of suffering caused by health care interactions were conceptualized into a psychotherapy framework. Third, principles of mindfulness were incorporated into the framework to form a mindfulness-based psychotherapy.
Results:
Mindfulness-based supportive therapy (MBST) was developed with the following 5 components of presence, listening, empathy, compassion, and boundary awareness.
Conclusion:
We believe that MBST is a potentially useful psychological intervention in palliative care, specifically designed to address psychoexistential suffering of terminally ill patients.
CassellEJ. The Nature of Suffering and the Goals of Medicine. Oxford, UK: Oxford University Press; 1991:3–33.
2.
CassellEJ. The nature of suffering and the goals of medicine. N Engl J Med. 1982;302(12):758–760.
3.
ChapmanCRGavrinJ. Suffering and its relationship to pain. J Palliat Care. 1993;9(2):5–13.
4.
ChapmanCRGavrinJ. Suffering: the contributions of persistent pain. Lancet. 1999;353(9171):2233–2237.
5.
LazarusRSFolkmanS. Stress, Appraisal and Coping. New York, NY: Springer; 1984.
6.
KearneyM. A Place of Healing: Working With Suffering in Living and Dying. Oxford, UK: Oxford University Press; 2000:5.
7.
SaundersCBainesM. Living With Dying: The Management of Terminal Disease. 1st ed. Oxford, UK: Oxford University Press; 1983:74.
8.
Al-ShahriMZEldaliAMAl-ZahraniO. Prevalence and severity of suffering among patients with advanced cancer. Support Care Cancer. 2012;20(12):3137–3140.
9.
RuijisCDKerkhofAJvan der WalGOnwuteaka-PhilipsenBD. The broad spectrum of unbearable suffering in end-of-life cancer studied in Dutch primary care. BMC Palliat Care. 2012;11:12.
10.
MurataHMoritaT. Conceptualization of psycho-existential suffering by the Japanese task force: the first step of a nationwide project. Palliat Support Care. 2006;4(3):279–285.
11.
MoritaT. Existential concerns of terminally ill cancer patients receiving specialized palliative care in Japan. Support Care Cancer. 2004;12(2):137–140.
12.
BlindermanCDChernyNI. Existential issues do not necessarily result in existential suffering: lesson from cancer patients in Israel. Palliat Med. 2005;19(5):371–380.
13.
BerglundMWestinLSyanströmRSundlerAJ. Suffering caused by care—patients’ experiences from hospital settings. Int J Qual Stud Health Well-being. 2012;7:1–9.
14.
DaneaultSLussierVMongeauS. Primum non nocere: could the health care system contribute to suffering? In-depth study from the perspective of terminally ill cancer patients. Can Fam Physician. 2006;52(12):1574–1575.
15.
ArmanMRehnsfeldtALindhomlLHamrinEErikssonK. Suffering related to health care: a study of breast cancer patients’ experiences. Int J Nurs Pract. 2004;10(6):248–156.
16.
EgnewTR. The meaning of healing: transcending suffering. Ann Fam Med. 2005;3(3):255–262.
17.
MountBKearneyM. Healing and palliative care: charting our way forward. Palliat Med. 2003;17(8):657–658.
18.
DewaldPA. Principles of supportive psychotherapy. Am J Psychother. 1994;48(4):505–518.
19.
KissaneDWGrabschBClarkeDM. Supportive-expressive group therapy for women with metastatic breast cancer: survival and psychosocial outcome from a randomized controlled trial. Psychooncology. 2007;16(4):277–286.
20.
StrakerN. Psychodynamic psychotherapy for cancer patients. J Psychother Pract Res. 1998;7(1):1–9.
21.
DevineECWestlakeSK. The effects of psychoeducational care provided to adults with cancer: meta-analysis of 116 studies. Oncol Nurs Forum. 1995;22(9):1369–1381.
22.
