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Meaning Adaptability in Cancer: Comparison
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Please note this is a comparison between Version 2 by Lindsay Dong and Version 1 by David F. Carreno.

Cancer diagnosis and treatment evoke existential concerns, especially ones related to meaning in life and meaning-making processes. The cancer experience is a vital challenge that often entails changes in what is personally important in life. Meaning adaptability is the way people adapt their meaning in life to the cancer experience, is a central element in the mental health of cancer patients. 

  • meaning in life
  • cancer
  • psychological therapy
  • meaning-centered psychotherapy

1. Existential Concerns in Cancer

Cancer is a leading cause of death worldwide, showing a prevalence of 565.7 cases per 100,000 inhabitants in 2020 [1]. It is one of the most difficult challenges in the lives of millions of people, affecting all levels of human functioning, including various physiological, psychological, and social aspects. Especially, cancer inherently puts at the forefront one’s mortality, and thus, it is related to various existential fears [2]. Existential concerns among cancer patients are prevalent and have been studied in the past [3]. These concerns include, among others, meaning in life and meaning-making processes; faith, belief, and spirituality; love and belonging; forgiveness and giving; and peace and harmony [3,4,5][3][4][5].

2. Meaning in Life in Cancer

One of the most accepted definitions of meaning in life understands it as the “sense made of, and significance felt regarding, the nature of one’s being and existence” ([6], p. 81). There is a certain scholarly agreement that the three primary components of meaning in life are coherence/comprehension, purpose, and significance/existential mattering [7,8][7][8]. That is, “lives may be experienced as meaningful when they are felt to have significance beyond the trivial or momentary, to have a purpose, or to have a coherence that transcends chaos.” ([9], p. 180). Besides these three components, another crucial aspect of meaning is responsibility: the commitment to actions related to personal values (i.e., actions that the person thinks are morally right) [10]. In this sense, meaning in life is not only about the cognitions and emotions regarding one’s purpose and significance in life but also about whether one behaves according to one’s personal values. Indeed, when this behavioral aspect is included in the understanding of meaning, the influence of this construct on other psychological variables seems to be higher than when only cognitive and emotional aspects are considered [11]. This multidimensional conceptualization of meaning (including coherence, purpose, significance, and responsibility) seems to be central in cancer: the diagnosis and treatment of this illness entail an existential plight, as the person’s whole belief system, the purpose of life, identity, and values-based actions are called into question [12]. Such an existential crisis triggers a search for meaning in most cases [12]. According to Park et al. [13], these meaning-making efforts may lead patients towards better adjustment when they achieve the creation of adaptive meanings as a result of the cancer experience (the sense of growth, increased life meaningfulness, and restored just-world belief). In this line, there are two ways of making meaning in the context of cancer. The first one is through making situational meaning: people can assimilate the cancer situation within their existing meaning in life [14]. This type of meaning-making is more related to comprehensibility, that is, the cognitive assimilation of new trauma-related information into a pre-existing worldview. The second way of meaning-making happens through the adaptation of global meaning in life to the cancer conditions: people can accommodate or change their worldview to integrate the cancer experience. This second via of meaning-making is more associated with the “significance” aspect of meaning (the question about what matters in life). Paradoxically enough, mortality salience related to cancer (the acknowledgment of personal death) has the potential to make us not only think about meaning but possibly to lead to a more meaningful, authentic, and fulfilling life [15]. Data show that meaning in life is negatively associated with depression, anxiety, and feelings of distress, while it is positively related to psychological well-being during the cancer experience [16,17][16][17]. These observations are supported by a longitudinal study that establishes global meaning as a negative predictor of demoralization and depression [18]. On the contrary, the loss of meaning can be related to several adverse outcomes. Approximately 17% of cancer patients reported a desire to terminate their life, not because of their pain levels but due to meaninglessness, loss of hope, and depression [19]. Other studies confirmed that, among people with advanced cancer, meaninglessness was closely related to a desire for hastened death [20], and it mediated the relationship between physical impairment and the wish for a hastened death [21]. These findings show that the adaptability of meaning in life is closely related to the well-being of cancer patients.

