Vol.2, No.4, 342-346 (2010) Health
doi:10.4236/health.2010.24051
Copyright © 2010 SciRes. Openly accessible at http://www.scirp.org/journal/HEALTH/
Efficacy of the structured life review and the
short-term life review on the spiritual well-being
of terminally ill cancer patients
Michiyo Ando1, Tatsuya Morita2
1 Faculty of Nursing, St. Mary’s College, Kurume, Japan; andou@st-mary.ac.jp
2 Department of Palliative and Supportive Care, Palliative Care Team, and Seirei Hospice, Seirei Mikatahara General Hospital,
Shizuoka, Japan
Received 27 November 2009; revised 4 January 2010; accepted 20 January 2010.
ABSTRACT
GOALS: The aims of this study were to evaluate
the treatment efficacy of the structured life re-
view interviews and the Short-Term Life Review
on the spiritual well-being of terminally ill can-
cer p atient s, in order to improv e p atient s’ quality
of life. SUBJECTS and METHODS: Participants
were patients in palliative care units in Japan. In
the study 1, the structured life review interviews
were conducted with 12 patients. They com-
pleted the QOL scale of the SELT-M (Skalen zur
Erfassung von Lebens qualitat bei Tumor-
kranken–Modified Version) questionnaire before
and after the interviews. In the study 2, the
Short-Term Life Review was conducted with 30
patients. They reviewed their lives in the first
session and they confirmed the contents in the
album based on the life review in the second
session. Duration of the treatment was one
week. Measurement instruments included Func-
tional Assessment Chronic Illness Therapy-
Spiritual (FACIT-Sp). RESULTS: After the struc-
tured life review, the mean overall QOL score
and Spirituality subscale score of the SELT-M
significantly increased, from 2.57 ± 0.61 to 3.58
± 1.0 (p=0.013) and 2.57 ± 0.61 to 3.14 ± 2.25
(P=0.023), respectiv ely. After the Short-Term Life
Review, the mean FACIT-Sp scores significantly
increased from 16 ± 8.2 to 24 ± 7.1. CONCLU-
SION: Both the structured life review and the
Short-Term Life Review may be effective in im-
proving the spiritual well-being of terminally ill
cancer patients, being higher feasibility for the
Short-Term Life Review. We need to use these
therapies understanding characteristics of each
therapy.
Keywords: Psychotherapy; Life Review; Terminally
Patients; Spiritual Well-Being
1. INTRODUCTION
Meaning of life or meaning of existence is an important
for human, and it is called spirituality. World Health Or-
ganization demonstrates that spirituality is an important
factor for human’s quality of life. From the study of
Japanese terminally ill cancer patients, Murata & Morita
[1] defined spiritual well-being as meaning of life and
peaceful of mind, and psycho-existential sufferings as
loss of meaning of life or meaning of existence. Al-
though terminally ill cancer patients often experience
psycho-existential sufferings, there have been few inter-
ventions for these problems. The present study describes
an intervention to elevate spiritual well-being in termi-
nally ill cancer patients.
Butler [2] reported that the life review process is a
mean of reintegration and can give new significance and
meaning to an individual’s life. It is defined as “the pro-
gressive return to consciousness of prior experience,
which can be re-evaluated with the intentio n of resolving
and integrating past conflict, thereby giving new signifi-
cance to one’s life.” A life review is a type of reminis-
cence therapy [2]. Reminiscence itself is an act ivity of lif e
review or reminiscence therapy. Reminiscence is an in-
terpersonal or communicative psychosocial process that
can be carried out individually or in groups [3]. Previous
studies have shown the effects of life review on depres-
sion [4-6], self-esteem [4 ], and life satisfaction [7].
There are relatively few studies concerning life review
interviews for cancer patients, particularly in the form of
empirical studies, though there are some studies. To use
life review effectively in the clinical situation, we had to
know the efficacy of life review empirically. We are re-
viewing two empirical studies [8,9].
2. STUDY 1 STRUCTURED LIFE REVIEW
2.1. Purpose
In the Study 1, we evaluate the treatment efficacy of the
M. Ando et al. / Health 2 (2 010) 342-346
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343
structured life review interviews on the spiritual well-
being of terminally ill cancer patients.