SavardJSimardSGiguèreI. Randomized clinical trial on cognitive therapy for depression in women with metastatic breast cancer: psychological and immunological effects. Palliat Support Care. 2006;4(3):219–237.
23.
EdelmanSBellDRKidmanAD. A group cognitive behaviour therapy programme with metastatic breast cancer patients. Psychooncology. 1999;8(4):295–305.
24.
AndersonTWatsonMDavidsonR. The use of cognitive behavioural therapy techniques for anxiety and depression in hospice patients: a feasibility study. Palliat Med. 2008;22(7):814–821.
25.
CuijpersPGeraedtsASvan OppenPAnderssonGMarkowitzJCvan StratenA. Interpersonal psychotherapy for depression: a meta-analysis. Am J Psychiatry. 2011;168(6):581–592.
26.
McLeanLMJonesJM. A review of distress and its management in couples facing end-of-life cancer. Psychooncology. 2007;16(7):603–616.
27.
McLeanLMNissimR. Marital therapy for couples facing advanced cancer: case review. Palliat Support Care. 2007;5(3):303–313.
28.
KissaneDWMcKenzieMBlochSMoskowitzCMcKenzieDPO’NeillI. Family focused grief therapy: a randomized, controlled trial in palliative care and bereavement. Am J Psychiatry. 2006;163(7):1208–1218.
29.
ChochinovHMHackTHassardTKristjansonLJMcClementSHarlosM. Dignity therapy: a novel psychotherapeutic intervention for patients near the end of life. J Clin Oncol. 2005;23(24):5520–5525.
30.
ChochinovHMKristjansonLJBreitbartW. Effect of dignity therapy on distress and end-of-life experience in terminally ill patients: a randomized controlled trial. Lancet Oncol. 2011;12(8):753–762.
31.
BreitbartWPoppitoSRosenfeldB. Pilot randomized controlled trial of individual meaning-centered psychotherapy for patients with advanced cancer. J Clin Oncol. 2012;30(12):1304–1309.
32.
BreitbartWRosenfeldBGibsonC. Meaning-centered group psychotherapy for patients with advanced cancer: a pilot randomized controlled trial. Psychooncology. 2010;19(1):21–28.
33.
StanleyPHurstM. Narrative palliative care: a method for building empathy. J Soc Work End Life Palliat Care. 2011;7(1):39–55.
34.
AndoMMoritaTOkamotoTNinosakaY. One-week short-term life review interview can improve spiritual well-being of terminally ill cancer patients. Psychooncology. 2008;17(9):885–890.
35.
StradaEASourkesBM. Psychotherapy in the palliative care setting. Primary Psychiatry. 2009;16(5):34–40.
36.
MountB. Whole person care: beyond psychosocial and physical needs. Am J Hosp Palliat Care. 1993;10(1):28–37.
37.
MehtaACohenSRChanLS. Palliative care: a need for a family systems approach. Palliat Support Care. 2009;7(2):235–243.
38.
JüngerSPestingerMElsnerFKrummNRadbruchL. Criteria for successful multiprofessional cooperation in palliative care teams. Palliat Med. 2007;21(4):347–354.
39.
KearneyMKWeiningerRBVachonMLHarrisonRLMountBM. Self-care of physicians caring for patients at the end of life: “Being connected… a key to my survival”. JAMA. 2009;301(11):1155–1164.
40.
PeriyakoilVS. First, do not abandon. J Palliat Med. 2007;10(4):865–866.
41.
Kabat-ZinnJ. Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life. New York: Hyperion; 1994:4.
42.
Kabat-ZinnJ.Coming to our senses: Healing ourselves and the world through mindfulness. New York: Hyperion; 2005:108.
43.
BrownKWRyanRMCreswellJD. Mindfulness: theoretical foundations and evidence for its salutary effects. Psychological Inquiry. 2007;18(4):211–237.
44.
CramerHHallerHLaucheRDobosG.Mindfulness-based stress reduction for low back pain. A systematic review. BMC Complement Altern Med. 2012;12:162. doi:10.1186/1472-6882-12-162.