3. Sources of Meaning in Cancer: Shift and Reprioritization

Sources of meaning, those personal values or valued life areas from where one derives a sense of coherence, purpose, mattering, and responsibility, are inherently subjective and individual. However, in the general population, the most frequently mentioned contribution to meaning in life seems to be personal relationships [22[22][23][24][25],23,24,25], followed by a variety of other sources, such as personal growth, self-actualization, work, achievement, creativity, self-transcendence, generativity, or religion, among others [25,26,27,28,29,30][25][26][27][28][29][30]. Similar to the healthy population, relationships and contributions to the welfare of other people seem to be at the forefront of the experience of meaningfulness among cancer patients [17,31] [17][31]. In addition, there are some data available showing that, as compared to people without cancer, terminally ill patients reported interpersonal relationships higher on their list of sources of meaning [16]. Other personally valued areas from which people derive meaning can also differ in importance between people with cancer and the general population. A previous study reported that the highest-rated personal values among terminally ill people were benevolence, universalism, and self-direction, while power, achievement, and stimulation were the lowest-rated [32]. Cancer patients showed higher levels of benevolence and lower levels of self-enhancement values than their healthy counterparts [32]. These differences in sources of meaning compared to the general population may indicate a shift related to the personal values system and quality of life as a result of the cancer experience [33,34][33][34]. This response shift has been defined as “a change in the meaning of one’s self-evaluation of quality of life as a result of changes in internal standards, values and the conceptualization of quality of life” ([35], p. 1509).

4. Theories on the Impact of the Cancer Experience on Meaning in Life

According to one of the most prominent theories in the area, the Terror Management Theory (TMT) [36,37][36][37], death reminders trigger death anxiety and terror, which in turn activates defense mechanisms, for instance, escapism and the reaffirmation of cultural beliefs. This theory thus hypothesizes that the key motivator for the shift in personal values among cancer patients is the management of death anxiety. Another explanation for the impact of cancer on meaning in life is presented by the Meaning Management Theory (MMT) [38]. According to this approach, death reminders do not only trigger defense mechanisms as described by the TMT but also can evoke other processes, such as the search for meaning, life appreciation, and a quest for a more purposeful life. Defensive mechanisms serve a protective function by seeking security and self-preservation, while the search for meaning and life appreciation serves a growth-related function, as it creates opportunities for personal development. This model thus postulates the existence of a dual existential system. As indirect support for this theory, data show that confronting death with acceptance instead of defense mechanisms/avoidance seems to be related to lower levels of anxiety and existential distress [39], while denial and avoidance have been associated with psychological maladjustment and loss of meaning in life [40,41][40][41]. Notably, one of the core processes described by the MMT as promoting meaning is the so-called meaning-reconstruction. Meaning-reconstruction involves active meaning-seeking, meaning-making, and personal transformation to reinstate a sense of coherence and order when certain events challenge one’s worldview, core values, or life goals. This theory affirms that the adjustment to changes in life is facilitated by finding meaning in them and by discovering benefits amidst the suffering. These ideas are in line with Viktor Frankl’s work on meaning stating that meaning can be found even under the most difficult circumstances [42][42].

