Pilot Randomized Controlled Trial of Individual Meaning-Centered Psychotherapy for Patients With Advanced Cancer
Open accessAbstract
Purpose: Spiritual well-being and sense of meaning are important concerns for clinicians who care for patients with cancer. We developed Individual Meaning-Centered Psychotherapy (IMCP) to address the need for brief interventions targeting spiritual well-being and meaning for patients with advanced cancer. Patients and Methods: Patients with stage III or IV cancer (N = 120) were randomly assigned to seven sessions of either IMCP or therapeutic massage (TM). Patients were assessed before and after completing the intervention and 2 months postintervention. Primary outcome measures assessed spiritual well-being and quality of life; secondary outcomes included anxiety, depression, hopelessness, symptom burden, and symptom-related distress. Results: Of the 120 participants randomly assigned, 78 (65%) completed the post-treatment assessment and 67 (56%) completed the 2-month follow-up. At the post-treatment assessment, IMCP participants demonstrated significantly greater improvement than the control condition for the primary outcomes of spiritual well-being (b = 0.39; P <.001, including both components of spiritual well-being (sense of meaning: b = 0.34; P = .003 and faith: b = 0.42; P = .03), and quality of life (b = 0.76; P = .013). Significantly greater improvements for IMCP patients were also observed for the secondary outcomes of symptom burden (b = −6.56; P < .001) and symptom-related distress (b = −0.47; P < .001) but not for anxiety, depression, or hopelessness. At the 2-month follow-up assessment, the improvements observed for the IMCP group were no longer significantly greater than those observed for the TM group. Conclusion: IMCP has clear short-term benefits for spiritual suffering and quality of life in patients with advanced cancer. Clinicians working with patients who have advanced cancer should consider IMCP as an approach to enhance quality of life and spiritual well-being.
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Early randomized controlled trials have shown that a meaning-centered therapy, delivered either in a group or individual format, can help raise meaning and purpose in life among people with cancer.
“Additionally, early randomized controlled trials have shown that a meaning-centered therapy, delivered either in a group or individual format, can help raise meaning and purpose in life among people with cancer (32, 33).”
From Purpose in life and use of preventive health care services (2014) · cites this paper as [32]
In an RCT with patients with stage III or IV cancer, individual MCP produced greater improvement in meaning in life, spiritual wellbeing, faith, physical symptoms of distress, burnout, and quality of life compared with a control group of massage therapists.
“Individual MCP was compared with a control group (massage therapists), and the results showed that MCP produced a greater improvement in meaning in life, spiritual wellbeing, faith, physical symptoms of distress, burnout, and quality of life.”
From Spanish Adaptation of Meaning-Centered Psychotherapy for Participants With Cancer: Study Protocol of a Randomized Control Trial (2022) · cites this paper as [13]
There were no statistically significant improvements in depression or anxiety in the individual MCP RCT.
“The same authors indicated that there were no statistically significant improvements in depression or anxiety.”
From Spanish Adaptation of Meaning-Centered Psychotherapy for Participants With Cancer: Study Protocol of a Randomized Control Trial (2022) · cites this paper as [13]
The improvement from individual MCP was not sustained at 2 months.
“However, the improvement was not sustained at 2 months.”
From Spanish Adaptation of Meaning-Centered Psychotherapy for Participants With Cancer: Study Protocol of a Randomized Control Trial (2022) · cites this paper as [13]
Many interventions for adults with metastatic cancer are disconnected from the scientific evidence base on how to effectively reduce distress or change behavior.
“Further, many interventions for adults with metastatic cancer (e.g., [14, 23]) are disconnected from the scientific evidence base on how to effectively reduce distress or change behavior.”
Palliative care research has developed personally tailored, individually delivered interventions requiring significant resources.
“Palliative care research has developed personally tailored, individually delivered interventions requiring significant resources (e.g., [14, 23, 38])”
An increasing number of randomized controlled trials show that purpose in life can be raised.
“An increasing number of randomized controlled trials show that purpose in life can be raised.”
From Purpose in life and use of preventive health care services (2014) · cites this paper as [32]
Findings of physical benefits from interventions designed to enhance R/S indicate that R/S does contribute to better health.
