ArticlePublisher preview available

Effect of logotherapy counseling program on chronic sorrow, dignity, and meaning in life of palliative care patients: a randomized controlled trial

Authors:
Yasemin Eskigülek at Baskent University
Yasemin Eskigülek
Sultan Kav at Baskent University
Sultan Kav
Read publisher preview
Download citation
To read the full-text of this research, you can request a copy directly from the authors.

Abstract and Figures

Purpose Palliative care patients experience chronic sorrow with loss in dignity and meaning in life. Logotherapy is an effective way to cope with loss. This study aimed to evaluate the effect of logotherapy on chronic sorrow, dignity, and meaning in life of palliative care patients. Methods This study was conducted with 58 adults hospitalized due to advanced cancer and assigned to either intervention or control group by simple randomization. Data were collected with descriptive information form, Palliative Performance Scale, Patient Dignity Inventory (PDI), Prolonged Grief Disorder Scale-Patient Form (PGDS-PF), and Meaning in Life Questionnaire (MIL) on admission, at the 4th and 8th weeks. The intervention group received eight sessions of logotherapy. The control group received routine care. Results The mean scores of PGDS-PF (p = 0.01), PDI (p = 0.01), and searched meaning subdimension of MIL (MIL-SM) (p = 0.11) decreased in the intervention group compared to controls, both at the 4th and 8th week evaluation. The mean score of the present meaning subdimension of MIL (MIL-PM) (p = 0.02) increased at the 4th week evaluation but decreased at a non-statistically significant level at the 8th week. The mean scores of PGDS-PF and PDI increased in the control group while MIL-PM and MIL-SM decreased, both at the 4th and 8th week evaluation. Conclusions Logotherapy was found effective in decreasing the sorrow and dignity-related distress of palliative care patients, while increasing finding meaning in life. Logotherapy is recommended to be used by palliative care professionals to empower patients. Trial registration Clinicaltrials registration number and date: NCT05129059, 19/01/2021.
Figures - available from: Supportive Care in Cancer
This content is subject to copyright. Terms and conditions apply.
A preview of this full-text is provided by Springer Nature.
Learn more
Content available from Supportive Care in Cancer
This content is subject to copyright. Terms and conditions apply.
Vol.:(0123456789)
Supportive Care in Cancer (2024) 32:587
https://doi.org/10.1007/s00520-024-08792-w
RESEARCH
Effect oflogotherapy counseling program onchronic sorrow,
dignity, andmeaning inlife ofpalliative care patients: arandomized
controlled trial
YaseminEskigülek1 · SultanKav1
Received: 21 March 2024 / Accepted: 7 August 2024 / Published online: 13 August 2024
© The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2024
Abstract
Purpose Palliative care patients experience chronic sorrow with loss in dignity and meaning in life. Logotherapy is an effec-
tive way to cope with loss. This study aimed to evaluate the effect of logotherapy on chronic sorrow, dignity, and meaning
in life of palliative care patients.
Methods This study was conducted with 58 adults hospitalized due to advanced cancer and assigned to either intervention
or control group by simple randomization. Data were collected with descriptive information form, Palliative Performance
Scale, Patient Dignity Inventory (PDI), Prolonged Grief Disorder Scale-Patient Form (PGDS-PF), and Meaning in Life
Questionnaire (MIL) on admission, at the 4th and 8th weeks. The intervention group received eight sessions of logotherapy.
The control group received routine care.
Results The mean scores of PGDS-PF (p = 0.01), PDI (p = 0.01), and searched meaning subdimension of MIL (MIL-SM)
(p = 0.11) decreased in the intervention group compared to controls, both at the 4th and 8th week evaluation. The mean
score of the present meaning subdimension of MIL (MIL-PM) (p = 0.02) increased at the 4th week evaluation but decreased
at a non-statistically significant level at the 8th week. The mean scores of PGDS-PF and PDI increased in the control group
while MIL-PM and MIL-SM decreased, both at the 4th and 8th week evaluation.
Conclusions Logotherapy was found effective in decreasing the sorrow and dignity-related distress of palliative care patients,
while increasing finding meaning in life. Logotherapy is recommended to be used by palliative care professionals to empower
patients.
Trial registration Clinicaltrials registration number and date: NCT05129059, 19/01/2021.
Keywords Chronic sorrow· Dignity· Logotherapy· Meaning in life· Nursing
Introduction
Palliative care patients experience psychosocial problems
such as depressive mood, fear of metastasis or pain, uncer-
tainty, and loneliness, as well as chronic sorrow due to loss
of sense of dignity, meaning in life, and autonomy [1–4].
Chronic sorrow, an unavoidable part of chronic illness,
encompasses the painful emotions experienced by indi-
viduals with chronic illnesses and their loved ones due to
a sense of recurrent and living loss and differs from grief
related to death [5]. If chronic sorrow, also recognized as
a nursing diagnosis by North American Nursing Diagno-
sis Association, is not appropriately managed, individuals
may experience psychosomatic problems, such as feeling
tightness in the throat, shortness of breath, and muscular
weakness, or perceive this as a disruptive threat, making
it difficult to adapt to the situation for individual [6–8].
