REVIEW

CURRENT
OPINION Psychological interventions in palliative care
Pia von Blanckenburg and Nico Leppin

Purpose of review
To provide an update on recent studies about psychological interventions in palliative (mainly cancer) care
with a focus on physical, psychological, spiritual, and social aspects.
Recent findings
Some promising psychological interventions for physical challenges, such as fatigue, pain, dyspnea, and
insomnia do exist, but further research is needed. Regarding psychological aspects, current reviews
showed small to large effects in the reduction of depression and anxiety symptoms through cognitive
behavioral-based interventions, mindfulness-based interventions, and meaning-based interventions.
Meaning-based or dignity-based approaches were also used for targeting spiritual aspects or existential
distress. Social aspects that play a crucial role in palliative care are addressed by social support
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interventions, end-of-life discussions, and advanced careplanning. All of these psychological interventions
must meet the specific requirements of palliative care, namely abbreviated session time and flexibility
concerning locality of interventions, a minimized questionnaire burden and a high attrition rate caused by
patients’ poor physical conditions or deaths.
Summary
There is substantial research on psychological interventions in palliative care that shows promising results,
but sample sizes were often small. Due to its high relevance for this growing patient group, there is a
strong need for ongoing/further research.
Keywords
end of life, meaning-based therapy, palliative cancer care, psychological interventions

INTRODUCTION consistently [5]. Palliative care teams work with

’They said I need palliative care. Well, they also
could have said, the end is near’. This is one of
the most frequent sentences that we hear during
our daily contact with cancer patients. However,
palliative care is more than a death sentence. It aims
to help patients with life-threatening diseases and
their families to improve quality of life by prevent-
ing, identifying, and relieving psychosocial, physi-
cal, and spiritual problems [1]. The need for
palliative care is growing as populations continue
aging, and as chronic diseases become more preva-
lent. Currently, 69–82% of those who pass away
require palliative care [2]. For example, in 2015, 25.5
million people worldwide used palliative care.
Within this population, the cancer to noncancer
ratio was around 1 : 2 [3].
Cancer patients (as well as noncancer patients)
show high distress levels and palliative care needs
when their diseases progress [4]. Therefore, assessing
and managing this distress is of high importance.
Although guidelines for distress management (e.g.,
psychological interventions) already exist, palliative
care clinicians are not prepared to follow them
various, very different models, but they commonly
use an interdisciplinary and holistic approach [6,7].
Guidelines are not clear about which assessment
tools or psychological interventions should be used.
They also do not state which member of the pallia-
tive care team should be responsible for such inter-
ventions, and what training is required to deliver
proficient psychological help. Manualized psycho-
logical interventions and a stepped-care approach
may help to improve this situation.
New guidelines for clinical practice in oncology
affirmed that there is a need to integrate evidence-
based interventions into standard oncological palli-
ative care [8]. Thus, in the last years, a large number
Department of Clinical Psychology and Psychotherapy, Philipps-
University Marburg, Marburg, Germany
Correspondence to Pia von Blanckenburg, Department of Clinical Psy-
chology and Psychotherapy, Philipps-University Marburg, Gutenbergstr.
18, 35032 Marburg, Germany. Tel: +49 6421 2824051;
e-mail: blanckep@uni-marburg.de
Curr Opin Psychiatry 2018, 31:389–395
DOI:10.1097/YCO.0000000000000441

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Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

Psychiatry, medicine and the behavioral sciences

dimensions: Content of intervention, proposed

KEY POINTS
 The abundance of new trials shows an emerging field
of research, but mainly small/pilot trials were
conducted rather than large RCTs.
 There are promising psychological approaches (e.g.,
CBT, IMCP, CALM, DT, ACP) that emphasize the
various aspects in palliative care.
 Overall, conducting psychological interventions in a
palliative care setting requires an increased rate of
flexibility, particularly regarding session time and
locality due to high attrition rates caused by deaths and
poor physical conditions.
 Including a partner and/or family members in the
existing interventions may be relevant for further
research.
 The role of psychological interventions in palliative care
should be further developed.
mechanisms, type of delivery, and targeted out-
comes [9]. In this review, we define psychological
interventions as treatments that use learnable, psy-
chological techniques to increase well being and
alleviate physical, psychological, social and spiritual
symptoms, and problems. This definition is based
on the widely accepted research and practice model
from Sulmasy [10]. His model recommends a holis-
tic end-of-life care which ‘must address the totality
of the patient’s relational existence – physical, psy-
chological, social, and spiritual’. The aim of this
review is to give an overview of how research has
developed in this field over the last year. The article
will focus on randomized controlled trials (RCTs)
and systematic reviews in order to provide an evi-
dence based-approach to current psychological
interventions for patients with incurable diseases
(mainly cancer).