5. Meaning-Centered Interventions in Cancer

Therapeutic interventions that aim at improving meaning, meaning-making, and spiritual well-being can potentially be beneficial for cancer patients. These therapies, implicitly or explicitly, promote a re-evaluation of life priorities (and a possible response shift) to be able to adapt to the cancer experience. These therapies include, for instance, different iterations of meaning-centered psychotherapy (in individual or group format) [43,44[43][44][45],45], the Managing Cancer and Living Meaningfully intervention (CALM) [46], and the dignity therapy [47]. These therapies have been generally successful in positively impacting areas related to quality of life, spiritual well-being, meaning in life, and sense of dignity, while decreasing markers of psychopathology, such as depression, anxiety, and the wish to hasten death (e.g., [3,43,44,45,47][3][43][44][45][47]). Therapies focusing on personal values and purpose can also be beneficial in the adjustment to living with cancer. The Acceptance and Commitment Therapy (ACT) [48] has an emphasis on accepting unwanted thoughts and feelings and promoting actions in accordance with personal values. ACT showed to be effective at increasing quality of life, positive emotional states, and psychological flexibility among cancer patients [49,50][49][50]. In addition, other therapies that indirectly promote meaning in life, such as mindfulness-related therapies, can be beneficial (for a review of the utility of mindfulness in cancer, see [51]).  

