Skip to main content
SpringerLink
Log in

Meaning in life assessed with the “Schedule for Meaning in Life Evaluation” (SMiLE): a comparison between a cancer patient and student sample

  • Original Article
  • Published:
Supportive Care in Cancer Aims and scope Submit manuscript

Abstract

Background

The aims of the study were (a) to assess individual meaning in life (MiL) in a mixed sample of cancer patients with the Schedule for Meaning in Life Evaluation (SMiLE), (b) to evaluate the acceptability of its French version, and (c) to compare it to a student sample.

Materials and methods

Consecutive cancer patients (N = 100) treated as outpatients in the University Hospital Lausanne (N = 80) and in a nearby hospice (N = 20) were evaluated with the SMiLE, a reliable and validated respondent-generated instrument for the assessment of MiL. The respondents list three to seven areas, which provide meaning to their life and rate the level of importance (weighting) and satisfaction of each area. Indices of total weighting (index of weighting (IoW), range 20–100), total satisfaction (index of satisfaction (IoS), range 0–100), and total weighted satisfaction (index of weighted satisfaction (IoWS), range 0–100) are calculated.

Results

Patients most often indicated areas related to relationships as providing MiL, while material things were listed less often. Since satisfaction with relevant areas was high, cancer patients reported the same level of weighted satisfaction (IoWS) as a healthy student sample, assessed with the SMiLE in a prior validation study. Patients judged the SMiLE as reflecting well their MiL, not distressing to fill in and were moderately positive with regard to its helpfulness.

Conclusions

MiL of cancer patients was surprisingly high, possibly due to the “response shift” of the severely ill. The SMiLE might become a useful tool for research and an opener to communication between patients and clinicians about this highly relevant topic in cancer care. Further studies with larger sample sizes and different designs, complemented by qualitative research, are needed to deepen our understanding of this so characteristically human topic, which is so easy to perceive and so difficult to grasp.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Moadel A, Morgan C, Fatone A, Grennan J, Carter J, Laruffa G, Skummy A, Dutcher J (1999) Seeking meaning and hope: self-reported spiritual and existential needs among an ethnically-diverse cancer patient population. Psychooncology 8:378–385

    Article  PubMed  CAS  Google Scholar 

  2. Lee V, Cohen RS, Edgar L, Lainzner AM, Gagnon AJ (2004) Clarifying « meaning » in the context of cancer research: a systematic literature review. Palliative and Supportive Care 2:291–303

    PubMed  Google Scholar 

  3. Frankl V (1976) Man's search for meaning. Pocket, New York

    Google Scholar 

  4. Meier DE, Emmons CA, Wallenstein S, Quill T, Morrison RS, Cassel CK (1998) A national survey of physician-assisted suicide and euthanasia in the United States. N Engl J Med 338(17):1193–1201

    Article  PubMed  CAS  Google Scholar 

  5. Kissane D, Clark D, Street A (2001) Demoralization syndrome—relevant psychiatric diagnosis for palliative care. J Palliat Care 17:12–21

    PubMed  CAS  Google Scholar 

  6. Breitbart W, Rosenfeld B, Pessin H, Kaum M, Funesti Esch J, Galietta M, Nelson C, Brescia R (2000) Depression, hopelessness, and desire for hastened death in terminally ill cancer patients. JAMA 284:2907–2911

    Article  PubMed  CAS  Google Scholar 

  7. Meier D, Emmons C, Wallenstein S, Quill T, Morrison R, Cassel C (1998) A national survey of physician-assisted suicide and euthanasia in the United States. N Engl J Med 338:1193–1201

    Article  PubMed  CAS  Google Scholar 

  8. Breitbart W, Gibson C, Poppito SR, Berg A (2004) Psychotherapeutic interventions at the end of life: a focus on meaning and spirituality. Can J Psychiatry 49:366–372

    PubMed  Google Scholar 

  9. Breitbart W, Heller K (2003) Reframing hope: meaning-centered care for patients near the end of life. J Palliat Med 6:979–988

    Article  PubMed  Google Scholar 

  10. Chochinov H, Hack T, Hassard T, Kristjanson L, McClement S, Harlos M (2005) Dignity therapy: a novel psychotherapeutic intervention for patients near the end of life. J Clin Oncol 23:5520–5525

    Article  PubMed  Google Scholar 

  11. Eckhardt P (2001) Skalen zur Erfassung von existentieller Motivation, Selbstwert und Sinnerleben. Existenzanalyse 1:35–39

    Google Scholar 

  12. Fife BL (1995) The measurement of meaning in illness. Soc Sci Med 40:1021–1028

    Article  PubMed  CAS  Google Scholar 

  13. Reker G (1992) Manual of the life attitude profile—revised. Student Psychologists, Peterborough (ON)

    Google Scholar 

  14. Salmon P, Manzi F, Valori RM (1996) Measuring the meaning of life for patients with incurable cancer: the Life Evaluation Questionnaire (LEQ). Eur J Cancer 32A(5):755–760

    Article  PubMed  CAS  Google Scholar 

  15. Hablas R, Hutzell RR (1982) The Life Purpose Questionnaire: An alternative to the Purpose-in-Life Test for geriatric, neuropsychiatric patients. In: Wawrytko SA (ed) Analecta Frankliana. Strawberry Hill, Berkeley (CA)

