Life Review Therapy (Dear Memories Therapy)

Structured life review using autobiographical retrieval practice in palliative cancer patients 

Background
Patients with cancer in the palliative phase often experience feelings of reduced quality of life, sadness, hopelessness and spiritual distress, such as an evaluation of one’s past and problems with finding a new meaning in life while suffering from an incurable disease. There is an urgent need to evidence-based psychosocial intervention methods enhancing the quality of life and dying and relieving the emotional distress in palliative cancer patients in the daily practice of psychosocial care. Structured life review therapy seems to be an intervention appropriate to this need. 

The autobiographical retrieval practice ‘’Dear Memories’’ focuses on bringing up positive specific events. The protocol has shown to be effective in depressed older adults, and pilot studies suggested improved quality of life in depressed and non-depressed cancer-patients and in the general population. The intervention might help palliative cancer patients in mentally understanding their prognosis and their end of life. Retrieving positive memories seem to enhance feelings of mastery, enables re-thinking and re-evaluation of life events, and may contribute to reconstruct life including the diagnosis of cancer.

According to theories on the relationship between depression or distress and autobiographical memory depressed of sombre people have difficulties being specific in retrieving autobiographical memories. This protocol trains patients in retrieving specific positive autobiographical memories in order to improve the quality of life, reduce symptoms of depressed mood, and relieving the emotional distress

Relevance
In 2008 99603 Dutch people suffered from cancer, in that same year 40993 Dutch people died from this disease. A majority of cancer patients report emotional distress, a reduced quality of life, and they are having questions about life and meaning.

Objective
The goal of this study is to investigate the effectiveness of a structured life review protocol named ‘’Dear Memories’’ on enhancing quality of life in palliative cancer patients and their partners, via improving the autobiographical memory. We would like to investigate possible determinants of efficacy of the intervention, such as age, gender and cultural background. If the protocol appears to be an effective intervention, it can be introduced in the regular psycho-oncological care. Spouses of these included patients will be asked to participate to study a possible effect on their quality of life: although the intervention is targeting the patients, insight from earlier studies indicate that there may be a beneficial effect on spouses as well.

Methods
Study design: A multicenter prospective randomised control trial with two parallel groups. Patients are assigned to either an intervention condition; receiving the life review protocol immediately after premeasurement or to a waiting list condition, receiving care-as-usual and a follow-up measurement after one month to asses long-term effectiveness.
Study population: A sample of 150 cancer patients without curative treatment options with a prognosis of > 3 months will be included. Exclusion criteria are cognitive impairment, inability to communicate verbally, insufficient mastery of the Dutch language and psychotic symptoms or behaviour (delusions or hallucinations). 
Intervention: The intervention will be individually administered and consists of four weekly sessions, with every session focusing on a particular period in life – childhood, adolescence, adulthood and whole life span. For each period, 14 questions are prepared that are designed to prompt specific positive memories.  For example: ‘’What is the most pleasant situation that you remember from your childhood?” The interviewer tries to get a specific view of the situation by asking for more information. Patients receive feedback on how well they are doing in retrieving specific memories.
Main study parameters:  Primary outcomes are the specificity of Autobiographical Memory (AMT), quality of life (EORTC QLQ-PAL15), and ego-integrity (NEIS). Secondary outcomes regard depressive symptoms (HADS; MINI). Spouses are measured on level of depressive symptoms (HADS), personal growth (PTGI), and care giving burden (CRA).

METc
This project is approved by the Medical Ethical Committee, VU University Medical Center (VUmc).

Funding
ZonMw (2010 - 2013)

Staff
PhD student
G. Kleijn MSc., Researcher-Psychologist, dpt. of Clinical Psychology, VU Faculty of Psychology and Education.
Project leader
Prof. I.M. Verdonck-de Leeuw PhD, Psychologist, Speech and Language Therapist, Linguist, dpt. of Clinical Psychology, VU Faculty of Psychology and Education.
Project members
Prof.  W.J.M.J. Cuijpers PhD, Psychologist, dpt. of Clinical Psychology, VU Faculty of Psychology and Education.
Prof. C.R. Leemans MD PhD, Head and Neck Surgeon, dpt. of Otolaryngology-Head & Neck Surgery, VUmc.
Prof. R. De Bree, MD PhD, Head and Neck Surgeon, Vdpt. of Otolaryngology-Head & Neck Surgery, VUmc.
Prof. E.F. Smit, MD PhD, Pulmonary Specialist, dpt. of  Pulmonary Disease, VUmc.
A. Becker, MD PhD, Pulmonary Specialist, dpt. of  Pulmonary Disease, VUmc.
Prof. P. Huijgens, MD PhD, Hematologist, dpt. of Hematology, VUmc
C. Eeltink, MA RN, Nurse Practitioner, dpt. of Hematology, VUmc
D. Rietveld, MD, Radiotherapist, dpt. of Radiotherapy, VUmc
J. Vos PhD, Psychologist, Filosofist, LUMC
B. Steunenberg, PhD, Psychologist, University medical Center Utrecht (UMCU)
M. van den Brekel, MD PhD, Head and Neck Surgeon, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital
Drs. R. Fles,  Research technician, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital
Prof. E.T. Bohlmeijer, PhD, Psychologist, dpt. of Mental Health, University Twente,
V. Willemsen PhD, Psychologist, Ingeborg Douwes Center

Questions?
For questions, please contact:
Gitta Kleijn, MSc, Psychologist
Email: g.kleijn@vumc.nl
Phone: + 31( 0)20-5988782