Interventions for Posttraumatic Growth and Spiritual Well-being for Adults Living With and Beyond Cancer (2018

Abstract

Systematic review briefs provide a summary of the findings from systematic reviews evaluated in conjunction with the American Occupational Therapy Association’s Evidence-Based Practice Program. Each systematic review brief summarizes the evidence on a theme related to a systematic review topic. This systematic review brief presents findings related to posttraumatic growth and spiritual well-being for adults living with and beyond cancer.

Full Systematic Review Question

This systematic review addressed the question “What is the evidence for the effectiveness of interventions within the scope of occupational therapy practice to improve performance and participation for adults living with cancer?”

Current Theme Reported

The main theme of the studies presented in this systematic review brief includes interventions for posttraumatic growth and spiritual well-being for adults living with and beyond cancer.

Clinical Scenario

As individuals cope with and beyond cancer, posttraumatic growth (PTG) and spiritual well-being can be important entities to explore and develop. PTG is commonly referred to as positive behavioral, emotional, or cognitive changes following cancer (Menger et al., 2021). These changes may include increased feelings of appreciation and meaning for life, relationships, and spirituality (Menger et al., 2021). It has been found that moderate-high posttraumatic growth has been reported in around 60% of adults living with and beyond cancer (Jansen et al., 2011; Sharp et al., 2018 as cited in Menger et al., 2021). According to the Occupational Therapy Practice Framework: Domain and Process—Fourth Edition (American Occupational Therapy Association, 2020), spirituality is defined as “a deep experience of meaning brought about by engaging in occupations that involve the enacting of personal values and beliefs, reflection, and intention within a supportive contextual environment” (Billock, 2005, p. 887). Posttraumatic growth and spiritual well-being may be experienced by those across the continuum and can be important facets in coping for occupational therapy practitioners to facilitate during and beyond cancer.

Summary of Key Findings

Three systematic reviews were included related to posttraumatic growth and spiritual well-being for adults living with and beyond cancer. (Table 1). The levels of evidence used in this review are from Oxford Centre for Evidence-Based Medicine (2009). The strength-of-evidence designations are based on the guidelines of the U.S. Preventive Services Task Force (2018).

Table 1.

Evidence Table for Interventions for Posttraumatic Growth and Spiritual Well-Being