2.2. Methods
2.2.1. Participant s
Participants were patients with incurable cancer receiv-
ing specialized care in the palliative care unit of a gen-
eral hospital in Japan. The inclusion criteria for this
study were 1) the patient had incurable cancer, 2) the
patient was 20 years of age or older, and 3) the primary
physicians were in agreement that the patient would
benefit from the psychological interventions. Exclusion
criteria were, 1) the patients had strong physical symp-
toms, 2) the patients had cognitive impairment. During 6
month study periods, a total of 21 patients were recruited
from the primary physicians; however 9 patients were
later excluded from this study for various reasons. Thus,
12 patients (2 males, 10 females) finally participated in
the study. The patients’ ages ranged from 54 to 82, with
a mean of 63. The primary tumor sites were breast (n =
3), liver (n = 2), colon (n = 2), lun g (n = 2), thyroid (n =
1), stomach (n = 1), and gallbladder (n = 1).
2.2.2. Interv entions an d O utcome M ea surements
The interviewer was a clinical psychologist. The inter-
view procedure entailed a structured life review inter-
view [7] in which patients reviewed their own childhood,
adolescence, adult life, and current situation along Erik-
son’ development stages [10]. Some of the questions
asked were 1) Please tell me about your childhood, 2)
What do you remember to be th e most impressive ev ents
in your childhood?, and 3) How do you feel now when
you review those impressive events (Ta ble 1). Four ses-
sions were planned for each patient, addition to one ses-
sion for making relationships between a patient and the
interviewer. Interviews were conducted in the dayroom
or at the bedside. The patient reviews were recorded in
the form of notes taken during or immediately after the
session.
To evaluate the spiritual well-being, we used the
Table 1. The question items in the structured life review.
Times Examples of ques t i o n i t e ms
1 Making relati onshi ps and liste ning t o patients’ feel ing now
Theme: feeling life in the hospitals, problems, e tc .
2 Child period:
Theme: parents, home town, family members, playing,
etc.
3 Young Adult period:
Theme: study, work, human-relation in social life, etc.
4 Adult period:
Theme: marriage, born in children, role in family or
social life, etc.
5 From adult to now:
Theme: illness, medical treatment, human-relationships,
etc.
SELT-M (Skalen zur Erfassung von Lebens qualitat
bei Tumorkranken–Modified Version) [11]. The pa-
tients completed the Japanese version of the SETL-
M [12] before and after the intervention. The reli-
ability and validity of the Japanese version of the
SELT-M has been reported. The SELT-M consisted of
6 subscales, namely, Physical well-being (3 items),
Mood (6 items), Support (3 items), Orientation (3
items, e.g., “Today, I see many things in a more
positive light”), Spirituality (3 items, e.g., “It is dif-
ficult for me to see positive meaning in my illness”),
and Overall QOL (1 item). We used the overall QOL
score and Spirituality subscale score in the
post-interview results. Each subscale ranged from 1
to 5, with a higher score indicating a higher level of
patient-perceived QOL.
The institutional review board of this hospital ap-
proved this study from both ethical and scientific aspects,
and a patient gave written consent.
2.2.3. Statisti cal Analysis
In order to evaluate the treatment efficacy of life review
interviews on the patient’s spiritual well-being, a Wil-
coxon sign rank test was conducted on the sections of
the SELT-M before and after the life review interviews.
2.3. Results
As shown in Tab le 2, overall QOL and Spirituality sus-
cale scores, in addition to Mood and Orientation suscale
scores, significantly increased after the intervention.
3. STUDY 2 SHORT-TERM LIFE REVIEW
Although structured life review may be effective in
improving the spiritual well-being of terminally ill
cancer patients, the long sessions decrease the feasi-
bility, thus we need a shorter version of life review
therapy. We propose a new psychotherapy-the Short-
Term Life Review with short sessions for terminally
ill cancer patients. A Short-Term Life Review involves
only two sessions. Patients review or narrate their
lives about questions which promote the integration of
lives referring other previous studies. In the first ses-
sion, patients review their lives, and the review is then
recorded and edited. The therapist makes an album
after the first session. In the second session, the pa-
tient and therapist view the album, and confirm the
contents with appreciation.
