Meaning-centered psychotherapy versus dignity therapy for spiritual well-being in patients with cancer: A systematic review and meta-analysis.

Abstract

e24118 Background: Meaning-Centered Psychotherapy (MCP) and Dignity Therapy (DT) are frequently employed psychotherapeutic approaches in palliative cancer care. Both are grounded in existential principles and designed to assist patients with advanced cancer. Evidence suggests that both interventions can improve spiritual well-being in this population. To date, no systematic meta-analysis has compared the efficacy of these interventions in enhancing spiritual well-being, and it remains unclear which intervention may be more effective. Implementing these therapies requires substantial resources, and in settings with limited resources, palliative care services must make strategic decisions about which intervention to prioritize. This study examined the comparative effectiveness of MCP and DT for improving spiritual well-being in adults with cancer using an indirect meta-analytic approach. Methods: This systematic review and meta-analysis was registered in PROSPERO (CRD42025642106). PubMed/MEDLINE, PsycINFO, Embase, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched from inception to January 28, 2025, without language or date restrictions. Randomized controlled trials and cohort studies involving adult cancer patients receiving MCP or DT were included. Usual care or palliative care without structured psychotherapeutic intervention served as comparators. The characteristics of MCP and DT were extracted and reported using the Template for Intervention Description and Replication (TIDieR) checklist. The primary outcome was spiritual well-being measured using the Functional Assessment of Chronic Illness Therapy–Spiritual Well-Being (FACIT-Sp). Two reviewers independently screened and extracted data. Random-effects meta-analyses were conducted for MCP and DT versus usual care, with indirect comparison using the Bucher method and heterogeneity assessed by I². Results: Four studies comparing MCP with usual care ( N = 758; 374 MCP, 384 control) and three studies comparing DT with usual care ( N = 412; 214 DT, 198 control) were included.MCP was associated with a statistically significant improvement in spiritual well-being compared with usual care (MD = 3.23, 95% CI 0.82 to 5.64; I² = 74.1%).DT showed no significant difference compared with usual care (MD = −0.11, 95% CI −1.23 to 4.69; I² = 18.2%). Indirect comparison using the Bucher method showed no statistically significant difference between MCP and DT (MD = 3.47, 95% CI −4.13 to 11.07). Conclusions: The indirect comparison found no significant difference between MCP and DT. In the absence of evidence demonstrating the superiority of MCP or DT, these findings raise important considerations for palliative care services. Our results emphasize the need for direct head-to-head trials and economic evaluations to guide service planning and clinical decision-making.