of psychological interventions have been developed CHALLENGES FOR PATIENTS IN

or adapted for palliative patients. Hodges et al. sug- PALLIATIVE PHASE
gest defining psychological interventions within Severe and progredient diseases challenge various
cancer care by use of at least four different aspects of palliative patients’ lives. Figure 1 gives an

meaning-based
intervenons, dignity-
based and life review
intervenons

death anxiety, loss of

important roles or
dignity, regrets over
past, demoralizaon

Spiritual
CBT, facilitate social
mindfulness- anxiety, loss sense of support,
of control, isolaon,
based Psycho- advanced care
depression, communicaon
intervenons
change in life Social about disease
planning, end-
and meaning- logical of-life
goals and self topics, changes
based image in interacons communicaon
intervenons and discussion

Physical

fague, lack of
energy, weakness,
dyspnea, insomia,
pain, immobility.
appete loss

CBT, psychoeducaon, Legend

self-hypnosis,
breathing and aspects of personhood
relaxaon techniques

challenges in the
palliave seng

recent psychological
intervenons in the field

FIGURE 1. Psychological approaches for challenges in the palliative phase.

390 www.co-psychiatry.com Volume 31  Number 5  September 2018

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overview of typical challenges emerging in the pal-
liative phase. All aspects interact with each other
and affect patients just as their loved ones. The listed
psychological interventions were investigated in the
past year and seldom focus on a single aspect but are
listed where they are most effective.
PSYCHOLOGICAL APPROACHES
Physical aspects
Occurring in more than 50% of the patients, the five
most prevalent physical symptoms in advanced
cancer are fatigue, pain, weakness, lack of energy,
and appetite loss [11]. Even with an optimal dosing
of medication relief from these symptoms is not
guaranteed for every palliative patient [12]. Still,
looking at the example of cancer pain management,
recommendations focus on pharmacological solu-
tions. Psychological approaches are rather viewed as
last or ultimate step, although biopsychosocial
models of cancer pain are widely accepted. In the
past year, no RCT was published on psychological
interventions for pain reduction in palliative care
settings. Though, Brugnoli et al. conducted a non-
randomized clinical trial on a long-term interven-
&
tion using clinical hypnosis and self-hypnosis [13 ].
In weekly meetings, a group of 25 patients learned
hypnosis techniques like self-suggestion, reinterpre-
tation, and positive visualization. The resulting pain
and anxiety reduction in the treatment groups are
very promising. Additionally, a study protocol from
Carson et al. describes a mindful yoga intervention
that will be tested in a RCT [14]. The use of breathing
techniques, meditation, yogic principles to optimal
coping and group discussions shall lead to reduced
pain and fatigue.
Persistent tiredness (fatigue) is perceived as one
of the most distressing symptoms among advanced
cancer patients and is strongly associated with
reduced activity levels and a decrease in quality of
life [15]. Poort et al. reviewed 14 studies on psycho-
social interventions for fatigue, concluding that
evidence quality was very low and effect estimates
&&
could therefore not be trusted [16 ]. The question-
able effect estimates convey benefits of psychologi-
cal interventions, as compared with controls at the
first follow-up (but not at postintervention or the
second follow-up). The same research group also
designed a study protocol that expressed intent to
examine the effects of cognitive-behavioral therapy
(CBT) on fatigue, as compared with usual care and
&
graded exercise therapy in a RCT [17 ].
Another physical problem, especially for ad-
vanced lung cancer patients, is shortness of breath
or dyspnea. In Lehto’s recent review of research from
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Palliative care von Blanckenburg and Leppin
the past 10 years, one RCT and two feasibility studies
&&
showed an effect on dyspnea [18 ]. The RCT
