Katherine Piderman on Life Review

Transforming Chaplaincy welcomes guest commentator Dr. Katherine Piderman, who is a board-certified chaplain, associate professor of psychiatry, and administrative assistant for research at Mayo Clinic. We thank Dr. Piderman for her insight today and encourage chaplains and researchers – even those not working directly in palliative or end-of-life care – to explore the article. For this Idea in Brief, Piderman comments on Wang C-W, Chow AYM, Chan CLW, “The effects of life review interventions on spiritual well-being, psychological distress, and quality of life in patients with terminal or advanced cancer: a systematic review and meta-analysis of randomized controlled trials,” Palliative Medicine 31, no. 10 (2017): 

Wang and colleagues’ results suggest that life review may be helpful in augmenting meaning, diminishing existential distress and improving overall quality of life in those with advanced cancer. In their background section, the authors provide a thorough overview of the suffering that those with advanced cancer experience.  They offer a clear rationale for the potential of life review for these patients to address and alleviate existential and spiritual distress.  They indicate that the life review process may be helpful in three key ways: “life completion, burden relief, and hope promotion” (894).

This study is unique in providing a synthesis of the results of existing randomized controlled trials (RCT) in this population.  Though other meta-analyses have been done, this is the first that analyzes data to provide an overview of the combined results.  The methodology section provides a helpful view into the rigors of doing such work, as well as an understanding of the limited research available in this area.  Though the authors began by identifying 1,387 articles with potential for their analysis, following further screening they ended up with only nine articles (two on the same RCT) that met all criteria.

The authors emphasize that their results should be viewed cautiously, certainly because of the small number of RCTs that met inclusion criteria, but also because of the variation in approach, dose and frequency of the interventions; the high attrition rates; and the possibility of bias. They recommend that future studies give more rigorous attention to standardization of the intervention used, especially in regard to its delivery, and work to curtail any bias that may be present when the life review is conducted.

I concur with the authors’ humble approach to their results and also their suggestions for further research.  I encourage researchers interested in this area to read the article in its entirety, as I found it rich in information and provocative.  The complexities of research in this area are sizable and should be addressed; in the meantime, the potential of life review to benefit patients with advanced cancer suggests the importance of considering creative adaptations of life review research for use in clinical practice.