3.1. Purpose
The primary aim of this study was to assess the efficacy
of the Short-Term Life Review on the spiritual well-
being, as well as anxiety, depression, sufferings, and
happiness, or terminally ill cancer patients.
M. Ando et al. / Health 2 (2 010) 342-346
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344
Table 2. Mean scores and P value by the Wilcoxon sign rank test on scores of SELT-M.
SELT-M
Physical
well-being Mood Support Orientation Spirituality Overall QOL
Before 2.33 (SD = 0.79)3. 16 ( S D = 0 . 65 ) 3.28 (SD = 0. 65)2.93 (SD = 0.75)2.57 (SD = 0.61) 2.57 ( SD = 0.61)
After 2.80 (SD = 1.16)3.79 (SD = 0. 74) 3.61 (SD = 0. 83)3.65 (SD = 1.03)3.14 (SD = 2.25) 3.58 (SD = 1.0)
P value Z = –1.02,
P = 0.307 Z = –2.67,
P = 0.008 Z = –1.18,
P = 0.237 Z = –2.05,
P = 0.041 Z = –2.23,
P = 0.023 Z = –2.49,
P = 0.013
Table 3. Patient backgrounds.
Primary tumor site Gender
Lung
Stomach
Pancreas
Gallbladder
Uterine
Breast
Kidney
Leukemia
Rectal
Tongue
Colon
Mesothelioma
Myeloma
Lymphoma
n = 8
n = 5
n = 2
n = 2
n = 2
n = 1
n = 1
n = 1
n = 1
n = 1
n = 1
n = 1
n = 1
n = 1
Male (n = 8)
Female (n = 22)
Age
Mean age;74 (Total SD = 9.1)
Martial states
Married (n = 29); Widow (n = 11), Widower (n = 3)
Non-married (1)
Religion
Christian (n = 4)
Buddhism (n = 3) None(n = 22)
ECOG-PS
1 (n = 1), 2 (n = 3)
3 (n = 13), (n = 1 3)
Duration from the interview to patients’ death
Mean; 67 days
3.2. Methods
3.2.1. Participants
The participants were cancer p atients from the palliative
care unit of two general hospitals and one home-care
clinic. The inclusion criteria for this study were 1) pa-
tients with incurable cancer; 2) patients without cogni-
tive impairment; 3) patients 20 years of age or older; and
4) patients for whom the primary physicians agreed
would benefit from the psychological interventions.
During the 11-month study period, 35 patients were re-
cruited through primary physicians. Table 3 shows the
patients’ background.
3.2.2. Intervention
Ethical aspect of this study was validated by both the
board and the ethical committee of St. Mary’s Hospital
and St. Mary’s College.
The Short-Term Life Review has two parts. In the first
part, patients review their lives, and in the second, they
re-evaluate, re-construct, and appreciate their life. The
interviewer was a clinical psychologist (therapist). The
interview procedure was based on a structured life re-
view interview that was conducted individually, and the
patient was asked to re-evaluate both good and bad
memories. Question items were mainly based on the
structured life review, and some items from Chochinov
et al. [13] were added. The following questions were
asked in the revi ewi n g sessi o n ( Table 4):
1) What is the most im portant thing in your life and why?
2) W hat are the most impressive memories in your life ? 3)
In your life, what was the event that or the person who
affected you the most? 4) What is the most important
role in your life? 5) Which is the proudest moment of
your life? 6) Is ther e anyth ing abou t you th at your family
would need to know, are there things you would want
them to tell you, and, if possible, are there things you
would want them to remember? 7) What advice or word
of guidance would you wish to pass on othe important
people in your life or to the younger generation?
The patient’s narratives were recorded, and the thera
pist tried to listen to each word uttered by the patient. Af-
ter the first session, the interview was first transcribed
verbatim and the therapist made the album. To make the
album, 1) key words in the answer to each question were
selected. Words or phrases used by the patient were writ-
ten in the album as often as possible; both good and bad
things were included and feelings or re-framed thoughts-
how he feels now-were written in the album. 2) The
therapist pasted photos or drawings from various books or
magazines that were related to the patients’ words or
phrases, to make the album more beautiful and more
memory-provoking. It t ook a week for the treatm ent.