These consequences negatively affect the quality of life of
individuals with chronic and palliative care-requiring ill-
nesses [1]. Nursing interventions, enhancing the autonomy
of individuals and facilitating finding new meaning in life
through positive thinking techniques, have been reported as
beneficial for coping with chronic sorrow [7–9]. Another
way to increase an individual’s autonomy in palliative care is
to promote dignity, a unique feeling allowing the individual
* Yasemin Eskigülek
yaseminuslu12@gmail.com
1 Department ofNursing, Başkent University Faculty
ofHealth Sciences, Bağlıca Kampüsü Fatih Sultan Mahallesi
Eskişehir Yolu 18.Km TR 06790, Etimesgut,Ankara, Turkey
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
ResearchGate has not been able to resolve any citations for this publication.
View
Dignity and loss of dignity: Experiences of older women living with incurable cancer at home
Article
Full-text available
  • Sep 2020
In this study, we explored and identified crucial experiences that constitute dignity and loss of dignity among older women living with incurable cancer at home. In-depth interviews with 13 women, and participant observations of five of these women, were performed. Hermeneutical interpretations of interview texts and field notes were conducted. Crucial experiences that preserved the women’s dignity included having a sense of control, making one’s own decisions, experiencing hope and meaningfulness, feeling valued as a human being and having the opportunity to be in a treasured and nurturing environment. Dignity loss was related to losing the opportunity for self-determination, sensing hopelessness and worthlessness in a shroud of illness, experiencing violation of their personal life and being situated in surroundings that enhanced their sense of disconnection and alienation. Quality of care was experienced as more important than the physical place in which to spend their final stage of life. The findings suggest that dignity preservation should be a core dimension in care for older women living with incurable cancer at home. Future research should investigate how dignity-preserving care can be organized and practiced within municipal palliative care services.
View
The impact of leisure time physical activity on mental health and health perception among people with cancer
Article
Full-text available
  • Mar 2020
Background: People with cancer often report high levels of negative psychological symptoms and poor perception of health due to cancer treatment and activity limitations. Prior studies have suggested that participation in leisure time physical activity (LTPA) can reduce negative psychological symptoms and improve health perception. However, a few studies have examined the contribution of LTPA to health benefits among people with cancer. Thus, we aimed to examine how a different level of LTPA engagement contributed to mental health and health perceptions among people with cancer. Methods: Using the 2017 Health Information National Trends Survey (HINTS) data, cross sectional data of 504 respondents diagnosed with any types of 22 cancers listed in the survey questionnaire were analyzed. A multivariate analysis of variance (MANOVA) was used to test for mean differences in mental health and health perception among the three different LTPA groups(i.e., inactive, moderately active, and vigorously active groups). Results: Results indicated that people with cancer who reported higher levels of LTPA scored higher on mental health and health perception than those with lower levels of LTPA (Pillai’s trace= 0.060, F (4,944) = 15.06, P < 0.001). Conclusion: This finding suggests that individuals with cancer gained more health benefits through high engagement in LTPA. Moreover, we suggested that LTPA can be used as an important therapeutic intervention to promote health quality and wellbeing among people with cancer. Implications for practical suggestions are further discussed.
View
View
Dignity and Its Influencing Factors in Patients with Cancer in North China: A Cross-Sectional Study
Article
Full-text available
  • Apr 2019
  • Curr Oncol
Background: Patients with cancer experience various levels of loss of dignity. Exploring levels of loss of dignity and the factors that influence such losses for patients with cancer is rare, but important in palliative care in China. Methods: Participants were cancer patients with early and advanced cancer recruited from a tertiary cancer hospital in North China. Patients were surveyed to assess their level of loss of dignity and potentially relevant factors. Data were collected using the Patient Dignity Inventory, the MD Anderson Symptom Inventory-Chinese, the distress thermometer, the Hospital Anxiety and Depression Scale, and the 30-question core Quality of Life Questionnaire from the European Organisation for Research and Treatment of Cancer, and were analyzed using quantitative methods. Results: The study included 202 cancer patients, 143 of whom experienced mild loss of dignity (71%); 37, moderate loss of dignity (18%); and 10, severe loss of dignity (5%). The problems with dignity were slightly different in patients with early-stage disease than in those with advanced-stage disease. Loss of dignity in the patients was significantly correlated with psychological distress, symptom burden, and quality of life (p < 0.05). Logistic regression showed that age, Karnofsky performance status, anxiety, and symptom burden were significant predictors of loss of dignity. Conclusions: Most patients with early and advanced cancer experienced some level of loss of dignity. Loss of dignity was more likely for patients of younger age, high Karnofsky performance status, high symptom burden, and anxiety. Understanding the dignity of cancer patients and potentially relevant factors is of great value for implementing comprehensive palliative care in China.
