Existential Distress in Advanced Cancer: Comparing a Short-term Psychodynamic Psychotherapy (ORPHYS) to Treatment as Usual (TAU)

Items are scored on a 3-point Likert scale from 0 (never) to 2 (often), with a total score ranging from 0 to 32. Higher scores indicate higher demoralization.

Presence of the following mental disorders is indicated with "yes" or "no" based on SCID-5 criteria: Major depression, Persistent depressive disorder, Bipolar diorders, Panic disorder, Agoraphobia, Social phobia, Generalized anxiety disorder, Simple phobia, Posttraumatic stress disorder

Presence of Adjustment disorder is indicated with "yes" or "no" based on ICD-11 criteria.

Items are scored on a 6-point Likert scale from 0 (no distress) to 5 (extreme distress), with a total score ranging from 0 to 75. Higher scores indicate higher levels of death anxiety.

Item is scord on a 7-point Likert-scale from 0 (no sense of loss of dignity) to 6 (extreme sense of loss of dignity).

The following subscales of the PDI are used: 1) Physical Symptom Distress, 2) Body Image and Loss of Autonomy. Items are scored on a 5-point Likert-scale from 0 (no problem) to 5 (an overwhelming problem). Higher scores indicate a higher sense of loss of dignity.

Subscales used: 1) Life completion, 2) Preparation for the end of life. Items are scored on a 5-point Likert scale from 0 (not at all) to 4 (completely), with a total score ranging from 0 to 36. Higher scores indicate higher quality of life.

Patients are asked about perceived goals of the cancer treatment and what they perceive to be their oncologists' goals for their treatment.

Patients are asked whether they discussed their wishes regarding medical treatment with their oncologist and how they experienced these conversation.

Subscale Relationship with Healthcare Provider. Items are scored on a 5-point Likert scale from 0 (not at all) to 4 (completely), with a subscale score ranging from 0 to 20. Higher scores indicate a stronger relationship with health care providers.

Items are scored on a 5--point Likert scale from 0 (not at all) to 4 (nearly all the time). High scores indicate high levels of loss orientation, life engagement and coping efforts, respectively.

Chemotherapy, immunotherapy, targeted therapy, hormonal therapy, inpatient treatment, emergency room visits, intensive care treatment, receipt of ambulatory or inpatient specialized or general palliative care

Measures include a) identical versions of the measures used for patients, b) complementary versions of patient measures adapted for caregivers, c) caregiver-specific instruments

Items are scored with either being true (1) or false (0). For the total score, number of endorsed items are counted, ranging from 0 to 6. Higher scores indicate higher levels of desire for hastened death.

Intensity of suicidal tendencies is measured with three statements for each item. Statements are scored from 0 to 2. If screening items for active and passive suicidal ideation are scored with 0, participants are asked to skip to the items regarding previous suicidal attempts. The screening score ranges from 0 to 10, the total score ranges from 0 to 38. Higher values indicate stronger suicidal tendencies.

Items are scored on a 4--point Likert scale ranging from 0 (not at all) to 3 (nearly every day), with a total score ranging from 0 to 27. Scores ≥10 indicate moderate, scores ≥15 severe depression.

Items are scored on a 4--point Likert scale ranging from 0 (not at all) to 3 (nearly every day), with a total score ranging from 0 to 21. Scores ≥10 indicate moderate, scores ≥15 severe anxiety.

Six items are scored on a scale from 7-point scale from -3 (worsening) to 3 (improvement), fifteen items are scored on a 4-point Likert-scale from 0 (not at all) to 4 (completely). If patients attributed changes to the therapy itself, frequencies, means, and standard deviation of negative (-3 to 1), no (0), and positive changes (1 to 3) are calculated.

Therapists document adverse events on a standardized form after each therapy session.

Items are scored on a 5-point Likert-scale from 1 (never) to 5 (always), with a total score ranging from 12 to 60. Higher scores indicate a stronger working alliance.

Items are scored on a 5-point Likert-scale from 1 (not true) to 5 (very true), with a total score ranging from 15 to 75. Higher scores indicate a stronger sense of agency.

Items are scored on a 5-point Likert-scale from 0 (not) to 4 (very much), with the total score ranging from 0 to 128. Higher total scores indicate higher distress due to interpersonal problems.

Items are scored on a 7-point Likert scale from 1 (strongly disagree) to 7 (strongly agree), with a total score ranging from 18 to 126. Higher scores indicate higher dependence on others to regulate emotional distress.

Items are scored on a 5-point Likert scale from 1 (strongly disagree) to 5 (strongly agree), with a total score ranging from 10 to 50. Higher scores indicate better communication in relationships.

Rating by trained observers.

Trained observers rate each audio recorded therapy session on a 5-point Likert-scale from 0 (not at all) to 4 (very much), with a total score ranging from 0 to 48. Higher scores indicate a more complex understanding of internal states and interpersonal processes.

Therapy session transcripts are rated by trained observers, Items are scored on a 5-point Likert-scale from 0 (not at all) to 4 (very much). A percentage score of defensive functioning is calculated.

Subscales used: 1) coping competence, 2) adaptability. Items are scored on a 6-point Likert scale from 0 (not at all) to 5 (completely), with a total score ranging from 0 to 35, and subscale scores ranging from 0 to 20 and 0 to 15. Higher scores indicate better coping.

Day 0: Tumor site, date of first diagnosis, type of disease, date of diagnosis of recurrence/second tumor, stage of disease, Charlson Comorbidity Index (CCI); Day 0, month 6 and month 12: oncological treatments received, number of therapy lines, psychopharmacological medication, performance status (ECOG Status/Karnofsky Index), presence and date of disease progression

Items are scored on a 5-point Likert-scale ranging from 0 (not at all distressed) to 4 (very much distressed). The average symptom score is calculated. Higher scores indicate higher physical symptom burden.

Scale expanded by frequent intervention techniques used in psycho-oncologyícal treatments. Items are scored on a 5-point Likert-scale from 1 (not at all typical of the session) to 5 (very typical of the session), with a total score ranging from 39 to 195. Higher scores indicate a rather typical use of intervention techniques.