45.
YookKLeeSHRyuM. Usefulness of mindfulness-based cognitive therapy for treating insomnia in patients with anxiety disorders: a pilot study. J Nerv Ment Dis. 2008;196(6):501–503.
46.
BohlmeijerEPrengerRTaalECuijpersP. The effects of mindfulness-based stress reduction therapy on mental health of adults with chronic medical disease: a meta-analysis. J Psychosom Res. 2010;68(6):539–544.
47.
ZainalNZBoothSHuppertFA. The efficacy of mindfulness-based stress reduction on mental health of breast cancer patients: a meta-analysis. Psychooncology. 2013;22(7):1457–1465.
48.
FoleyEBaillieAHuxterMPriceMSinclairE. Mindfulness-based cognitive therapy for individuals whose lives have been affected by cancer: a randomized controlled trials. J Consult Clin Psychol. 2010;78(1):72–79.
49.
WhitebirdRRKreitzerMCrainALLewisBAHansonLREnstadCJ. Mindfulness-based stress reduction for family caregivers: a randomized controlled trial. Gerontologist. 2013;53(4):676–686.
50.
ShennanCPayneSFenlonD. What is the evidence for the use of mindfulness-based interventions in cancer care? A review. Psychooncology. 2011;20(7):681–697.
51.
SmithJERichardsonJHoffmanCPilkingtonK. Mindfulness-based stress reduction as supportive therapy in cancer care: a systematic review. J Adv Nurs. 2005;52(3):315–327.
52.
GreenePBPhilipEJPoppitoSRSchnurJB. Mindfulness and psychosocial care in cancer: Historical context and review of current and potential applications [published online May 22, 2012]. Palliat Support Care. 2012.
53.
AndoMMoritaTAkechiT. The efficacy of mindfulness-based meditation therapy on anxiety, depression, and spirituality in Japanese patients with cancer. J Palliat Med. 2009;12(12):1091–1094.
54.
TeasdaleJDMooreRGHayhurstHPopeMWilliamsSSegalZV. Metacognitive awareness and prevention of relapse in depression. J Consult Clin Psychol. 2002;70(2):275–287.
55.
CarmodyJ. Evolving conceptions of mindfulness in clinical settings. J Cogn Psychother. 2009;23(3):270–280.
56.
LutzASlagterHADunneJDDavidsonRJ. Attention regulation and monitoring in meditation. Trends Cogn Sci. 2008;12(4):163–169.
57.
FrescoDMSegalZVBuisTKennedyS. Relationship of post-treatment decentering and cognitive reactivity to relapse in major depression. J Consult Clin Psychol. 2007;75(3):447–455.
58.
ShapiroSLCarlsonLEAstinJAFreedmanB. Mechanisms of mindfulness. J Clin Psychol. 2006;62(3):373–386.
59.
DeyoMWilsonKAOngJKoopmanC. Mindfulness and rumination: does mindfulness training lead to reductions in the ruminative thinking associated with depression?Explore. 2009;5(5):265–271.
60.
Seng BengTChong GuanNKheng SeangL. The experiences of suffering of palliative care patients in Malaysia: a thematic analysis [published online September 5, 2012]. Am J HospPalliat Care. 2012.
61.
Seng BengTChong GuanNKheng SeangL. The experiences of suffering of palliative care informal caregivers in Malaysia: a thematic analysis. Am J Hosp Palliat Care. 2013;30(5):473–489.
62.
Seng BengTChong GuanNEe JaneLEe ChinL. Health care interactional suffering in palliative care [published online May 20, 2013]. Am J Hosp Palliat Care. 2013.
63.
ChurchillRP. Logic: An introduction. New York, NY: St. Martin’s Press; 1990:162.
64.
FalmagneRJGonsalvesJ. Deductive inference. Annu Rev Psychol. 1995;46(1):525–559.
65.