focused on psychoeducation and progressive muscle
relaxation and revealed small effects on breathless-
ness and fatigue. The feasibility studies made use of
group exercise, relaxation, and breathing techni-
ques. The data from the pilot patients pointed in
a positive direction. Insomnia or sleep impairments
are also common in advanced cancer patients.
Savard and Savard announced that they would soon
publish results of their pilot study, which uses cog-
nitive behavioral and environmental therapy target-
ing insomnia [19]. CBT has proved to be effective for
physical symptom management in earlier stages of
cancer, but there is an urgent need for further
research in a palliative setting.
Psychological aspects
Occurring in approximately one third of palliative
cancer patients, the most frequent psychiatric dis-
orders are depression, adjustment disorder, and anx-
iety disorders [20]. Two current meta-analyses
showed that psychological interventions are effec-
tive in reducing depressive symptoms in palliative
&& &&
samples [21 ,22 ]. Okuyama et al. reported moder-
ate effect sizes of depression reduction over 12 RCTs
among incurable cancer patients, but the studies
&&
included were of low quality [22 ]. Although the
European guidelines on the management of depres-
sion in palliative cancer care recommend that ‘clini-
cians should consider psychological therapy for
treatment of depression in palliative care’ [23],
high-quality studies on this subject are lacking. A
minimized questionnaire burden and high attrition
rates due to patients’ poor physical conditions and/
or deaths lead to difficulties producing high-quality
studies in this field. Fulton and colleagues analyzed
32 RCTs, including 1536 patients with various con-
ditions relevant to palliative care, in which half of
the studies focused on cancer patients [21 ]. They
&&
found large effect sizes of reduced depression symp-
toms and small effects of reduced anxiety symp-
toms. By comparison, CBT and mindfulness-based
interventions had greater effects on symptom reduc-
tion than dignity-based interventions [21 ].
&&
The core of mindfulness-based interventions
focuses on the ‘here-and-now’, which may help
patients in palliative settings to live 1 day at a time
and to better cope with their situations. A recent
systematic review of mindfulness-based interven-
tions showed medium effect sizes in depression,
anxiety, self-compassion, cancer-specific quality of
life, and mindfulness [24]. Nevertheless, based on
their RCT on a mindfulness-based cognitive group
therapy conducted by telephone, Chambers et al.
www.co-psychiatry.com 391
Psychiatry, medicine and the behavioral sciences
argue that certain patient groups might not profit
from this approach. They did not find any effects
on psychological distress, cancer-specific distress, or
prostate-specific antigen anxiety in men with
&
advanced prostate cancer [25 ]. The authors argued
that other interventions that consider male-specific
support needs and coping styles could be more
favorable for these patients. Including spouses/
partners could be another possible topic for future
research, as an interesting pilot study of a couple-
based mind–body intervention for metastatic
&
lung-cancer patients recently has shown [26 ]. The
intervention focused within four sessions on mind-
fulness, connection, gratitude, and purpose. It
included techniques as meditation and education
about mindfulness, a guided visualization exercise,
lessons of compassionate listening, reflection on
core values/ things to be grateful for. First results
showed promising effects on patients’ sleep-distur-
bances, cancer-related distress, as well as their part-
ners’ depression scores.
Interestingly, although interventions with a
greater number of treatment sessions resulted in a
greater reduction of symptoms, longer treatment
&&
sessions resulted in fewer effects [21 ]. This finding
may reflect the inability of palliative patients to
endure long treatments. Hence, more frequent
and shorter sessions could be more beneficial com-