“findings of physical benefits from interventions designed to enhance R/S indicate that R/S does contribute to better health.39-41”
From Religion, spirituality, and physical health in cancer patients: A meta‐analysis (2015) · cites this paper as [39]
Available data suggest that spiritually-based interventions may improve quality of life and physical recovery in cancer patients.
“Although few spiritually-based interventions have been tested in cancer patients, available data suggest that they may improve quality of life and physical recovery. 39-41”
From Religion, spirituality, and physical health in cancer patients: A meta‐analysis (2015) · cites this paper as [39]
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A brain-tumor neural circuit controls breast cancer progression in mice
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Rosenfeld, B. D., Cham, H., Pessin, H., & BREITBART, W. S. (2017) · Psycho-Oncology · doi:10.1002/pon.4578 · Cited by 72 · see citing works
Self-citationRodin, G., An, E., Shnall, J., & Malfitano, C. (2020) · Journal of Clinical Oncology · doi:10.1200/jco.19.00058 · Cited by 75 · see citing works
Association Between Purpose in Life and Glucose Control Among Older Adults
Hafez, D., Heisler, M., Choi, H., Ankuda, C. K., Winkelman, T., & Kullgren, J. T. (2018) · Annals of Behavioral Medicine · doi:10.1093/abm/kax012 · Cited by 71 · see citing works
Palliative Care Psychiatry: Update on an Emerging Dimension of Psychiatric Practice
Fairman, N. P., & Irwin, S. A. (2013) · Current Psychiatry Reports · doi:10.1007/s11920-013-0374-3 · Cited by 68 · see citing works
“The effect was short-lived, however, as differences in the treatment arms were absent by the two-month assessment [33].”
BackgroundSpatuzzi, R., Giulietti, M. V., Ricciuti, M., Merico, F., Fabbietti, P., Raucci, L., Bilancia, D., Cormio, C., & Vespa, A. (2018) · Palliative & Supportive Care · doi:10.1017/s1478951518000160 · Cited by 67 · see citing works
Meaning-Centered Psychotherapy: A Form of Psychotherapy for Patients With Cancer
Thomas, L. P. M., Meier, E. A., & Irwin, S. A. (2014) · Current Psychiatry Reports · doi:10.1007/s11920-014-0488-2 · Cited by 67 · see citing works
Kasl‐Godley, J., King, D. A., & Quill, T. E. (2014) · American Psychologist · doi:10.1037/a0036735 · Cited by 68 · see citing works
Assessment of spiritual suffering in the cancer context: A systematic literature review
Best, M. C., Aldridge, L. J., Butow, P. N., Olver, I., Price, M. A., & Webster, F. (2014) · Palliative & Supportive Care · doi:10.1017/s1478951514001217 · Cited by 67 · see citing works
“86 1⁄4 / ? Evidence of responsiveness to change from a number of intervention studies (e.g., Ando et al., 2010; Breitbart et al., 2012; 2010; Henry et al., 2010)”
Bai, M., Lazenby, M., Jeon, S., Dixon, J. K., & McCorkle, R. C. (2014) · Palliative & Supportive Care · doi:10.1017/s1478951514000820 · Cited by 65 · see citing works
“cing a sense of meaning and purpose in their lives (Breitbart et al., 2012).”
BackgroundPsychotherapy at the End of Life
Saracino, R. M., Rosenfeld, B. D., BREITBART, W. S., & Chochinov, H. M. (2019) · The American Journal of Bioethics · doi:10.1080/15265161.2019.1674552 · Cited by 63 · see citing works
Self-citationDemoralization: A Life-Preserving Diagnosis to Make for the Severely Medically Ill
Kissane, D. W. (2014) · Journal of Palliative Care · doi:10.1177/082585971403000402 · Cited by 63 · see citing works
“Recent trials of meaning-centred therapy have shown enhanced spiritual well-being and a sense of meaning in life (14, 15).”
BackgroundDoes desire for hastened death change in terminally ill cancer patients?
