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

Abstract

AbstractObjectiveFor 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.MethodsWe 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.ResultsAll 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]).ConclusionsMCPC is a highly feasible, engaging, and promising approach for improving pain management in advanced cancer. Future efficacy testing is warranted.Trial registrationClinicalTrials.gov Identifier: NCT04431830, registered 16 June 2020.