pared with fewer and longer sessions. These results
were confirmed by a study in the United Kingdom
asking psychotherapists for their experiences with
& &
advanced cancer patients [27 ]. Due to poor physical
conditions, medication, and cognitive difficulties,
more flexibility regarding the length and scheduling
of appointments is required.
Although mental disorders are quite common in
palliative cancer samples [20], the majority of palli-
ative physicians reported difficulties accessing psy-
chological and psychiatric services [28]. Difficulties
often arise due to a lack of local service provisions,
staff shortages, or waiting times that are inappropri-
ately long for patients with such prognoses. To take
a step toward overcoming these problems, a small
pilot trial in the United Kingdom evaluated the
effectiveness of a short and focused narrative inter-
&
vention among palliative cancer patients [29 ]. The
intervention contained the reflection about contrib-
uting factors of depression and about own inner
resources and coping methods. The authors empha-
size that this intervention could be conducted by
any member of a palliative care team according to
&
clinical practice [30 ]. Another recent pilot trial
comparing a CBT intervention (targeting mindful-
ness, gratitude, and positive reappraisal) conducted
meetings online and in person and did not
find any differences in feasibility, acceptability, or
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preliminary efficacy outcomes [31]. Thus, it is pos-
sible that the psychological care for palliative
patients could be augmented using online services
or interdisciplinary approaches. However, the inte-
gration of clinical psychologists and psychiatrists
in palliative care within a stepped care approach
is essential, because interventions delivered by men-
tal health providers seem to be more effective
than interventions administered by other health-
&&
care staff [21 ].
Spiritual aspects
Existential and spiritual distress can be seen as a
distinct dimension of distress and can occur inde-
pendently from, or together with, psychological
distress [32]. Existential distress may include death
anxiety, loss of important roles, sense of isolation,
and regrets about the past. The desire for hastened
death, a loss of dignity, and demoralization are
clinically relevant syndromes that occur among
approximately 10–25% of advanced cancer patients
[33–35]. Vehling et al. argued that the most impor-
tant intervention principle for dealing with existen-
tial fears is the counterbalancing of confrontation
(e.g., planning and preparing) and deflection (e.g.,
by use of meaningful daily life activities) [36]. A
current review that examined death anxiety inter-
ventions in 1178 advanced cancer patients distin-
guished between two types of interventions:
Meaning-based interventions and dignity-based
interventions [37 ].
Meaning-based interventions discuss existential
themes such as death openly and help patients to
cope with loss and grief, renegotiate life goals, make
peace with missed opportunities, and live with
uncertainty [38]. One important approach is Rose-
nfeld et al.’s meaning-centered psychotherapy
(MCP) that has recently been adapted to patients
&
in their last weeks of life [39 ]. The individual ver-
sion of MCP was currently evaluated in a large RCT
&&
[40 ]. A total of 321 patients were allocated to either
individualised meaning-centered psychotherapy
(IMCP), supportive therapy, or enhanced usual care.
IMCP showed the strongest effects on overall quality
of life, sense of meaning, and spiritual well being.
Effect sizes were small to moderate compared with
usual care, and small compared with supportive
therapy. The authors therefore highlight the im-
portance of addressing existential issues with
patients approaching the end of life. Rosenfeld
et al. analyzed the mechanisms of change in MCP
and found an enhanced sense of meaning as
a particularly powerful mediator of increased
&
quality of life and decreased depression [41 ].
Another important meaning-based approach is the
Volume 31  Number 5  September 2018