Rosenfeld, B. D., Pessin, H., Marziliano, A. M., Jacobson, C. M., Sorger, B., Abbey, J. G., Olden, M., Brescia, R. J., & BREITBART, W. S. (2014) · Social Science & Medicine · doi:10.1016/j.socscimed.2014.03.027 · Cited by 62 · see citing works
“Our research team has been exploring such interventions (Breitbart et al., 2010b, 2012), but not with patients in their final weeks of life.”
MethodSelf-citationBalogh, L., Tanaka, M., Török, N., Vécsei, L., & Taguchi, S. (2021) · Biomedicines · doi:10.3390/biomedicines9040340 · Cited by 57 · see citing works
“The IMCP and MCGP were superior to enhanced usual care and supportive psychotherapy [25-28].”
BackgroundVehling, S., Oechsle, K., Koch, U., & Mehnert, A. (2013) · PLoS ONE · doi:10.1371/journal.pone.0059417 · Cited by 58 · see citing works
“Adequate management of existential distress is essential to psychosocial care in cancer, yet it has only recently been focused in specialized interventions and distress measures [1–3].”
BackgroundMeaning-Centered Interventions for Patients With Advanced or Terminal Cancer
Kang, K., Han, S. J., Lim, Y.-S., & Kim, S. (2018) · Cancer Nursing · doi:10.1097/ncc.0000000000000628 · Cited by 55 · see citing works
“Some authors also observed that the presence of MIL can help people cope more effectively with disease and to tolerate physical symptoms even with a severe condition.(16,17,20,21,41) However, only 3 studies have been confirmed; therefore, further study on the effects of MCI on physical symptom relief is needed.”
BackgroundA comprehensive review of palliative care in patients with cancer
Jaiswal, R., Alici, Y., & BREITBART, W. S. (2014) · International Review of Psychiatry · doi:10.3109/09540261.2013.868788 · Cited by 53 · see citing works
“A later study examining individual meaning-centred psychotherapy found that patients with advanced cancer had clear short-term benefi ts for spiritual suffering and quality of life when compared to therapeutic massage (Breitbart et al., 2012).”
BackgroundSelf-citationThe role of palliative care in patients with neurological diseases
Borasio, G. D. (2013) · Nature Reviews Neurology · doi:10.1038/nrneurol.2013.49 · Cited by 53 · see citing works
Lleras de Frutos, M., Medina, J. C., Vives, J., Casellas‐Grau, A., Marzo, J. L., Borràs, J. M., & Ochoa‐Arnedo, C. (2020) · Psycho-Oncology · doi:10.1002/pon.5457 · Cited by 50 · see citing works
Kleijn, G., Lissenberg-Witte, B. I., Bohlmeijer, E. T., Steunenberg, B., Knipscheer-Kuijpers, K., Willemsen, V., Becker, A., Smit, E. F., Eeltink, C. M., Bruynzeel, A. M. E., et al. (2018) · PLOS ONE · doi:10.1371/journal.pone.0197277 · Cited by 52 · see citing works
Mosher, C. E., Seçinti, E., Johns, S. A., O’Neil, B. H., Helft, P. R., Shahda, S., Jalal, S. I., & Champion, V. L. (2017) · Quality of Life Research · doi:10.1007/s11136-017-1620-7 · Cited by 51 · see citing works
Jeste, D. V., Thomas, M. L., Liu, J., Daly, R. E., Tu, X. M., Treichler, E. B. H., Palmer, B. W., & Lee, E. E. (2021) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2020.09.033 · Cited by 50 · see citing works
Scheffold, K., Mehnert-Theuerkauf, A., Müller, V., Koch, U., Härter, M. C., & Vehling, S. (2013) · European Journal of Cancer Care · doi:10.1111/ecc.12152 · Cited by 51 · see citing works
Rodin, G., Malfitano, C., Rydall, A. C., Schimmer, A. D., Marmar, C. R., Mah, K., Lo, C., Nissim, R. S., & Zimmermann, C. (2019) · Supportive Care in Cancer · doi:10.1007/s00520-019-04723-2 · Cited by 52 · see citing works
“intervention in patients with advanced cancer [42] and similar to those of individual psychotherapies, such as dignity therapy [40] and meaning-centered psychotherapy [41].”