References

  1. Global Cancer Observatory: Cancer Today. Lyon: International Agency for Research on Cancer. 2020. Available online: https://gco.iarc.fr/today (accessed on 15 March 2022).
  2. Strang, P. Existential consequences of unrelieved cancer pain. Med. 1997, 11, 299–305.
  3. Henoch, I.; Danielson, E. Existential concerns among patients with cancer and interventions to meet them: An integrative literature review. Psycho‐Oncol.2009, 18, 225–236.
  4. Ross, L. Spiritual care in nursing: An overview of the research to date. Clin. Nurs. 2006, 15, 852–862.
  5. Weisman, A.D.; Worden, J.W. The existential plight in cancer: Significance of the first 100 days. J. Psychiatry Med. 1977, 7, 1–15.
  6. Steger, M.F.; Frazier, P.; Oishi, S.; Kaler, M. The meaning in life questionnaire: Assessing the presence of and search for meaning in life. Couns. Psychol. 2006, 53, 80–93.
  7. King, L.A.; Hicks, J.A. The Science of Meaning in Life. Rev. Psychol. 2021, 72, 561–584.
  8. Martela, F.; Steger, M.F. The three meanings of meaning in life: Distinguishing coherence, purpose, and significance. Posit. Psychol. 2016, 11, 531–545.
  9. King, L.A.; Hicks, J.A.; Krull, J.L.; Del Gaiso, A.K. Positive affect and the experience of meaning in life. Pers. Soc. Psychol. 2006, 90, 179–196.
  10. Wong, P.T.P. Toward a dual-systems model of what makes life worth living. In The Human Quest for Meaning: Theories, Research, and Applications, 2nd ed.; Routledge/Taylor & Francis Group: New York, NY, USA, 2012; pp. 3–22.
  11. Eisenbeck, N.; Carreno, D.F.; Wong, P.T.; Hicks, J.A.; María, R.-R.G.; Puga, J.L.; Greville, J.; Testoni, I.; Biancalani, G.; López, A.C.C.; et al. An international study on psychological coping during COVID-19: Towards a meaning-centered coping style. J. Clin. Health Psychol. 2022, 22, 100256.
  12. Lee, V.; Cohen, S.R.; Edgar, L.; Laizner, A.M.; Gagnon, A.J. Meaning-making intervention during breast or colorectal cancer treatment improves self-esteem, optimism, and self-efficacy. Sci. Med. 2006, 62, 3133–3145.
  13. Park, C.L.; Edmondson, D.; Fenster, J.R.; Blank, T.O. Meaning making and psychological adjustment following cancer: The mediating roles of growth, life meaning, and restored just-world beliefs. Consult. Clin. Psychol. 2008, 76, 863–875.
  14. Joseph, S.; Linley, P.A. Positive Adjustment to Threatening Events: An Organismic Valuing Theory of Growth through Adversity. Gen. Psychol. 2005, 9, 262–280.
  15. Decarvalho, R.J. The growth hypothesis and self-actualization: An existential alternative. Psychol. 2000, 28, 59–66.
  16. Testoni, I.; Sansonetto, G.; Ronconi, L.; Rodelli, M.; Baracco, G.; Grassi, L. Meaning of life, representation of death, and their association with psychological distress. Palliat Support Care 2018, 16, 511–519.
  17. Jaarsma, T.A.; Pool, G.; Ranchor, A.V.; Sanderman, R. The concept and measurement of meaning in life in Dutch cancer patients. Psychooncology 2007, 16, 241–248.
  18. Vehling, S.; Lehmann, C.; Oechsle, K.; Bokemeyer, C.; Krüll, A.; Koch, U.; Mehnert, A. Global meaning and meaning-related life attitudes: Exploring their role in predicting depression, anxiety, and demoralization in cancer patients. Support Care Cancer 2011, 19, 513–520.
