Multimedia-assisted narrative intervention for existential distress among patients with advanced cancer: a one-group pre–post study

Abstract

Purpose Patients with advanced cancer often experience challenges related to life meaning, coping confidence, and death-related concerns, which may impair quality of life. This preliminary one-group quasi-experimental pre–post study examined whether meaning in life, terminal self-efficacy, and death anxiety changed after a multimedia-assisted narrative psychosocial intervention. The uncontrolled design was intended to identify preliminary within-participant signals and cannot establish intervention efficacy. Methods A one-group quasi-experimental pre–post study was conducted in three hospice care facilities. Of 50 recruited patients, 43 completed the 4-week program and post-intervention assessment. The intervention integrated weekly group storytelling sessions, individual interviews, daily educational dissemination, multimedia-supported reflection, and structured legacy-oriented activities. Outcomes were assessed using validated scales and analyzed with paired-samples t-tests, mean differences, 95% confidence intervals, Cohen's dz, and Holm-adjusted P values. Results Meaning in life increased from 2.28 ± 0.65 to 2.70 ± 0.52 (mean difference = 0.42, 95% CI 0.33 to 0.51, dz = 1.49), and terminal self-efficacy increased from 2.38 ± 0.58 to 2.88 ± 0.47 (mean difference = 0.50, 95% CI 0.40 to 0.59, dz = 1.62). After scale-keying the T-DAS scores so that higher scores indicated greater death anxiety, death anxiety decreased from 3.11 ± 0.27 to 2.97 ± 0.29 (mean difference = −0.13, 95% CI −0.22 to −0.05, dz = −0.49). All Holm-adjusted P values for the three primary outcomes were < 0.01. Conclusion This preliminary one-group pre–post study observed favorable changes in meaning in life, terminal self-efficacy, and death anxiety following a multimedia-assisted narrative intervention. Because the study lacked a control group and used a small convenience sample, the findings should be interpreted as hypothesis-generating rather than evidence of intervention efficacy.