BackgroundResultDiagnosis and Management of Depression in Palliative Care
Fairman, N. P., & Irwin, S. A. (2022) · Oxford University Press eBooks · doi:10.1093/med/9780197583838.003.0004 · Cited by 50 · see citing works
Salamanca‐Balen, N., Merluzzi, T. V., & Chen, M. (2021) · Palliative Medicine · doi:10.1177/0269216321994728 · Cited by 50 · see citing works
The central role of meaning in adjustment to the loss of a child to cancer
Lichtenthal, W. G., & BREITBART, W. S. (2015) · Current Opinion in Supportive and Palliative Care · doi:10.1097/spc.0000000000000117 · Cited by 47 · see citing works
Self-citationDepression in the medically ill
Rosenblat, J. D., Kurdyak, P. A., Cosci, F., Berk, M., Maes, M. H. J., Brunoni, A. R., Li, M., Rodin, G., McIntyre, R. S., & Carvalho, A. F. (2019) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/0004867419888576 · Cited by 46 · see citing works
“For example, in cancer and palliative care, several new modalities have shown promising results, such as meaning-centered psychotherapy (Breitbart et al., 2012; Dose and Rhudy, 2018; Martínez et al., 2017) and CALM”
BackgroundThe Present State of Existential Interventions Within Palliative Care
Terao, T., & Satoh, M. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.811612 · Cited by 46 · see citing works
“(19) performed an RCTwhere 120 patients with advanced cancer were randomly assigned to IMCP or therapeutic massage.”
BackgroundMethodComparing counseling and dignity therapies in home care patients: A pilot study
Rudilla, D., Galiana, L., Oliver, A., & Barreto, P. (2015) · Palliative & Supportive Care · doi:10.1017/s1478951515001182 · Cited by 46 · see citing works
“Several studies have successfully tested psychosocial interventions for palliative care patients (Breitbart et al., 2010; 2012; 2015; Fegg, 2006; Gysels & Higginson, 2004; Houmann et al., 2014; Li et al., 2012; Lorenz et al., 2008; Newell et al., 2002; Price & Hotopf, 2009; Uitterhoeve et al.,…”
BackgroundExistential Suffering in Palliative Care: An Existential Positive Psychology Perspective
Wong, P. T. P., & Yu, T. T. F. (2021) · Medicina · doi:10.3390/medicina57090924 · Cited by 44 · see citing works
The relationship between spiritual well-being and quality of life in cancer survivors
Yılmaz, M., & Cengiz, H. Ö. (2019) · Palliative & Supportive Care · doi:10.1017/s1478951519000464 · Cited by 44 · see citing works
“In three studies by Breitbart et al. (2010, 2012, 2015), it was found that SpWB and QoL in Table 3.”
BackgroundSpiritual Well-Being, Depression, and Quality of Life Among Latina Breast Cancer Survivors
Garduño-Ortega, O., Morales-Cruz, J., Hunter-Hernández, M., Gany, F. M., & Costas-Muñíz, R. (2021) · Journal of Religion and Health · doi:10.1007/s10943-020-01147-9 · Cited by 44 · see citing works
Ruijs, C. D., Kerkhof, A. J. F. M., van der Wal, G., & Onwuteaka-Philipsen, B. D. (2013) · BMC Family Practice · doi:10.1186/1471-2296-14-201 · Cited by 44 · see citing works
“Existential aspects of suffering are addressed by psycho-oncologic interventions directed at meaning [29,53,57] and dignity [35,54].”
