ABSTRACT
Oncological disease in the palliative stage is a huge challenge for patients and their family caregivers (FCs) due to the fact that it confronts them with death, as well as physical, psychological, and existential suffering. Meaning of Life Therapy (MLT) is a brief structured psycho-existential intervention aiming to help patients in a meaning-making life review process, promoting end-of-life adaptation. The Life Letter (LL) resulting from MLT is an element that facilitates communication between the patient and their caregivers. The goal of this study was to understand the impact of MLT on the grieving processes of eight FCs and to study their perceptions of the role of the LL on grief through semi-structured interviews. The results of our qualitative analysis indicate that MLT was perceived by the FCs as a positive experience despite the conspiracy of silence being identified as a drawback. The LL was interpreted as a communicational element, promoting emotional closeness with the cancer patients and serving as a valuable tool in the FCs' adaptation to loss. Our research findings show that the needs of FCs, especially after experiencing the loss of their relative, are dynamic and specific. This is why it is urgent to develop interventions that consider the idiosyncrasies of end-of-life cancer patients and their FCs in order to avoid frustrated farewells, lonely deaths, and maladaptive grieving processes. This is the direction in which MLT should evolve.
ABSTRACT
Intervention in Palliative Care aims to provide physical, psychosocial, and spiritual relief for patients and family members. Brief interventions with a psycho-existential approach have shown positive responses; however, cultural adaptations are needed. This pilot study aimed to develop the Meaning of Life Therapy (MLT), a novel psycho-existential intervention, rooted in the Dignity Therapy, Life Review, and Meaning-Centered Psychotherapy. MLT was culturally adapted to the Portuguese context to include questions about forgiveness, apology, reconciliation, farewell, and a legacy document, i.e., the Life Letter. Nine PC cancer patients answered a 14-question MLT protocol, intended to help patients find purpose and meaning in life. Eight themes emerged: Family, Preservation of Identity, Life Retrospective, Clinical Situation, Achievements, Socio-Professional Valorization, Forgiveness/Apology/Reconciliation, and Saying Goodbye. MLT has proved its ability to respond to the psycho-existential needs of PC patients. Further studies should be conducted to gain extensive knowledge of the effectiveness of culturally responsive interventions.
ABSTRACT
Introduction: Suicidal behavior has been associated with several risk factors, including depression, maladaptive coping, and neuropsychological dysfunction. This study aimed to evaluate coping orientations, executive functioning, attentional capabilities and decision-making in depressed suicidal patients. Methods: Two groups were selected: 32 depressed patients with history of suicide attempt and 30 depressed patients without history of suicide attempt. The Beck Depression Inventory and the COPE Inventory scales were applied, as well as the following neuropsychological tests: Wisconsin Card Sorting Test, Stroop Test, and a modified Iowa Gambling Task. Results: The results indicate a higher level of dysfunction in the executive functioning, mental control, and decision-making domains, and lower levels of orientation to active and reflective coping strategies, humor, and positive signification in the suicidal group. Conclusions: These results indicate that there are neuropsychological differences between depressed patients with and without history of suicide attempt, which may contribute significantly to the occurrence of suicidal behavior. However, the processes involved and the way they contribute to the phenomenon are aspects that still need further clarification.