    Google Scholar 

  16. Battista J, Almond R (1973) The development of meaning in life. Psychiatry 36(4):409–427

    PubMed  CAS  Google Scholar 

  17. Shapiro S (1976) Development of a life-meanings survey. Psychol Rep 39:467–480

    Google Scholar 

  18. DeVogler K, Ebersole P (1980) Categorization of college students' meaning of life. Psychol Rep 46:387–390

    Google Scholar 

  19. Ebersole P, Quiring G (1991) Meaning in life depth: the MILD. J Humanist Psychol 31:113–124

    Article  Google Scholar 

  20. Warner S, Williams J (1987) The meaning in life scale: determining the reliability and validity of a measure. J Chronic Dis 40(6):503–512

    Article  PubMed  CAS  Google Scholar 

  21. Starck P (1985) Guidelines—meaning in suffering test. Institute of Logotherapy, Berkeley (CA)

    Google Scholar 

  22. Crumbaugh J, Maholick L (1969) Manual of instructions for the Purpose-in-Life Test. Psychometric Affiliates, Munster (IN)

    Google Scholar 

  23. Reker G (2005) Meaning in life of young, middle-aged, and older adults: factorial validity, age, and gender invariance of the Personal Meaning Index (PMI). Pers Individ Differ 38:71–85

    Article  Google Scholar 

  24. Wong P (1998) Implicit theories of meaningful life and the development of the personal meaning profile. In: Wong P, Fry P (eds) The human quest for meaning. A handbook of psychological research and clinical applications. Erlbaum, Mahwah (NJ), pp 111–140

    Google Scholar 

  25. Crumbaugh J (1977) The Seeking of Noetic Goals Test (SONG): a complementary scale to the Purpose in Life Test (PIL). J Clin Psychol 33:900–907

    Article  PubMed  CAS  Google Scholar 

  26. Antonovsky A (1993) The structure and properties of the sense of coherence scale. Soc Sci Med 36(6):725–733

    Article  PubMed  CAS  Google Scholar 

  27. Reker G (1996) Manual of the sources of meaning profile—revised (SOMP-R). Student Psychologists, Peterborough (ON)

    Google Scholar 

  28. Fegg MJ, Kramer M, L'hoste S, Hickey A, Borasio GD (2008) The Schedule for Meaning in Life Evaluation (SMiLE): validation of a new instrument in meaning-in-life research. J Pain Symptom Manage (in press)

  29. O'Boyle C (1995) Making subjectivity scientific. Lancet 345:602

    Article  PubMed  Google Scholar 

  30. O'Boyle C, McGee H, Hickey A, O'Malley K, Joyce C (1992) Individual quality of life in patients undergoing hip replacement. Lancet 339:1088–1091

    Article  PubMed  Google Scholar 

  31. Joyce C, Hickey A, McGee H, O'Boyle C (2003) A theory-based method for the evaluation of individual quality of life: the SEIQoL. Qual Life Res 12:275–280

    Article  PubMed  CAS  Google Scholar 

  32. Fegg MJ, Kramer M, Bausewein C, Stiefel F, Borasio GD (2007) Meaning in life in the Federal Republic of Germany: results of a representative survey. Health Qual Life Outcomes 5:59

    Article  PubMed  Google Scholar 

  33. Reed P (1991) Self-transcendence and mental health in oldest-old adults. Nurs Res 40:5–11

    Article  PubMed  CAS  Google Scholar 

  34. Scientific Advisory Committee of the Medical Outcome Trust (2002) Assessing health status and quality-of-life instruments: attributes and review criteria. Qual Life Res 11:193–205

    Article  Google Scholar 

  35. Schwartz C, Rapkin B (2004) Reconsidering the psychometrics of quality of life assessment in light of response shift and appraisal. Health Qual Life Outcomes 2:1–11

    Article  Google Scholar 

  36. Stiefel F, Real O, Guex P (1998) An introduction to psycho-oncology with a special emphasis in its historical and cultural context. In: Portenoy RK, Bruera E (eds) Topics of palliative care. Oxford University Press, New York, pp 175–196

    Google Scholar 

  37. Guex P, Stiefel F, Rousselle I (2000) Psychotherapy with patients with cancer. Psychother Rev 2:269–273

    Google Scholar 

  38. Carr AJ, Higginson IJ (2001) Are quality of life measures patient centered? BMJ 322:1357–1360

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

This study was supported by a grant from OncoSuisse (No. 26840). The last author (MF) was supported by a scholarship of the Dr. Werner Jackstead Foundation (S134-10.007).

Author information

Authors and Affiliations

  1. Psychiatry Service, University Hospital, Lausanne, Switzerland

    F. Stiefel, S. Krenz, C. Zdrojewski & D. Stagno

  2. Fondation Rive-Neuve, Villeneuve, Switzerland

    M. Fernandez

  3. Pluridisciplinary Center of Oncology, University Hospital, Lausanne, Switzerland

    J. Bauer, N. Fucina, F. Lüthi & S. Leyvraz

  4. Interdisciplinary Center for Palliative Medicine, University Hospital, Munich, Germany

    G. D. Borasio & M. Fegg

  5. Service de Psychiatrie de Liaison, Centre Universitaire Hospitalier Vaudois, 1011, Lausanne, Switzerland

    F. Stiefel

Authors
  1. F. Stiefel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. Krenz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. Zdrojewski
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. D. Stagno
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Fernandez
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. J. Bauer
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. N. Fucina
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. F. Lüthi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. S. Leyvraz
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. G. D. Borasio
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. M. Fegg
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to F. Stiefel.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Stiefel, F., Krenz, S., Zdrojewski, C. et al. Meaning in life assessed with the “Schedule for Meaning in Life Evaluation” (SMiLE): a comparison between a cancer patient and student sample. Support Care Cancer 16, 1151–1155 (2008). https://doi.org/10.1007/s00520-007-0394-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00520-007-0394-9

Keywords

Search

Navigation