BackgroundLloyd‐Williams, M., Shiels, C., Ellis, J., Abba, K., Gaynor, E., Wilson, K., & Dowrick, C. F. (2017) · Palliative Medicine · doi:10.1177/0269216317711322 · Cited by 43 · see citing works
Cost‐utility analysis of meaning‐centered group psychotherapy for cancer survivors
van der Spek, N., Jansen, F., Holtmaat, K., Vos, J., BREITBART, W. S., van Uden‐Kraan, C. F., Tollenaar, R. A. �. �., Cuijpers, P. J., Coupé, V. M. H., & Leeuw, I. M. V. (2018) · Psycho-Oncology · doi:10.1002/pon.4726 · Cited by 42 · see citing works
Self-citationMcLouth, L. E., Ford, C. G., Pustejovsky, J. E., Park, C. L., Sherman, A. C., Trevino, K., & Salsman, J. (2020) · Psycho-Oncology · doi:10.1002/pon.5562 · Cited by 39 · see citing works
Spiritual Experiences of Transcendence in Patients With Advanced Cancer
Renz, M., Mao, M. S., Omlin, A. G., Bueche, D., Cerny, T., & Strasser, F. (2013) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/1049909113512201 · Cited by 42 · see citing works
Verbalized desire for death or euthanasia in advanced cancer patients receiving palliative care
Güell, E., Ramos, A., Zertuche-Maldonado, T., & Pascual, A. (2014) · Palliative & Supportive Care · doi:10.1017/s1478951514000121 · Cited by 42 · see citing works
“A novel intervention called “meaning-centered psychotherapy” (Breitbart et al., 2010; 2012) was recently implemented in a pilot randomized controlled trial with advanced cancer patients.”
Review of Psychological Interventions in Oncology: Current Trends and Future Directions
Anghel, T., MELANIA, B. L., Costea, I., Albai, O., Marinca, A., Levai, C. M., & Hogea, L. (2025) · Medicina · doi:10.3390/medicina61020279 · Cited by 41 · see citing works
“Individual meaning-centered psychotherapy (IMCP) was the most frequently studied, with three articles [3,15,29].”
InfluentialChan, W. C. H. (2016) · The British Journal of Social Work · doi:10.1093/bjsw/bcv144 · Cited by 41 · see citing works
“Meaning in life can also be the outcomes of social work intervention in which the focus is on helping clients to search for the meaning in sufferings (Breitbart et al., 2012; MacKinnon et al., 2014).”
BackgroundEvidence-Based Management of Depression in Palliative Care: A Systematic Review
Perusinghe, M. A., Chen, K. Y., & McDERMOTT, B. M. (2021) · Journal of Palliative Medicine · doi:10.1089/jpm.2020.0659 · Cited by 40 · see citing works
“Most used the HADS, 34,37,39,40,42–46, 48–”
InfluentialRuijs, C. D., van der Wal, G., Kerkhof, A. J. F. M., & Onwuteaka-Philipsen, B. D. (2014) · BMC Palliative Care · doi:10.1186/1472-684x-13-62 · Cited by 40 · see citing works
“Another driver of requests for EAS may be loss of the will to continue living [56-58], caused by loss of positive feelings towards life and (or) loss of connectedness with life [32,36,38,47,53,57].”
BackgroundCurrent pharmacotherapy options for cancer anorexia and cachexia
Macciò, A., Madeddu, C., & Mantovani, G. (2012) · Expert Opinion on Pharmacotherapy · doi:10.1517/14656566.2012.734297 · Cited by 40 · see citing works
“Similarly, a recent randomized trial demonstrated the effectiveness of an Individual Meaning-Centered Psychotherapy, which was specifically tailored to the needs of patients with advanced cancer, at inducing benefits for spiritual suffering and QL [136].”
BackgroundSpirituality and Emotional Distress Among Lung Cancer Survivors
Gudenkauf, L. M., Clark, M. M., Novotny, P. J., Piderman, K. M., Ehlers, S. L., Patten, C. A., Nes, L. S., Ruddy, K. J., Sloan, J. A., & Yang, P. (2019) · Clinical Lung Cancer · doi:10.1016/j.cllc.2019.06.015 · Cited by 40 · see citing works
Fraguell, C., Limonero, J. T., & Gil, F. (2020) · Supportive Care in Cancer · doi:10.1007/s00520-020-05322-2 · Cited by 40 · see citing works
Recent trends in the management of depression in persons with cancer
Panjwani, A. A., & Li, M. (2021) · Current Opinion in Psychiatry · doi:10.1097/yco.0000000000000727 · Cited by 41 · see citing works
Existential distress among healthcare providers caring for patients at the end of life
Pessin, H., Fenn, N. Q., Hendriksen, E., DeRosa, A. P., & Applebaum, A. J. (2015) · Current Opinion in Supportive and Palliative Care · doi:10.1097/spc.0000000000000116 · Cited by 41 · see citing works
“originally developed to address existential distress and suffering among patients at EOL [27,28] and adapted to address similar concerns among informal cancer caregivers [29], will likely have similar benefits for HCPs.”