  19. Breitbart, W.; Rosenfeld, B.; Pessin, H.; Kaim, M.; Funesti-Esch, J.; Galietta, M.; Nelson, C.J.; Brescia, R. Depression, hopelessness, and desire for hastened death in terminally ill patients with cancer. JAMA 2000, 284, 2907–2911.
  20. Morita, T.; Sakaguchi, Y.; Hirai, K.; Tsuneto, S.; Shima, Y. Desire for death and requests to hasten death of Japanese terminally ill cancer patients receiving specialized inpatient palliative care. Pain Symptom Manag. 2004, 27, 44–52.
  21. Guerrero-Torrelles, M.; Monforte-Royo, C.; Tomas-Sabado, J.; Marimon, F.; Porta-Sales, J.; Balaguer, A. Meaning in Life as a Mediator Between Physical Impairment and the Wish to Hasten Death in Patients With Advanced Cancer. Pain Symptom Manag. 2017, 54, 826–834.
  22. Yalom, I.D. Existential Psychotherapy; Hachette, UK, 2020.
  23. De Vogler, K.L.; Ebersole, P. Adults’ Meaning in Life. Rep. 1981, 49, 87–90.
  24. Baum, S.K.; Stewart, R.B. Sources of meaning through the lifespan. Rep. 1990, 67, 3–14.
  25. Wong, P.T.P. Implicit theories of meaningful life and the development of the personal meaning profile. In The Human Quest for Meaning: A Handbook of Psychological Research and Clinical Applications; Lawrence Erlbaum Associates Publishers: Mahwah, NJ, USA, 1998; pp. 111–140.
  26. Grouden, M.E.; Jose, P.E. How do sources of meaning in life vary according to demographic factors? Z. J. Psychol. 2014, 43, 29–38.
  27. Delle Fave, A.; Brdar, I.; Freire, T.; Vella-Brodrick, D.; Wissing, M.P. The Eudaimonic and Hedonic Components of Happiness: Qualitative and Quantitative Findings. Indic. Res. 2011, 100, 185–207.
  28. Schnell, T. The Sources of Meaning and Meaning in Life Questionnaire (SoMe): Relations to demographics and well-being. Posit. Psychol. 2009, 4, 483–499.
  29. Prager, E. Exploring personal meaning in an age-differentiated Australian sample: Another look at the Sources of Meaning Profile (SOMP). J. Aging Stud.1996, 10, 117–136.
  30. Schnell, T. Individual differences in meaning-making: Considering the variety of sources of meaning, their density and diversity. Individ. Differ. 2011, 51, 667–673.
  31. Tomas-Sabado, J.; Villavicencio-Chávez, C.; Monforte-Royo, C.; Torrelles, M.G.; Fegg, M.J.; Balaguer, A. What Gives Meaning in Life to Patients With Advanced Cancer? A Comparison Between Spanish, German, and Swiss Patients. Pain Symptom Manag. 2015, 50, 861–866.
  32. Fegg, M.J.; Wasner, M.; Neudert, C.; Borasio, G.D. Personal values and individual quality of life in palliative care patients. Pain Symptom Manag. 2005, 30, 154–159.
  33. Rees, J.; Clarke, M.G.; Waldron, D.; O’Boyle, C.; Ewings, P.; MacDonagh, R.P. The measurement of response shift in patients with advanced prostate cancer and their partners. Health Qual. Life Outcomes 2005, 3, 21.
  34. Sharpe, L.; Butow, P.; Smith, C.; McConnell, D.; Clarke, S. Changes in quality of life in patients with advanced cancer: Evidence of response shift and response restriction. Psychosom. Res. 2005, 58, 497–504.
  35. Sprangers, M.A.; Schwartz, C.E. Schwartz, Integrating response shift into health-related quality of life research: A theoretical model. Sci. Med. 1999, 48, 1507–1515.
  36. Greenberg, J.; Solomon, S.; Pyszczynski, T. Terror Management Theory of Self-Esteem and Cultural Worldviews: Empirical Assessments and Conceptual Refinements; Academic Press: Cambridge, MA, USA, 1997.