individual psychotherapeutic intervention manag-
ing cancer and living meaningfully (CALM) devel-
oped by Rodin et al. A recent RCT with 305 advanced
cancer patients treated with CALM reported less
severe depressive symptoms at the 3-month
(d ¼ 0.23) and 6-month follow-ups (d ¼ 0.29) com-
&&
pared with patients in usual care [42 ]. CALM con-
sists of three to six sessions delivered over 3–6
months that addresses four domains: symptom
management and communication with healthcare
providers, changes in self and relations with close
others, sense of meaning and purpose, and concerns
related to the future and mortality. Thus, CALM
focuses on several aspects in palliative care.
Dignity therapy (DT), in contrast, focus on the
opportunity to reflect on and review issues that are
important in patients’ lives. The results of these life
reviews, composed of memories, values, or messages
to loved ones, are typically recorded in a legacy
document that can be shared with others. Two
current systematic reviews about dignity-based
interventions and life-review interventions in palli-
ative and advanced cancer patients indicated posi-
tive effects on spiritual well being, general well
&
being, and overall quality of life [43,44 ]. Neverthe-
less, results are inconsistent regarding the stability
of these effects at the 3-month follow-up. Positive
effects on depression symptoms cannot be found
&&
[21 ]. However, one new Portuguese RCT showed
positive effects of dignity-based interventions on
&
existential distress [45 ]. Another small RCT
(n ¼ 57) suggests that life reviews and dignity ther-
apy are similar, except for the legacy document
&&
utilized in dignity-based interventions [46 ]. Due
to higher generativity and ego-integrity scores in the
dignity group, the authors highlight the importance
of creating those documents. Some new approaches
integrate the partner or the family of the patient
into the therapy process with the aim to improve
end-of-life experience by decreasing feelings of iso-
lation and despair while enhancing communication
and connectedness [47,48].
Social aspects
Social resources are crucial for patients in the pallia-
tive phase. Therefore, intervention before or during
the occurrence of social difficulties is important
[49,50]. Typical difficulties for cancer patients
include problems with relationships, communica-
tion, financial or legal matters, sexuality, as well as
domestic problems. In the past year, different psy-
chological approaches have tried to address these
issues.
Providing sufficient social support could be one
of the most crucial components of psychosocial
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Palliative care von Blanckenburg and Leppin
interventions in palliative settings. A new system-
atic review from Bradley et al. examined the effects
of interventions which facilitate social support
&&
[51 ]. All 16 studies (three RCTs) included, focused
exclusively on, or focused mainly on cancer
patients. A total of 13 of the studies focused on
psychological well being as a primary outcome,
but only one study measured social support as an
explicit outcome. Seven of the 13 studies reported
significant positive changes in psychological well
being, four showed nonsignificant improvements,
and two showed no changes.
Discussing end-of-life topics is another tech-
nique that utilizes social resources. These discus-
sions are potentially associated with a better
quality of dying and death, as they prepare families
to make informed decisions about medical treat-
&
ments near the time of death [52 ]. Patients also
get the opportunity to reflect on their treatment
preferences, which can then be carried out. A clus-
ter-randomized trial in oncologists’ offices in New
York revealed that by patient communication
coaching, including a question prompt list, progno-
sis-related topics came up three more times in sub-
sequent oncologist visits [53]. A cluster RCT from
Epstein et al. also yielded an improvement of
patient-centered communication after conducting
a training for oncologists. They were instructed to
give information corresponding to patients’ knowl-
edge, respond to emotions, encourage patients to
ask questions, and to frame consequences of deci-
&
sions well balanced [52 ].
Though seldom conducted by psychologists or
psychiatrists, advanced care planning (ACP) is a
communication process that aims to ‘‘enable indi-
viduals to define goals and preferences for future
medical treatment and care, to discuss these goals
and preferences with family and health-care pro-
viders, and to record and review these preferences if
&
appropriate’’ [54 ]. Rietjens et al. used a delphi-for-
mat to formulate this definition and recommenda-
tions for its practical implementation. The growing
literature and research on the effects of ACP made
this step necessary. The concept can now further be
evaluated. First reviews and meta-analyses showed
promising effects on quality of end-of-life care,
&
communication, and comfort [54 ]. The role of psy-
chologists and psychiatrists may become more rele-
vant in this field as Rietjens et al. emphasized the
importance of assessing values with patients.
CONCLUSION
Innovative progress in the development and evalu-
ation of psychological interventions in palliative
care can be observed. Psychological approaches