3.2.3. Outcome Measurements
To measure the effects of the Short-Term Life Review,
we used the Japanese version of FACIT-Sp [14]. The
validity and reliability of th e FACIT-Sp Japanese version
is well-established [15].
3.2.4. S ta tistical Analysis
To evaluate the efficacy of the Short-Term Life Review
in improving the patients’ spiritual well-being, the Wil-
M. Ando et al. / Health 2 (2 010) 342-346
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345
Table 4. The question items in the short-term life review.
Question Items
1) Wha t is the most impor t a nt thing in your life and w hy?
2) What are the most impressive memories in your life ?
3) In your life, what was the event that or the person who affected you the most?
4) What is the most important role in your life?
5) Which is the proudest moment of your life?
6) Is there anything about you that your family would need to know, are there things you would want t hem to tell you, and, if possible, are
there things you would want them to remember?
7) What advice or word of guidance would you wish to pass on to the important people in your lif e or to the younger generation?
coxon signed rank test was conducted on all scores of
each scale before and after the Short-Term Life Review.
3.3. Results
Five of the patients were excluded from this study be-
cause of unexpected deterioratio n in health. Thus, a total
of 30 patients completed all sessions. After the Short-
Term Life Review, the mean FACIT-Sp scores signifi-
cantly increas ed from 16 ± 8.2 to 24 ± 7.1 (Z = –4.2, P =
0.001).
4. DISCUSSION
4.1. Effects of the Structured Life Review
and the Short Term-Life Review
After the structured life review, the significant increase
in the SELT-M scores, as well as the Spirituality, Orien-
tation, and Mood subscales shows the efficacy of this
therapy on spiritual well-being of terminally ill cancer
patients. As the Spirituality and Orientation subscale
quantify the levels of the patients’ meaningfulness and
positive outlook , the patients may have found a meaning
to life and had more positive thoughts. The significant
increase in the Mood subscale for terminally ill cancer
patients is accord with previous studies for elders [3-5].
After the Short-Term Life Review, the FACIT-Sp
scores significantly increased. It shows the effect of this
therapy on spiritual well-being of cancer patients. We
confirm the efficacy of this therapy even when we com-
pare it with the control group [16]. Adapting these proc-
ess with the previous theoretical model [17,18], we can
explain the effects of Short-Term Life Review. A patient
has a purpose or a goal for his life when he is healthy.
However, when he falls into serious illness, it is often
difficult for him to attain his purpose or a goal because
of unexpected serious illness, and he feels much distress.
In this situation, when he receives the Short-Term Life
Review and he can re-think and modifies his original
purpose or goals into attainable ones, he feels positive
mood. Short-Term Life Review may contribute for a
patient to reconstruct his life being congruent with can-
cer in his life.
4.2. Feasibility
It would be remarkable for Short-Term Life Review to
have high feasibility. Th e percentage of patients deterio-
rating with this therapy was only 17%, although, it was
30% for patients using the structured life review. We
describe some factors related to feasibility. 1) The
Short-Term Life Review is completed in a week, and this
short-term intervention enables terminally ill cancer pa-
tients to complete an intervention. 2) Patients with very
low functionality in ADL can participate because the
patients review th eir lives wh ile lying on b ed. If p atien ts’
ADL is high, the Problem-solving therapy for cancer
patients [19] and cognitive behavior therapy for cancer
patients [20], or meaning-centered group psychotherapy
[21] are also effective.
4.3. Characteristics of Each Life Review
There are some characteristics of each therapy. The
structured life review is suitable for patients who have
much time for interviews and require little cognitive load.
Oppositely, The Short-Term Life review is suitable for
patients who do not have much time for interviews and
require a little more cognitive load. In the Short-Term
Life review, a patient needs to think of his life pro-
foundly, resulting in requiring much cognitive load. We
use these therapies understanding patients’ physical and
mental states.
5. CONCLUSIONS
Both the structured life review and the Short-Term Life
Review have efficacy on spiritual well-being of termi-
nally ill cancer patients, being higher feasibility for the
Shot-Term Life Review. We need to use these therapies
understanding characteristics of each therapy.
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