Meaning‐centered pain coping skills training for patients with metastatic cancer: Results of a randomized controlled pilot trial

• Published in: Psycho-oncology (Chichester, England) Vol. 32; no. 7; pp. 1096 - 1105
• Main Authors: Winger, Joseph G., Kelleher, Sarah A., Ramos, Katherine, Check, Devon K., Yu, Justin A., Powell, Victoria D., Lerebours, Reginald, Olsen, Maren K., Keefe, Francis J., Steinhauser, Karen E., Porter, Laura S., Breitbart, William S., Somers, Tamara J.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-07-2023
• Subjects: Adaptation, Psychological; Adult; Cancer; cognitive behavioral therapy; Cognitive-behavioral factors; Coping strategies; Efficacy; Emotions; Feasibility; Humans; Meaning; Metastasis; Neoplasms - psychology; Neoplasms - therapy; Neoplasms, Second Primary; oncology; Pain; Pain management; palliative care; Peace; Pilot Projects; Psychological distress; psychosocial intervention; psycho‐oncology; Sense of purpose; Severity; Skill development; spirituality; Tumors; Video conferencing; cognitive behavioral therapy; cancer; pain management; psychosocial intervention; spirituality; palliative care; oncology; psycho-oncology
• ISSN: 1057-9249; 1099-1611; 1099-1611
• DOI: 10.1002/pon.6151

Objective
For patients with advanced cancer, pain is a common and debilitating symptom that can negatively impact physical, emotional, and spiritual well‐being. This trial examined the feasibility and initial effects of Meaning‐Centered Pain Coping Skills Training (MCPC), a cognitive‐behavioral pain management intervention with an emphasis on enhancing meaning (i.e., a personal sense of purpose, worth, and significance) and peace.
Methods
We enrolled 60 adults with stage IV solid tumor cancers and moderate‐severe pain between February 2021 and February 2022. Participants were randomized 1:1 to MCPC + usual care or usual care alone. Meaning‐Centered Pain Coping Skills Training consisted of four weekly 60‐min individual sessions via videoconference or telephone, delivered by a trained therapist using a manualized protocol. Participants completed validated measures of pain severity, pain interference, pain self‐efficacy, spiritual well‐being (i.e., meaning, peace, and faith), and psychological distress at baseline and 5‐week and 10‐week follow‐ups.
Results
All feasibility metrics exceeded prespecified benchmarks. Fifty‐eight percent of screened patients were eligible, and 69% of eligible patients consented. Of those assigned to MCPC, 93% completed all sessions and 100% of those who completed follow‐ups reported using coping skills weekly. Retention was strong at 5‐week (85%) and 10‐week (78%) follow‐ups. Meaning‐Centered Pain Coping Skills Training participants reported better scores than control participants across outcome measures, including moderate‐to‐large sized differences at 10‐week follow‐up in pain severity (Cohen's d = −0.75 [95% confidence interval: −1.36, −0.14]), pain interference (d = −0.82 [‐1.45, −0.20]), and pain self‐efficacy (d = 0.74 [0.13, 1.35]).
Conclusions
MCPC is a highly feasible, engaging, and promising approach for improving pain management in advanced cancer. Future efficacy testing is warranted.
Trial registration
ClinicalTrials.gov Identifier: NCT04431830, registered 16 June 2020.