  37. Solomon, S.; Greenberg, J.; Pyszczynski, T. A Terror Management Theory of Social Behavior: The Psychological Functions of Self-Esteem and Cultural Worldviews. In Advances in Experimental Social Psychology; Zanna, M.P., Ed.; Academic Press: Cambridge, MA, USA, 1991; pp. 93–159.
  38. Wong, P.T.P. Meaning management theory and death acceptance. In Existential and Spiritual Issues in Death Attitudes; Lawrence Erlbaum Associates Publishers: Mahwah, NJ, USA, 2008; pp. 65–87.
  39. Philipp, R.; Mehnert, A.; Lo, C.; Müller, V.; Reck, M.; Vehling, S. Characterizing Death Acceptance among Patients with Cancer. Psychooncology 2019, 28, 854–862.
  40. Roesch, S.C.; Adams, L.; Hines, A.; Palmores, A.; Vyas, P.; Tran, C.; Pekin, S.; Vaughn, A. Coping with prostate cancer: A meta-analytic review. Behav. Med. 2005, 28, 281–293.
  41. Kvillemo, P.; Bränström, R. Coping with breast cancer: A meta-analysis. PLoS ONE 2014, 9, e112733.
  42. Frankl, V.E. Man's Search for Meaning: An Introduction to Logotherapy, 4th ed.; Lasch, I., Ed.; Beacon Press: Boston, MA, USA, 1992; p. 196.
  43. Breitbart, W.; Pessin, H.; Rosenfeld, B.; Applebaum, A.J.; Lichtenthal, W.G.; Li, Y.; Saracino, R.M.; Marziliano, A.M.; Ma, M.M.; Tobias, K.; et al.Individual meaning-centered psychotherapy for the treatment of psychological and existential distress: A randomized controlled trial in patients with advanced cancer. Cancer 2018, 124, 3231–3239.
  44. Breitbart, W.; Poppito, S.; Rosenfeld, B.; Vickers, A.J.; Li, Y.; Abbey, J.; Olden, M.; Pessin, H.; Lichtenthal, W.; Sjoberg, D.; et al. Pilot randomized controlled trial of individual meaning-centered psychotherapy for patients with advanced cancer. Clin. Oncol. 2012, 30, 1304–1309.
  45. Breitbart, W.; Rosenfeld, B.; Gibson, C.; Pessin, H.; Poppito, S.; Nelson, C.; Tomarken, A.; Timm, A.K.; Jacobson, C.; Sorger, B.; et al. Meaning-centered group psychotherapy for patients with advanced cancer: A pilot randomized controlled trial. Psychooncology 2010, 19, 21–28.
  46. Lo, C.; Hales, S.; Rydall, A.; Panday, T.; Chiu, A.; Malfitano, C.; Jung, J.; Li, M.; Nissim, R.; Zimmermann, C.; et al. Managing Cancer And Living Meaningfully: Study protocol for a randomized controlled trial. Trials 2015, 16, 391.
  47. Chochinov, H.M.; Hack, T.; Hassard, T.; Kristjanson, L.J.; McClement, S.; Harlos, M. Dignity therapy: A novel psychotherapeutic intervention for patients near the end of life. Clin. Oncol. 2005, 23, 5520–5525.
  48. Hayes, S.C.; Strosahl, K.; Wilson, K.G. Acceptance and Commitment Therapy: An Experiential Approach to Behavior Change; Guilford Press: 1999.
  49. González-Fernández, S.; Fernández-Rodríguez, C. Acceptance and Commitment Therapy in Cancer: Review of Applications and Findings. Med. 2019, 45, 255–269.
  50. Hulbert-Williams, N.J.; Storey, L.; Wilson, K.G. Psychological interventions for patients with cancer: Psychological flexibility and the potential utility of Acceptance and Commitment Therapy. J. Cancer Care 2015, 24, 15–27.
  51. Mehta, R.; Sharma, K.; Potters, L.; Wernicke, A.G.; Parashar, B. Evidence for the Role of Mindfulness in Cancer: Benefits and Techniques. Cureus 2019, 11, e4629.

