The Final ACT – Quality of Life for Palliative Patients and their Families, the role of Acceptance and Commitment Therapy (ACT)

Mr Christopher Martin1,2, Emeritus Professor Kenneth Pakenham1, Dr Fiona Maccallum1

1University of Queensland, Australia, Brisbane, Australia, 2Sunshine Coast Hospital and Health Service, Sunshine Coast, Australia


Palliative care aims to improve quality of life (QoL) across physical, spiritual, and psychosocial life domains.  Acceptance and Commitment Therapy’s (ACT) model of Psychological Flexibility (PF) has demonstrated improvements in QoL across multiple health conditions; palliative care is yet to be explored.

The aim of this research was to understand the relationships between PF and four palliative outcomes: QoL, psychological morbidity, physical pain, death attitudes. It was hypothesised that higher PF would be associated with increased QoL, improved death attitudes, and decreased psychological morbidity and physical pain.


A short-term longitudinal survey design was utilized with 81 patients from a Specialist Palliative Care Service.  Participants completed questionnaires assessing PF and the four palliative outcomes at two time points, one-month apart.  A 33% attrition rate resulted in 54 patients completing the Time 2 questionnaire.


There were no significant changes between Time 1 and 2 in PF or palliative outcomes.

Hierarchical Regression analysis demonstrated higher PF at Time 1 was significantly associated with Time 2 palliative outcomes of: increased psychological QoL, decreased psychological morbidity (Total; Anxiety), decreases on two death attitude dimensions (Fear of death; Death avoidance), and increases in one death attitudes dimension (Acceptance-neutral).


Findings are consistent with broader ACT literature showing greater PF is associated with increased QoL and lower psychological morbidity; and provide new evidence of associations with improved death attitudes.

The provision of an ACT intervention is indicated to improve PF and palliative outcomes which otherwise remained stable in the short-term.   A trial is underway.


Christopher Martin is a PhD Candidate at the University of Queensland, and a Clinical Psychologist with 14 years experience in mental health, physical health and tertiary education fields.  For the past 9 years Christopher has provided psychosocial support within an Integrated In-patient and Community Specialist Palliative Care Service.  During this time he has witnessed the field of Palliative Psychology begin to emerge and he is passionate about continuing to support its growth in the service of maximizing patients and families quality of life.

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