Power of the past: Life review therapy in palliative cancer care

Chapter 1 contains the general introduction of this thesis. It provides an overview of the epidemiology and treatment of cancer and palliative care, and the challenges this disease and its treatment puts on patients and their informal caregivers. Also, life review therapy is introduced, the intervention “Dear Memories” is described, and the main aim and the hypotheses of this dissertation are presented. The main aim of this dissertation is to obtain insight in the efficacy of the structured Life Review Therapy combined with memory specificity training (LRT-MST), named ‘’Dear Memories’’ among incurably ill cancer patients. Chapter 2 presents the study protocol of the randomized controlled trial (RCT) to assess the efficacy of LRT-MST in incurably ill cancer patients and their spouses. Spouses will not receive LRT themselves, but because it was expected that patients will talk about their memories during the intervention period with their spouses, it was hypothesized that LRT may have a positive effect on them as well. Chapter 3 describes a study on the psychometric characteristics of the primary outcome measure in in the RCT: the North-western Ego-integrity Scale (NEIS). It is a questionnaire on ego-integrity (the experience of wholeness and meaning in life, even in spite of negative experiences) and despair (the experience of regret about the life one has led, and feelings of sadness, failure and hopelessness) among cancer patients. It was concluded that the NEIS has good psychometric characteristics to assess ego-integrity and despair among cancer patients. Chapter 4 presents the results of the multicentre randomized controlled trial investigating the efficacy of LRT-MST among incurably ill cancer patients. A total of 107 patients were randomized to the intervention group (LRT-MST; n=55) or waiting-list control group (n=52). Linear mixed models (intention to treat) showed that the course of ego-integrity (not despair) improved significantly over time (p=.007) in the intervention group compared to the waiting-list control group, with moderate, but statistically not significant, effect sizes at T1 (ES=.42) and T2 (ES=.48). This study showed that LRT-MST seems effective to improve ego-integrity among cancer patients in palliative care. Chapter 5 includes the outcomes of a qualitative study which provided more in-depth knowledge on motivation to start with LRT-MST, experiences with LRT-MST, and perceived outcomes of LRT-MST in incurably ill cancer patients. Semi-structured interviews were conducted with 20 cancer patients in palliative care who participated in the RCT. The results of this study are important to further tailor LRT-MST and for development or improvement of other psychological interventions targeting cancer patients in palliative care. Chapter 6 investigated whether Life Review Therapy and Memory Specificity Training (LRT-MST) targeting incurably ill cancer patients, may also have a beneficial effect on caregiving burden, symptoms of anxiety and depression, and posttraumatic growth of the informal caregivers. Many caregivers experienced symptoms of anxiety (56%) and depression (30%). LRT-MST did not improve symptoms of depression and anxiety, negative aspects of caregiver burden or post-traumatic growth. LRT-MST may have a protective effect on self-esteem of informal caregivers (positive aspect of caregiver burden). Chapter 7 provides a general discussion putting the findings of the studies conducted in this dissertation in broader perspective. Also, strengths, limitations, implications for clinical practice and recommendations for future research are provided.