Online Individual Intervention Program to Make Sense of People's Experiences After a Breast Cancer Diagnosis
Condition: Breast Cancer
MeSH terms: Breast Neoplasms
Study type: Interventional

Summary: 
      The unexpected changes caused by the diagnosis and treatment of breast cancer can lead
      individuals to question their beliefs, life meanings, and goals, prompting a search for
      meaning. According to Park and Folkman's (1997) Meaning-Making Model, the process of meaning
      making functions as a coping mechanism. It helps individuals adapt challenging experiences
      into their lives, ultimately assisting in their psychological adjustment to stressful
      situations. Based on this theoretical model, principles from meaning therapy (Wong, 2010),
      literature reviews, interviews with breast cancer patients, and expert consultation, an
      8-week online individual psychological intervention was developed. It was aimed at
      facilitating the finding of new meanings in the experience of breast cancer and promoting
      psychological well-being. It includes psycho-educational, cognitive, existential, and
      behavioral components explicitly focusing on the meaning-making process. This intervention is
      called the Meaning Centered Coping Program (MCCP). The main purpose of this study was to test
      whether the MCCP was an effective intervention program for women diagnosed with breast
      cancer. For this purpose, the study sample consisted of women with stage I, II, and III
      breast cancer. Then, participants were randomly assigned to the MCCP group and the wait-list
      control group. A number of reliable and valid measurement tools were used to compare the MCCP
      group with the waitlist control group and to examine the effect of the program. Compared with
      the control group, significant improvements were expected in the level of meaning in life,
      post-traumatic growth, situational meanings, psychological inflexibility, and psychological
      well-being in the MCCP group.
    

Detailed description: 
      In recent years, there has been a growing discussion about the necessity for mental health
      services not only to alleviate individuals' psychological distress but also to focus on
      enhancing the sense of meaning in life. Therefore, the MCCP aimed not only to reduce
      distressing psychological symptoms but also to facilitate the discovery of new positive
      meanings in breast cancer and individual's life, despite existing limitations. In this
      regard, the MCCP has been developed by drawing upon Meaning-Making Model (Park, 2010; Park
      and Folkman,1997), principles of meaning therapy (Wong, 2010), the literature on meaning, and
      existing meaning centered psychotherapy approaches. Additionally, considering limitations
      such as potential program changes, transportation difficulties, and inadequate physical
      conditions, online interventions offer a reliable alternative that provides numerous
      advantages for individuals diagnosed with breast cancer. Therefore, the intervention program
      was implemented online via video conference for women diagnosed with breast cancer in the
      current study. After the program was developed, a pilot study was conducted. According to the
      expert's feedback, the final version of MCCP was developed. The primary aim was to test the
      effectiveness of MCCP among women with breast cancer. The research hypotheses are 1) compared
      to control grup, MCCP group would show better improvement in meaning in life and PTG scores
      2) compared to control grup, MCCP group would show better improvements in situational meaning
      (i.e. stress appraisal and violations in general meaning) 3) Compared to control group, the
      MCCP group would report significant decrease in automatic meaning making efforts (i.e.
      intrusion and avoidance) 4) Compared to control group, the MCCP group would report a
      significantly higher level of psychological flexibility and lower level of psychological
      distress.

      Before the data collection process, ethical approval was obtained from the Institutional
      Ethics Committee of Dokuz Eylül University, affiliated with Dokuz Eylül University School of
      Medicine (Ethics Committee Decision No: 2021/12-39). The study has been announced using
      social media platforms (Facebook, Twitter, Instagram), oncology associations established to
      support oncology patients, and referrals from healthcare professionals to reach potential
      participants. The sample size was determined using the power analysis method. Then, 44 women
      diagnosed with breast cancer who volunteered to participate in the study were randomly
      assigned to either the intervention group or the waitlist control group.

      The random assignment process was conducted using the website https://www.randomizer.org/.
      Participants in the MCCP group were assessed thrice: before the intervention, immediately
      after the intervention, and at the 2-month follow-up. The control group underwent the initial
      assessment before intervention began and the final assessment took place eight weeks later.
      After getting verbal and written consent from all participants, a number of measurement tools
      was applied. The Sociodemographic and Disease-Related Information Form, The Meaning in Life
      Questionnaire, Posttraumatic Growth Inventory-X, Stress Appraisal Measure, Global Meaning
      Violations Scale, Impact of Event Scale-Revised Form, Acceptance and Action Scale-II, and
      Hospital Anxiety and Depression Scale were used. To test the hypotheses of the study, Pearson
      correlation analysis, 2 (Group) X 2 (Time) repeated measures ANOVA, and one-way repeated
      measures ANOVA were applied. SPSS 29.0 Package Program for Social Sciences was used for
      statistical analyses.
    

Intervention name(s): Meaning Centered Coping Program
Intervention type(s): Other
Intervention description(s): Meaning Centered Coping Program is a psychological intervention program developed for women diagnosed with breast cancer, based on the Meaning Making Model (Park, 2010; Park and Folkman, 1997) and Wong's (2010) principles of Meaning Therapy. Each weekly session had specific topics. These are:
Session 1: Guiding patients to tell the story of their breast cancer and psycho-education; Session 2: Encouraging patients to talk about the effects of breast cancer on their lives and learning to accept their difficult emotions; Session 3: Focusing on cognition through the meaning attributed to breast cancer; Session 4: Learning to take alternative perspectives and defusing their negative thoughts; Session 5: Exploring personal strengths; Session 6: İdentifying important life values and moving toward value-based actions; Session 7: Finding meaning in breast cancer and life; Session 8: Focusing on Future plans and hopes
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: breast cancer; meaning making; online intervention program; psychological health