Discussion
Loneliness, depression, cancer, anxiety
CANCER, DISEASE, POSITIVE
The GRACE program was found to provide statistically significant improvements in spiritual well-being and overall quality of life compared to a wait-list control with durability for at least 1 month after the completion of the program. Additional significant improvements were identified for dimensions of general well-being (anxiety, depression, and hopelessness) in multivariate analysis. End of life care is enormously complex.Traditional support groups are available at many cancer centers and communities around the nation. However, we know from our clinical experience that many of our patients with cancer do not desire to participate in a traditional support group due to a perception that they are unstructured, or they lend themselves to a state of creating comparisons to others in terms of disease state and suffering.Keeping the limitations of traditional support groups in mind, GRACE was designed to: (1) be finite in duration (ie, 6 sessions) to allow for feasibility on both the part of the participant and institution or clinicians delivering the intervention; and (2) use an integrative psycho-educational process, with Logotherapy as its foundation, focused on enhancing well-being to engage patients with cancer both with high or low levels of psychological distress but still experiencing existential and spiritual challenges. A strength of the GRACE program is the integration of core tenets and techniques from Cognitive Behavioral Therapy, mindfulness intervention, and Positive Psychology to add clinical versatility to complement the foundation of Logotherapy.While the intervention demonstrated success in improving spiritual well-being and general quality of life, there are some limitations that must be considered for future research. To begin with, this study was relatively small in its sample size. This may account for the slightly higher anxiety scores at baseline of the intervention group compared to the control group. Secondly, of note, participation in GRACE did not result in improvements in loneliness scores. Loneliness is prominent in this population.