www.co-psychiatry.com 393
Psychiatry, medicine and the behavioral sciences
target different needs of palliative patients in an
effective way. Many feasibility/pilot studies were
conducted in the past year. However, large RCTs
and methodically high-quality studies are lacking.
Possible reasons are the multitude of specific
requirements of psychological interventions in
this patient group, the abbreviated session time,
required flexibility concerning locality of interven-
tions, a minimized questionnaire burden, and the
attrition rate due to patients’ poor physical condi-
tions and/or deaths.
Furthermore, it has become more apparent that
interventions addressing social, physical, psycho-
logical, and spiritual aspects are of great importance.
In many approaches, the inclusion of partners/ fam-
ily members got attention. Effective interventions
such as CALM and meaning-centered psycho ther-
apy already successfully focus on the patient, but we
need to consider how interventions could integrate
the partner/ primary caregiver into the sessions
as well.
In order to deliver holistic palliative care, many
care professionals must work closely together. The
role of clinical psychologists or psychiatrists in those
care teams is not yet clearly defined, but they bring
necessary competencies with them and can fulfill an
important function in interdisciplinary palliative
care. Hence, not only large and high-quality effec-
tiveness RCTs are required, but also further research
on the implementation of psychological interven-
tions in palliative stepped care models.
Acknowledgements
They are currently receiving grants from the German
Ministry of Education and Research for a large palliative
care intervention trial.
Financial support and sponsorship
None.
Conflicts of interest
There are no conflicts of interest.
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25. Chambers SK, Occhipinti S, Foley E, et al. Mindfulness-based cognitive
& therapy in advanced prostate cancer: a randomized controlled trial. J Clin
Oncol 2017; 35:291–297.
This RCT focusing on men with advanced prostate cancer found no significant
effects of their telephone intervention.
26. Milbury K, Engle R, Tsao A, et al. Pilot testing of a brief couple-based mind-
& body intervention for patients with metastatic non-small cell lung cancer and
their partners. J Pain Symptom Manage 2018; 55:953–961.
A small single-arm-trial in which partners were integrated in the therapy progress.
The psychological interventions were described in a readable way.
27. Hassan S, Bennett K, Serfaty M. Delivering cognitive behavioural therapy to
& advanced cancer patients: A qualitative exploration into therapists’ experi-
ences within a UK psychological service. Clin Psychol Psychother 2018;
00:1–10.
This interesting study investigates the psychotherapists’ view on their work with
chronically ill patients.
28. Atkin N, Vickerstaff V, Candy B. ’Worried to death’: the assessment and
management of anxiety in patients with advanced life-limiting disease, a
national survey of palliative medicine physicians. BMC Palliat Care 2017;
16:1–10.
29. Lloyd-Williams M, Shiels C, Ellis J, et al. Pilot randomised controlled trial of
& focused narrative intervention for moderate to severe depression in palliative
care patients: DISCERN trial. Palliat Med 2018; 32:206–215.
A small pilot trial also considering the survival time of the patients in addition to
depression reduction.
30. Kozlov E, Eghan C, Moran S, et al. Palliative care providers’ practices
& surrounding psychological distress screening and treatment: A national
survey. Am J Hosp Palliat Care 2017; 35:938–944.
This study evaluates the clinical practice surround palliative care by asking 236
practitioners.
31. Cheung EO, Cohn MA, Dunn LB, et al. A randomized pilot trial of a positive
affect skill intervention (lessons in linking affect and coping) for women with
metastatic breast cancer. Psychooncology 2017; 26:2101–2108.
32. Vehling S, Philipp R. Existential distress and meaning-focused interventions in
cancer survivorship. Curr Opin Support Palliat Care 2018; 12:46–51.
33. Bellido-Perez M, Crespo I, Wilson KG, et al. Assessment of the wish to hasten
death in patients with advanced cancer: a comparison of 2 different ap-
proaches. Psychooncology 2018; 27:1538–1544.
34. Grassi L, Costantini A, Caruso R, et al. Dignity and psychosocial-related
variables in advanced and nonadvanced cancer patients by using the
patient dignity inventory-Italian version. J Pain Symptom Manage 2017;
53:279–287.
35. Robinson S, Kissane DW, Brooker J, Burney S. A systematic review of the
demoralization syndrome in individuals with progressive disease and cancer:
a decade of research. J Pain Symptom Manage 2015; 49:595–610.
36. Vehling S, Gerstorf D, Schulz-Kindermann F, et al. The daily dynamics of loss
orientation and life engagement in advanced cancer: a pilot study to char-
acterise patterns of adaptation at the end of life. Eur J Cancer Care 2018;
e12842:1–14.
37. Grossman CH, Brooker J, Michael N, Kissane D. Death anxiety interventions in
& patients with advanced cancer: a systematic review. Palliat Med 2018;
32:172–184.
The first review focusing on the outcome death anxiety.
38. Guerrero-Torrelles M, Monforte-Royo C, Rodriguez-Prat A, et al. Understand-