View
The effect of logotherapy-based, nurse-guided meaning attribution conversations on women diagnosed with gynecologic cancer: A Turkish pilot study
Article
  • Aug 2023
  • WOMEN HEALTH
Although gynecological cancers are among the most common cancers worldwide, these diagnoses are among the most traumatic experiences in women's lives. This study aimed to examine the effects of logotherapy-based, nurse-guided meaning attribution conversations (MACs) on traumatic stress symptoms, post-traumatic growth, spiritual well-being, and life meaning attribution in gynecological cancer patients. This single-blind, randomized controlled trial consisted of face-to-face interviews with 68 women with gynecological cancer who received chemotherapy at Karadeniz Technical University Health Application And Research Center Farabi Hospital in 2019. Women in the intervention group underwent seven MAC sessions, whereas women in the control group only received routine nursing care. Data were collected using the Personal Information Form (PIF), the Traumatic Stress Symptom Scale (TSSS), the Post-Traumatic Growth Inventory (PTGI), the Meaning in Life Questionnaire (MLQ), and the Spiritual Well-Being Scale (SWBS). Descriptive statistics and parametric and nonparametric tests (Mann - Whitney U-test, Friedman test, Chi-squared test, and Fisher's exact test) were used to analyze the data. The study was registered at ClinicalTrials.gov (NCT05246462). We observed statistically significant differences in the post-intervention and follow-up mean TSSS, PTGI, and MLQ scores (p = .000) between groups. However, mean total SWBS scores were not significantly different between groups (p = .145). This study demonstrated that MACs decreased the traumatic stress symptoms of women with gynecological cancer and increased their post-traumatic growth and ability to attribute meaning to life, but did not affect their spiritual well-being.
View
Validity and reliability of the Turkish version of the Patient Dignity Inventory
Article
  • Jun 2021
Objective The aim of this study was to investigate the validity and reliability of the Patient Dignity Inventory (PDI) in the Turkish society, which was developed to evaluate dignity-related distress in palliative care patients. Methods One hundred and twenty-seven adults with advanced cancer hospitalized in several clinics of two university hospitals were included in the study. The patients whose Palliative Performance Scale score was at least 40% were recruited to study. The data were collected with a patient demographic form, the Turkish version of Hospital Anxiety and Depression Scale (HADS-TR), and the Turkish version of the PDI (PDI-TR). The PDI-TR was finalized and back-translated after translating into Turkish and obtaining 10 expert opinions. Exploratory and confirmatory factor analysis, internal consistency, concurrent validity, and test–retest reliability analysis were performed. Results The Cronbach's α coefficient of PDI-TR was 0.94. Factor analysis resulted in a five-factor solution, and all items were loaded on factors. Factors were labeled as symptom distress, existential distress, self-confidence, dependency, and supportive care needs and accounted for 68.70% of the overall variance. The model's normed fit index, comparative fit index, and X ² /SD were found between acceptable range (0.90, 0.93, and 2.64, respectively). A positive and strong correlation was found between subdimension scores of HADS-TR and the total score of PDI-TR ( r = 0.70 for anxiety subdimension; r = 0.73 for depression subdimension). The test–retest reliability was conducted with 32 patients within the sample two weeks after the first application, and no significant difference was found between the two application scores as the result of paired-sample t -test ( p > 0.05). An intraclass correlation coefficient of test–retest reliability was r = 0.855. Significance of results PDI-TR was found to be a valid and reliable tool in palliative care patients in Turkish society.
View
View
The Effects of Logotherapy on Distress, Depression, and Demoralization in Breast Cancer and Gynecological Cancer Patients: A Preliminary Study
Article
  • Aug 2019
Background: Globally, cancer is the second leading cause of death. Breast cancer and gynecological cancer can damage patients' body image and lead to psychological distress, depression, and demoralization syndrome. No studies have explored the effect of logotherapy in gynecological cancer patients' psychological distress, depression, and demoralization. Objective: To evaluate the effects of logotherapy on distress, depression, and demoralization in breast cancer and gynecological cancer patients. Methods: A quasi-experimental design was used in this study, involving 61 breast cancer and gynecological cancer patients: 31 in the experimental group and 30 in the control group. Participants in the experimental group received logotherapy 4 to 6 times during the 12 weeks of intervention. Outcomes were measured by the (1) Distress Thermometer, (2) Patient Health Questionnaire, and (3) Demoralization Scale Mandarin Version (DS-MV). Results: Distress Thermometer did not differ between groups, but significant differences in favor of the intervention group were noted in the Patient Health Questionnaire (U = 674.500, P = .002); the DS-MV subcategories of loss of meaning (U = 706.500, P = .000), dysphoria (U = 673.000, P = .002), disheartenment (U = 670.000, P = .003), helplessness (U = 621.000, P = .022), and sense of failure (U = 629.500, P = .016); and the total score of the DS-MV (U = 728.500, P = .000). Conclusion: Logotherapy was effective in the reduction of breast cancer and gynecological cancer patients' depression and demoralization. Implications for practice: Clinical professionals could add logotherapy to the treatment for breast cancer and gynecological cancer patients to reduce their depression and demoralization.
View
View