Author, YearLevel of Evidence (types of study designs)Risk of Bias (RoB)Setting	Systematic Review Details	Findings From Reviews
Three Level 1A reviews provided strong strength of evidence to support posttraumatic growth and spiritual well-being for adults with varying types of cancer at all stages.
McLouth et al. (2021) Level 1a—Systematic review with meta-analysis RoB Low Setting Outpatient setting (93%)	Participants N = 3,883; mixed cancer types and stages—cancer stage: early n = 9, advanced n = 8, mixed n = 18, not reported n = 6; cancer phase: curative n = 4, mixed n = 15, palliative n = 1, posttreatment n = 12, not reported n = 9; mean age: 56.4, SD = 7.2; average % female: 79.5; race/ethnicity: not reported Number of Articles 41 (RCT) Databases Searched MEDLINE (Ovid), PsycINFO (EBSCOhost), CINAHL with Full Text (EBSCOhost), EMBASE (Elsevier), The Cochrane Library (Wiley) and Web of Science (Clarivate Analytics) Outcome(s) of Interest Spiritual well-being (primary outcome n = 17, secondary outcome n = 15, unspecified n = 9) Intervention(s) of Interest Creative arts n = 5, education/healthy lifestyle behaviors n = 5, meaning/existential n = 7, meditation/yoga n = 10, multimodal n = 5, skills/based CBT n = 12 Delivery Methods Varied between phone n = 4, in-person n = 34; 83%, online n = 11, NR n = 1; individual n = 22, dyad n = 3, group n = 16 Dose Ranges Average intervention length was 7.6 sessions (SD = 5.4)	Interventions were associated with significant improvements in SpWb (g = 0.22, 95% CI [0.14, 0.29], p < .0001). Studies assessing the FACIT-Sp demonstrated larger effect sizes than did those using other measures of SpWb (g = 0.25, 95% CI [0.17, 0.34], vs. g = 0.10, 95% CI [−0.02, 0.23], p = .03).
Li et al. (2020) Level 1a—Systematic review with meta-analysis RoB Low Setting Varied; not reported for some	Participants N = 1,641 (n = 871 in the intervention group and n = 770 in the control group)—sample size ranged from 34 to 304; n = 6 cancer of any stage; n = 6 breast cancer, n = 2 prostate cancer, n = 1 colorectal cancer; mean age: ranged from 46.1–70.2; race/ethnicity: not reported Number of Articles 15 (RCT) Databases Searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trails (CENTRAL), CINAHL, and PsycINFO Outcome(s) of Interest Posttraumatic growth Intervention(s) of Interest Intervention varied; however, most used intervention approach was mindfulness- based intervention—n = 3 MBSR; n = 1 MBCR; CBSM n = 3; others varied Delivery Methods Not reported Dose Ranges Duration varied from 5 wk–24 wk; n = 9 used 8-wk psychosocial interventions, n = 2 used 10-wk interventions, n = 2 used 24-wk interventions, n = 1 used 5-wk intervention, n = 1 not reported	Eight out of 15 studies reported statistically significant differences between the intervention group and the control group (p < .05), with the intervention having better outcomes. CBSM and interventions based on behavioral change showed a significant effect, with mindfulness-based interventions found to be most effective in having a significant effect on posttraumatic growth.
Teo et al. (2019) Level 1a—Systematic review RoB Low Setting Majority outpatient settings or community	Participants CBT: Intervention (IG) n = 1,253, Control (CG) n = 1,154; Meaning-enhancing interventions: IG n = 669, CG n = 684; Dignity therapy, life review and narrative interventions: IG n = 328; CG n = 462; Other counseling interventions: IG n = 185, CG n = 192; Education-only interventions: IG n = 1,127, CG n = 837; Music, writing, and others: IG n = 356, CG n = 386; Advanced cancer [articles had to have a sample of at least 70% advanced cancer patients (stage 3 or 4)]; mean age: not reported; race/ethnicity: not reported Number of Articles 68 (RCT) Databases Searched MEDLINE (via Proquest), CINAHL Plus (via EBSCOhost), PsycINFO (via Ovid), and Scopus Outcome(s) of Interest Meaning, spiritual wellbeing and QOL generativity, ego integrity, forgiveness Intervention(s) of Interest Psychosocial interventions—Grouped based on six intervention approaches: (a) CBT-based, defined as counseling‐based interventions that targeted changing patient’s patterns of thought or behavior n = 20; (b) meaning enhancing, defined as counseling‐based interventions that enhanced patients’ sense of meaning, dignity, and spirituality n = 11; (c) dignity therapy, life review and narrative, defined as narrative interventions characterized by the recipient being given the opportunity to reflect on their life and to tell their story and its personal meaning n = 9; (d) other counseling, defined as counseling‐based interventions that did not fall into the former two categories n = 5; (e) education only, defined as interventions that enhanced patients’ knowledge and/or agency and were “unidirectional” in their delivery n = 11; and (f) music, writing, and others defined as miscellaneous interventions that did not fit into the aforementioned categories n = 10 Delivery Methods CBT-mixed including individual, dyadic, or groups delivered in person, over the phone, or online; some had mixed modalities; Meaning-enhancing interventions: in person; Dignity therapy, life review and narrative interventions: individually and in person; Other counseling interventions: majority in person; Music, writing, and other interventions: music therapy, expressive writing, and hope-focused video interventions were delivered individually, while Web-based interventions were facilitated as a group Dose Ranges CBT—90% conducted within six sessions; Dignity therapy, life review and narrative interventions: ranged between one and three sessions, typically conducted within 2 wk; Other counseling interventions: facilitated in eight or fewer sessions; Other counseling interventions: all were provided as a single session; four included booster sessions or symptom monitoring via telephone; Music, writing, and other interventions: most were conducted within two to four sessions, with sessions lasting 20 to 30 min and delivered within 3 wk	Meaning-enhanced interventions: Seven out of 11 studies with scores significantly higher in intervention group at p = .05 significance level. These findings included spiritual well-being, meaning, QOL, forgiveness, and spiritual QOL Dignity therapy, life review, and narrative interventions: Four out of nine studies with scores significantly higher in intervention group at p = .05 significance level. These findings included sense of meaning, global QOL, generativity, and ego integrity.

Note. CBSM = cognitive behavioral stress management; CBT = cognitive behavioral therapy; CG = control group; FACIT-Sp = Functional Assessment of Chronic Illness Therapy—Spiritual Well-Being Scale; IG = intervention group; MBSR = mindfulness-based stress reduction; MBCR = Mindfulness-Based Cancer Recovery; QOL = quality of life; RCTs = randomized controlled trials; RoB = risk of bias; SpWb = spiritual well-being; 95% CI = 95% confidence interval.

Bottom Line for Occupational Therapy Practice

As posttraumatic growth and spiritual well-being are often prevalent constructs in adults living with and beyond cancer, occupational therapy practitioners should support these areas. Interventions that can address these areas are vast, including but not limited to mindfulness-based interventions, cognitive behavioral therapy interventions, dignity therapy, life review and narrative, and meaning-enhancing interventions. These interventions have been shown to have a significant effect on posttraumatic growth and significant improvements on spiritual well-being. Delivery methods and dose of interventions found to be effective can vary, lending to flexibility for occupational therapy practitioners. Various assessments can be used to capture spiritual well-being and posttraumatic growth, with one systematic review finding that the Functional Assessment of Chronic Illness Therapy—Spiritual Well-Being Scale (FACIT-Sp; Peterman et al., 2002) demonstrated larger effect sizes than other measures of spiritual well-being. Adept at incorporating meaning-making interventions into the context of daily occupations, occupational therapy practitioners can support posttraumatic growth and spiritual well-being at all stages and phases of the cancer continuum.

Footnotes

*

Indicates articles included in the brief systematic review.

References

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Interventions for Posttraumatic Growth and Spiritual Well-being for Adults Living With and Beyond Cancer (2018–2022)