Spirituality and its role in end-of-life care has emerged as a central issue in palliative care. There have been several recent studies of terminally ill cancer patients, both by our research group and others, demonstrating the central role of spiritual well being, and sense of "meaning" in particular, in buffering against depression hopelessness, and desire for hastened death. We have developed, manualized, and pilot-tested just such a novel intervention - Meaning-Centered Psychotherapy (MCP). MCP, pilot-tested in an 8-week group format, is based on the principles of Viktor Frankl's work, and is designed to help patients with advanced cancer sustain or enhance a sense of meaning as they approach the end-of-life. Preliminary findings from our pilot randomized controlled trials demonstrate MCP significantly reduces psychological distress (e.g., depression, hopelessness, anxiety, and desire for hastened death), and significantly increase spiritual well-being and a sense of meaning and purpose in life in advanced cancer patients. The overall aim of the current proposal is to adapt the Meaning-Centered Group Psychotherapy (MCGP) intervention for Chinese immigrant cancer patients (MCGP-Ch), a large, underserved and understudied ethnic minority group. We will adapt the MCGP intervention to be culturally and linguistically targeted for this population, the resulting intervention will be used to apply for a subsequent grant to pilot test MCGP-Ch for feasibility, acceptability, and satisfaction. Culturally adapted treatments have been demonstrated to be more effective than those that have not been adapted, treatments with greater numbers of cultural adaptations tend to be most effective, and interventions targeted for a specific ethnic group are more effective than those delivered to patients from a variety of backgrounds. To inform the adaptation of the intervention, we will conduct a community needs assessment as well as 15-20 in-depth interviews with Chinese immigrants with advanced cancer, using the Ecological Validity Model (EVM) of Bernal et al. and the Cultural Adaptation Process (CAP) model of Domenech-Rodriquez and Weiling.
Significant gaps remain in understanding and addressing the spiritual needs of Chinese patients with advanced cancer, an understudied and underserved group. Given the unmet need in this population for spiritual support, the risk of cross-cultural misunderstanding surrounding care at the end of life, and the interrelatedness between Meaning-Centered Group Psychotherapy (MCGP) and the themes found in previous studies conducted in this area among Chinese patients, adapting MCGP is a logical and important next step. It will advance the knowledge base to enhance spiritual well-being and quality of life, and reduce psychological distress and end-of-life despair in this vulnerable population.