HölzelBKLazarSWGardTSchuman-OlivierZVagoDROttU. How does mindfulness meditation work? Proposing mechanisms of action from a conceptual and neural perspective. Perspectives Psychol Sci. 2011;6(6):537–559.
66.
CoulehanJLPlattFW, Egener B, et al. ‘Let me see if I have this right …’: Words that build empathy. Ann Intern Med. 2000;135(3):221–227.
67.
GoetzJLKeltnerDSimon-ThomasE. Compassion: an evolutionary analysis and empirical review. Psychol Bull. 2010;136(3):351–374.
68.
FarberNJNovackDHO’BrienMK. Love, boundaries, and the patient–physician relationship. Arch Intern Med. 1997;157(20):2291–2294.
69.
KrikorianALimoneroJTCoreyMT. Suffering assessment: a review of available instruments for use in palliative care. J Palliat Med. 2013;16(2):130–142.
70.
KellyBMcClementSChochinovHM. Measurement of psychological distress in palliative care. Palliat Med. 2006;20(8):779–789.
71.
SulmasyDP. A biopsychosocial–spiritual model for the care of patients at the end of life. Gerontologist. 2002;42(3):24–33.
72.
WilsonKGChochinovHMMcPhersonCJ. Suffering with advanced cancer. J Clin Oncol. 2007;25(13):1691–1697.
73.
ChernyNICoyleNFoleyKM. Suffering in the advanced cancer patient: a definition and taxonomy. J Palliat Care. 1994;10(2):57–70.
74.
SeligmanME.The effectiveness of psychotherapy. The consumer reports study. Am Psychol. 1995;50(12):965–974.
75.
WhistonSCSextonTL. An overview of psychotherapy outcome research: implications for practice. Prof Psychol Res Pract. 1993;24(1):43–51.
76.
ChochinovHMHackTHassardTKristjansonLJMcClementSHarlosM. Dignity and psychotherapeutic considerations in end-of-life care. J Palliat Care. 2004;20(3):134–142.
77.
LeMayKWilsonKG. Treatment of existential distress in life threatening illness: a review of manualized interventions. Clin Psychol Rev. 2008;28(3):472–493.
78.
FranksJA. The power of presence. J Palliat Med. 2010;13(3):331–332.
79.
IsemingerKLevittFKirkL. Healing during existential moments: the “art” of nursing presence. Nurs Clin North Am. 2009;44(4):447–459.
80.
PerezJC. Healing presence. Care Manag J. 2004;5(1):41–46.
CovingtonH. Caring presence. delineation of a concept for holistic nursing. J Holist Nurs. 2003;21(3):301–317.
83.
WyattJ. Matters of Life and Death. Nottingham, UK: Inter-Varsity Press; 2009.
84.
PuchalskiCM. Spirituality and end-of-life care: a time for listening and caring. J Palliat Med. 2002;5(2):289–294.
85.
PuchalskiCM. The role of spirituality in health care. Proc (Bayl Univ Med Cent). 2001;14(4):352–357.
86.
VermandereMLepeleireJDVan MechelenWWarmenhovenFThoonsenBAertgeertsB. Spirituality in palliative home care: a framework for the clinician. Support Care Cancer. 2013;21(4):1061–1069.
87.
KimblePBamford-WadeA. The journey of discovering compassionate listening [published online May 17, 2013]. J Holist Nurs. 2013.
FigleyC. Compassion Fatigue: Coping With Secondary Traumatic Stress Disorder in Those Who Treat the Traumatized. New York, NY: Brunner-Routledge; 1995:253.
90.
BarbourLT. Professional-patient boundaries in palliative care # 172. J Palliat Med. 2008;11(5):777–778.
91.
HarrisonRWestwoodM. Preventing vicarious traumatization of mental health therapists: identifying protective practices. Psychotherapy (Chic). 2009;46(2):203–219.
92.
Kabat-ZinnJ. Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain and Illness. New York, NY: Delacourt; 1990.