BackgroundSelf-citationApplebaum, A. J., Roberts, K. E., Lynch, K., Gebert, R. R., Loschiavo, M., Behrens, M., Walsh, L. E., Polacek, L. C., Diamond, E. L., & BREITBART, W. S. (2022) · Palliative & Supportive Care · doi:10.1017/s1478951521002030 · Cited by 41 · see citing works
Self-citationTreatment of holistic suffering in cancer: A systematic literature review
Best, M., Aldridge, L., Butow, P., Olver, I., Price, M., & Webster, F. (2015) · Palliative Medicine · doi:10.1177/0269216315581538 · Cited by 32 · see citing works
“…BHS Hopelessness FACIT-Sp Total = spiritual well-being (postintervention = 8 weeks, 4 months) FACIT-Sp Faith (post-intervention = 8 weeks, 4 months) Breitbart et al. (2012)27 FACIT-Sp Meaning/peace (postintervention = 7 weeks) FACIT-Sp Total = spiritual well-being (postintervention = 7 weeks)…”
Wingo, A. P., Wingo, T. S., Fan, W., Bergquist, S. H., Alonso, Á., Marcus, M., Levey, A. I., & Lah, J. J. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.11.124 · Cited by 41 · see citing works
“PiL is potentially modifiable and may be a target for treatment (Breitbart et al., 2012; Kissane et al., 2019; Park et al., 2019).”
BackgroundSleight, A. G., Boyd, P., Klein, W. M. P., & Jensen, R. E. (2020) · Psycho-Oncology · doi:10.1002/pon.5533 · Cited by 39 · see citing works
“Previous research has suggested that clinical interventions specifically designed to enhance life meaning/peace may be efficacious in promoting well-being among individuals with cancer.(33,34) In addition, among people with cancer, those with high levels of life meaning/peace are more likely to experience post-traumat…”
BackgroundDistinguishing and treating demoralization syndrome in cancer: A review
D, M. F. M., Sorg, E. M., Jacobs, J. M., Leadbetter, R. A., & Guidi, J. (2023) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2023.10.004 · Cited by 38 · see citing works
- Authors
- Breitbart, W., Poppito, S., Rosenfeld, B., Vickers, A. J., Li, Y., Abbey, J., Olden, M., Pessin, H., Lichtenthal, W., Sjoberg, D., & Cassileth, B. R.
- Affiliations
- Memorial Sloan Kettering Cancer Center (US)
- ORCID
- Venue
- Journal of Clinical Oncology
- Published
- 2012-04-20
- Volume
- 30
- Issue
- 12
- Pages
- 1304-1309
- ISSN
- 0732-183X (ISSN-L)
- 1527-7755
- PMC
- PMC3646315
- OpenAlex
- W2099057220
- Cited by
- 426
- References
- 30
- Citations by year
- 2026: 26 · 2025: 31 · 2024: 42 · 2023: 21 · 2022: 32 · 2021: 28 · 2020: 31 · 2019: 32 · 2018: 35 · 2017: 39 · 2016: 19 · 2015: 31 · 2014: 32 · 2013: 23 · 2012: 2
- FWCI
- 32.05
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Clinical Oncology (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Cancer Institute (P30CA008748)
- National Center for Complementary and Integrative Health (R21AT001031)
- Topics
- Social Sciences › Health › Religion, Spirituality, and Psychology
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative and Oncologic Care
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Keywords
- advanced cancer, spiritual well-being, meaningfulness, faith, quality of life, therapeutic massage, symptom burden, brief psychotherapy, spiritual distress
- MeSH terms
- Adaptation, Psychological, Adult, Aged, Aged, 80 and over, Anxiety Disorders, Depressive Disorder, Female, Humans, Lymphoma, Non-Hodgkin, Male, Middle Aged, Neoplasm Staging, Neoplasms, Patient Compliance, Pilot Projects, Prospective Studies, Psychotherapy, Psychotherapy, Group, Quality of Life, Terminal Care, Multivariate Analysis, Linear Models, Treatment Outcome, Terminally Ill, Spirituality, Precision Medicine
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