Meaning-Centered Pain Coping Skills Training: A Randomized Pilot Trial for Patients with Advanced Cancer and Pain
Patients with advanced cancer consistently describe pain as one of their most feared and distressing symptoms, with higher pain levels predicting worse physical, emotional, and existential well-being. Psychosocial interventions show promise for improving cancer-related pain; however, no interventions address existential concerns (e.g., a loss of meaning) that are common in those facing pain from life-limiting illness. To address this patient need, we recently developed a novel intervention called Meaning-Centered Pain Coping Skills Training (MCPC). MCPC is based on two efficacious approaches: 1) Pain Coping Skills Training for systematic training in cognitive and behavioral pain coping skills (e.g., guided imagery); and 2) Meaning-Centered Psychotherapy for enhancing a sense of meaning. In our preliminary work, we refined MCPC’s initial protocol based on stakeholder feedback. We then demonstrated its feasibility, acceptability, and promise for improving patient-reported outcomes in a single-arm trial. We now propose to test MCPC in a more rigorous pilot randomized clinical trial (RCT). Patients (N=60) with advanced cancer and persistent pain (i.e., pain score >4/10) will be randomly assigned to MCPC or an education and support attention control condition. Patient-reported outcomes will be assessed at baseline and 5- and 10-week follow-ups. The first aim is to assess the feasibility of conducting an RCT to test MCPC. The second aim is to characterize MCPC’s effects on patient-reported outcomes of pain severity (primary outcome), pain interference, meaning in life, self-efficacy for pain management, and psychological distress. The third aim is to describe participants’ experiences of MCPC and the attention control condition using semi-structured qualitative interviews. If we find that MCPC can be feasibly tested in an RCT and demonstrates promise for improving patient outcomes, we will have compelling support for a definitive efficacy trial.
Joseph G. Winger, PhD, is a licensed clinical
psychologist and an Assistant Professor in the Department of Psychiatry and
Behavioral Sciences at Duke University School of Medicine. Dr. Winger earned
his PhD in Clinical Health Psychology from Indiana University-Purdue University
Indianapolis, and completed his clinical psychology internship at Duke
University Medical Center in the Cancer Symptom Management and Support track.
His research focuses on the development and testing of novel psychosocial
interventions for patients facing life-limiting illnesses. A unique aspect of
his work is addressing the existential aspects of coping with debilitating