References

  1. Global Cancer Observatory: Cancer Today. Lyon: International Agency for Research on Cancer. 2020. Available online: https://gco.iarc.fr/today (accessed on 15 March 2022).
  2. Strang, P. Existential consequences of unrelieved cancer pain. Med. 1997, 11, 299–305.
  3. Henoch, I.; Danielson, E. Existential concerns among patients with cancer and interventions to meet them: An integrative literature review. Psycho‐Oncol.2009, 18, 225–236.
  4. Ross, L. Spiritual care in nursing: An overview of the research to date. Clin. Nurs. 2006, 15, 852–862.
  5. Weisman, A.D.; Worden, J.W. The existential plight in cancer: Significance of the first 100 days. J. Psychiatry Med. 1977, 7, 1–15.
  6. Steger, M.F.; Frazier, P.; Oishi, S.; Kaler, M. The meaning in life questionnaire: Assessing the presence of and search for meaning in life. Couns. Psychol. 2006, 53, 80–93.
  7. King, L.A.; Hicks, J.A. The Science of Meaning in Life. Rev. Psychol. 2021, 72, 561–584.
  8. Martela, F.; Steger, M.F. The three meanings of meaning in life: Distinguishing coherence, purpose, and significance. Posit. Psychol. 2016, 11, 531–545.
  9. King, L.A.; Hicks, J.A.; Krull, J.L.; Del Gaiso, A.K. Positive affect and the experience of meaning in life. Pers. Soc. Psychol. 2006, 90, 179–196.
  10. Wong, P.T.P. Toward a dual-systems model of what makes life worth living. In The Human Quest for Meaning: Theories, Research, and Applications, 2nd ed.; Routledge/Taylor & Francis Group: New York, NY, USA, 2012; pp. 3–22.
  11. Eisenbeck, N.; Carreno, D.F.; Wong, P.T.; Hicks, J.A.; María, R.-R.G.; Puga, J.L.; Greville, J.; Testoni, I.; Biancalani, G.; López, A.C.C.; et al. An international study on psychological coping during COVID-19: Towards a meaning-centered coping style. J. Clin. Health Psychol. 2022, 22, 100256.
  12. Lee, V.; Cohen, S.R.; Edgar, L.; Laizner, A.M.; Gagnon, A.J. Meaning-making intervention during breast or colorectal cancer treatment improves self-esteem, optimism, and self-efficacy. Sci. Med. 2006, 62, 3133–3145.
  13. Park, C.L.; Edmondson, D.; Fenster, J.R.; Blank, T.O. Meaning making and psychological adjustment following cancer: The mediating roles of growth, life meaning, and restored just-world beliefs. Consult. Clin. Psychol. 2008, 76, 863–875.
  14. Joseph, S.; Linley, P.A. Positive Adjustment to Threatening Events: An Organismic Valuing Theory of Growth through Adversity. Gen. Psychol. 2005, 9, 262–280.
  15. Decarvalho, R.J. The growth hypothesis and self-actualization: An existential alternative. Psychol. 2000, 28, 59–66.
  16. Testoni, I.; Sansonetto, G.; Ronconi, L.; Rodelli, M.; Baracco, G.; Grassi, L. Meaning of life, representation of death, and their association with psychological distress. Palliat Support Care 2018, 16, 511–519.
  17. Jaarsma, T.A.; Pool, G.; Ranchor, A.V.; Sanderman, R. The concept and measurement of meaning in life in Dutch cancer patients. Psychooncology 2007, 16, 241–248.
  18. Vehling, S.; Lehmann, C.; Oechsle, K.; Bokemeyer, C.; Krüll, A.; Koch, U.; Mehnert, A. Global meaning and meaning-related life attitudes: Exploring their role in predicting depression, anxiety, and demoralization in cancer patients. Support Care Cancer 2011, 19, 513–520.
  19. Breitbart, W.; Rosenfeld, B.; Pessin, H.; Kaim, M.; Funesti-Esch, J.; Galietta, M.; Nelson, C.J.; Brescia, R. Depression, hopelessness, and desire for hastened death in terminally ill patients with cancer. JAMA 2000, 284, 2907–2911.
  20. Morita, T.; Sakaguchi, Y.; Hirai, K.; Tsuneto, S.; Shima, Y. Desire for death and requests to hasten death of Japanese terminally ill cancer patients receiving specialized inpatient palliative care. Pain Symptom Manag. 2004, 27, 44–52.
  21. Guerrero-Torrelles, M.; Monforte-Royo, C.; Tomas-Sabado, J.; Marimon, F.; Porta-Sales, J.; Balaguer, A. Meaning in Life as a Mediator Between Physical Impairment and the Wish to Hasten Death in Patients With Advanced Cancer. Pain Symptom Manag. 2017, 54, 826–834.
  22. Yalom, I.D. Existential Psychotherapy; Hachette, UK, 2020.
  23. De Vogler, K.L.; Ebersole, P. Adults’ Meaning in Life. Rep. 1981, 49, 87–90.
  24. Baum, S.K.; Stewart, R.B. Sources of meaning through the lifespan. Rep. 1990, 67, 3–14.
  25. Wong, P.T.P. Implicit theories of meaningful life and the development of the personal meaning profile. In The Human Quest for Meaning: A Handbook of Psychological Research and Clinical Applications; Lawrence Erlbaum Associates Publishers: Mahwah, NJ, USA, 1998; pp. 111–140.