ing meaning in life interventions in patients with advanced disease: a sys-
tematic review and realist synthesis. Palliat Med 2017; 31:798–813.
39. Rosenfeld B, Saracino R, Tobias K, et al. Adapting meaning-centered psy-
& chotherapy for the palliative care setting: results of a pilot study. Palliat Med
2017; 31:140–146.
It is a small trial focusing on the adaption of MCP to persons in their last weeks of
life.
40. Breitbart W, Pessin H, Rosenfeld B, et al. Individual meaning-centered
&& psychotherapy for the treatment of psychological and existential distress: a
randomized controlled trial in patients with advanced cancer. Cancer 2018;
00:1–9.
This study confirms the effects of individual meaning-centered psychotherapy on
both psychological and existential distress.
0951-7367 Copyright ß 2018 Wolters Kluwer Health, Inc. All rights reserved.
Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.
Palliative care von Blanckenburg and Leppin
41. Rosenfeld B, Cham H, Pessin H, Breitbart W. Why is Meaning-Centered
& Group Psychotherapy (MCGP) effective? Enhanced sense of meaning as the
mechanism of change for advanced cancer patients. Psychooncology 2018;
27:654–660.
This article conducted a mediation analyses to get deeper insights in the mechan-
ism of change and emphasized the role of the sense of meaning.
42. Rodin G, Lo C, Rydall A, et al. Managing cancer and living meaningfully
&& (CALM): a randomized controlled trial of a psychological intervention for
patients with advanced cancer. JCO 2017; 35:LB10.
Large RCT evaluating the promising Canadian CALM intervention. This article is
published online before print.
43. Martinez M, Arantzamendi M, Belar A, et al. ’Dignity therapy’, a promising
intervention in palliative care: a comprehensive systematic literature review.
Palliat Med 2017; 31:492–509.
44. Wang C-W, Chow AY, Chan CL. The effects of life review interventions on
& spiritual well being, psychological distress, and quality of life in patients with
terminal or advanced cancer: a systematic review and meta-analysis of
randomized controlled trials. Palliat Med 2017; 31:883–894.
A systematic review that lament the low quality of the included studies and require
more research in this field.
45. Juliao M, Oliveira F, Nunes B, et al. Effect of dignity therapy on end-of-life
& psychological distress in terminally ill Portuguese patients: a randomized
controlled trial. Palliat Support Care 2017; 15:628–637.
A trial finding positive effects of dignity therapy on desire for death, demoralization,
and sense of dignity.
46. Vuksanovic D, Green HJ, Dyck M, Morrissey SA. Dignity therapy and life
&& review for palliative care patients: a randomized controlled trial. J Pain
Symptom Manage 2017; 53:162–170.
An interesting middle-sized RCT comparing dignity therapy and life reviews to
identify the role of the creation of a legacy document.
47. Guo Q, Chochinov HM, McClement S, et al. Development and evaluation of
the dignity talk question framework for palliative patients and their families: a
mixed-methods study. Palliat Med 2018; 32:195–205.
48. Ho AHY, Car J, Ho MR, et al. A novel Family Dignity Intervention (FDI) for
enhancing and informing holistic palliative care in Asia: study protocol for a
randomized controlled trial. Trials 2017; 18:1–12.
49. Garcı́a-Rueda N, Carvajal Valcárcel A, Saracı́bar-Razquin M, Arantzamendi
Solabarrieta M. The experience of living with advanced-stage cancer:
a thematic synthesis of the literature. Eur J Cancer Care 2016; 25:
551–569.
50. Wright EP, Kiely MA, Lynch P, et al. Social problems in oncology. Br J Cancer
2002; 87:1099–1104.
51. Bradley N, Lloyd-Williams M, Dowrick C. Effectiveness of palliative care
&& interventions offering social support to people with life-limiting illness-A
systematic review. Eur J Cancer Care 2018; 27:1–12.
This article systematically reviews existing quantitative evidence on palliative care
interventions that include facilitating social support. It analyses differential effects
of these interventions in certain patients group and thereby is a valuable con-
tribution to stepped-care approaches.
52. Epstein RM, Duberstein PR, Fenton JJ, et al. Effect of a Patient-centered
& communication intervention on oncologist-patient communication, quality of
life, and healthcare utilization in advanced cancer: The VOICE randomized
clinical trial. JAMA Oncol 2017; 3:92–100.
In this randomized clinical trial, the complexity and importance of communication
for advanced cancer patients were regarded with a brief combined intervention. It
involved clinicians as well as patients, but solely improved patient-centered
communication, not any secondary outcomes.
53. Rodenbach RA, Brandes K, Fiscella K, et al. Promoting end-of-life discussions
in advanced cancer: effects of patient coaching and question prompt lists.
J Clin Oncol 2017; 35:842–851.
54. Rietjens JAC, Sudore RL, Connolly M, et al. Definition and recommenda-
& tions for advance care planning: an international consensus supported by
the European Association for Palliative Care. Lancet Oncol 2017; 18:
543–551.
It is a study involving 109 experts in a formal Delphi consensus process a definition
of ACP and recommendations for its application were provided. Also, a brief
overview on the effects of ACP is given.
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