  26. Grouden, M.E.; Jose, P.E. How do sources of meaning in life vary according to demographic factors? Z. J. Psychol. 2014, 43, 29–38.
  27. Delle Fave, A.; Brdar, I.; Freire, T.; Vella-Brodrick, D.; Wissing, M.P. The Eudaimonic and Hedonic Components of Happiness: Qualitative and Quantitative Findings. Indic. Res. 2011, 100, 185–207.
  28. Schnell, T. The Sources of Meaning and Meaning in Life Questionnaire (SoMe): Relations to demographics and well-being. Posit. Psychol. 2009, 4, 483–499.
  29. Prager, E. Exploring personal meaning in an age-differentiated Australian sample: Another look at the Sources of Meaning Profile (SOMP). J. Aging Stud.1996, 10, 117–136.
  30. Schnell, T. Individual differences in meaning-making: Considering the variety of sources of meaning, their density and diversity. Individ. Differ. 2011, 51, 667–673.
  31. Tomas-Sabado, J.; Villavicencio-Chávez, C.; Monforte-Royo, C.; Torrelles, M.G.; Fegg, M.J.; Balaguer, A. What Gives Meaning in Life to Patients With Advanced Cancer? A Comparison Between Spanish, German, and Swiss Patients. Pain Symptom Manag. 2015, 50, 861–866.
  32. Fegg, M.J.; Wasner, M.; Neudert, C.; Borasio, G.D. Personal values and individual quality of life in palliative care patients. Pain Symptom Manag. 2005, 30, 154–159.
  33. Rees, J.; Clarke, M.G.; Waldron, D.; O’Boyle, C.; Ewings, P.; MacDonagh, R.P. The measurement of response shift in patients with advanced prostate cancer and their partners. Health Qual. Life Outcomes 2005, 3, 21.
  34. Sharpe, L.; Butow, P.; Smith, C.; McConnell, D.; Clarke, S. Changes in quality of life in patients with advanced cancer: Evidence of response shift and response restriction. Psychosom. Res. 2005, 58, 497–504.
  35. Sprangers, M.A.; Schwartz, C.E. Schwartz, Integrating response shift into health-related quality of life research: A theoretical model. Sci. Med. 1999, 48, 1507–1515.
  36. Greenberg, J.; Solomon, S.; Pyszczynski, T. Terror Management Theory of Self-Esteem and Cultural Worldviews: Empirical Assessments and Conceptual Refinements; Academic Press: Cambridge, MA, USA, 1997.
  37. Solomon, S.; Greenberg, J.; Pyszczynski, T. A Terror Management Theory of Social Behavior: The Psychological Functions of Self-Esteem and Cultural Worldviews. In Advances in Experimental Social Psychology; Zanna, M.P., Ed.; Academic Press: Cambridge, MA, USA, 1991; pp. 93–159.
  38. Wong, P.T.P. Meaning management theory and death acceptance. In Existential and Spiritual Issues in Death Attitudes; Lawrence Erlbaum Associates Publishers: Mahwah, NJ, USA, 2008; pp. 65–87.
  39. Philipp, R.; Mehnert, A.; Lo, C.; Müller, V.; Reck, M.; Vehling, S. Characterizing Death Acceptance among Patients with Cancer. Psychooncology 2019, 28, 854–862.
  40. Roesch, S.C.; Adams, L.; Hines, A.; Palmores, A.; Vyas, P.; Tran, C.; Pekin, S.; Vaughn, A. Coping with prostate cancer: A meta-analytic review. Behav. Med. 2005, 28, 281–293.
  41. Kvillemo, P.; Bränström, R. Coping with breast cancer: A meta-analysis. PLoS ONE 2014, 9, e112733.
  42. Frankl, V.E. Man's Search for Meaning: An Introduction to Logotherapy, 4th ed.; Lasch, I., Ed.; Beacon Press: Boston, MA, USA, 1992; p. 196.
  43. Breitbart, W.; Pessin, H.; Rosenfeld, B.; Applebaum, A.J.; Lichtenthal, W.G.; Li, Y.; Saracino, R.M.; Marziliano, A.M.; Ma, M.M.; Tobias, K.; et al.Individual meaning-centered psychotherapy for the treatment of psychological and existential distress: A randomized controlled trial in patients with advanced cancer. Cancer 2018, 124, 3231–3239.
  44. Breitbart, W.; Poppito, S.; Rosenfeld, B.; Vickers, A.J.; Li, Y.; Abbey, J.; Olden, M.; Pessin, H.; Lichtenthal, W.; Sjoberg, D.; et al. Pilot randomized controlled trial of individual meaning-centered psychotherapy for patients with advanced cancer. Clin. Oncol. 2012, 30, 1304–1309.
  45. Breitbart, W.; Rosenfeld, B.; Gibson, C.; Pessin, H.; Poppito, S.; Nelson, C.; Tomarken, A.; Timm, A.K.; Jacobson, C.; Sorger, B.; et al. Meaning-centered group psychotherapy for patients with advanced cancer: A pilot randomized controlled trial. Psychooncology 2010, 19, 21–28.
  46. Lo, C.; Hales, S.; Rydall, A.; Panday, T.; Chiu, A.; Malfitano, C.; Jung, J.; Li, M.; Nissim, R.; Zimmermann, C.; et al. Managing Cancer And Living Meaningfully: Study protocol for a randomized controlled trial. Trials 2015, 16, 391.
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