Meaning-Centered Grief Therapy for Parents Bereaved by Cancer: A Multisite Randomized Controlled Trial

对罹患癌症的父母进行以意义为中心的悲伤治疗：一项多中心随机对照试验

基本信息

批准号：
10878563
负责人：
Wendy G. Lichtenthal
金额：
$ 59.66万
依托单位：
UNIVERSITY OF MIAMI SCHOOL OF MEDICINE
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-08-26 至 2026-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10878563
关键词：
Address Advanced Malignant Neoplasm Anxiety Bereavement Blinded COVID-19 Cancer Patient Caregivers Caring Cessation of life Child Communities Complement Data Diagnostic Dissemination and Implementation Distress Emotional Evaluation Evidence based intervention Face Fathers Feeling hopeless Goals Grief reaction Health Services Accessibility Health behavior Healthcare Heart Diseases Home Institution Intervention Intervention Studies Interview Left Life Malignant Neoplasms Manuals Measurable Measures Mediating Mediator Mental Depression Mental Health Methods Mothers Outcome Outcome Study Pain Palliative Care Parents Patient Self-Report Population Productivity Psychotherapy Quality of life Randomized Randomized, Controlled Trials Reporting Research Research Personnel Risk Role Sampling Services Site Structure Symptoms Therapeutic Time Treatment Efficacy Underserved Population Videoconferencing Work arm barrier to care community setting comparative efficacy depressive symptoms design evidence base experience fighting high risk improved innovation intervention effect neglect novel physical conditioning post intervention primary outcome public health priorities recruit response secondary outcome sound telehealth therapy development treatment arm treatment as usual treatment effect trial comparing

项目摘要

Project Summary/Abstract Bereavement support is a core tenet of comprehensive palliative care. Yet, accessible, evidence-based interventions are limited, particularly for bereaved parents. Losing a child to cancer is one of the most devastating experiences a parent can endure. Bereaved parents are at higher risk for numerous poor mental and physical health outcomes, including prolonged grief (PG), depression, reduced quality of life, existential distress, decreased work productivity, adverse health behaviors, and even death. Despite their suffering, bereaved parents report emotional and logistical barriers to returning to the institution where their child was treated and do not know where to turn for support in their communities, resulting in underutilization of services. The need for empirically-supported, conceptually sound, acceptable, and accessible interventions for bereaved parents is clear. Grief researchers have long emphasized the therapeutic value of facilitating meaning-making to improve bereavement outcomes. However, meaning-based interventions have not been empirically evaluated for grieving parents. To address this, we developed a manualized intervention, Meaning-Centered Grief Therapy (MCGT), for this critically at-risk and underserved population. Our pilot randomized controlled trial (RCT) comparing MCGT to supportive psychotherapy (SP), the most commonly received grief therapy, showed that MCGT outperformed SP for parents with higher baseline PG levels, improving PG, depression, anxiety, hopelessness, and quality of life domains. It also showed that telehealth delivery in parents’ homes was feasible and could reduce access-to-care barriers. In the wake of COVID-19, telehealth grief interventions are needed now more than ever, and yet evidence is scant. To improve the quality of home-based palliative care through enhanced bereavement services, the objective of the proposed mixed methods, multisite 3-arm RCT is to build on our prior work and examine which grief interventions delivered in the home via telehealth work best for whom and why. We will compare the efficacy of MCGT to SP and enhanced usual care (EUC) for bereaved parents with elevated PG symptoms. Primary outcomes will be reduced PG and depression symptoms. We will randomize 265 bereaved parents recruited from four institutions and the community to MCGT, SP, or EUC. We will embed qualitative interviews concurrently with quantitative measures, which is an innovation in grief intervention research. Self-report measures, as well as blinded diagnostic interviews to increase rigor, will be given at multiple time points through 6 months post-intervention. We will conduct qualitative interviews about the interventions’ impact in a purposively sampled subset (n=48). The specific aims of this trial are: 1) to compare the efficacy of MCGT, SP, and EUC in reducing PG and depression symptoms in bereaved parents, 2) to contextualize quantitative findings with qualitative data, and 3) to explore mediators and moderators of outcomes. The long-term goal of our research is to identify an effective, accessible telehealth grief intervention that improves suffering in the bereaved as part of comprehensive palliative care.

项目概要/摘要丧亲支持是全面姑息治疗的核心原则，但又是易于获得、基于证据的。干预措施是有限的，特别是对于失去孩子的父母来说，这是最严重的干预措施之一。父母可能会经历毁灭性的经历，失去亲人的父母面临着更高的精神问题风险。和身体健康结果，包括长期悲伤（PG）、抑郁、生活质量下降、存在主义尽管他们遭受痛苦，但他们仍然感到痛苦、工作效率下降、不良健康行为，甚至死亡。失去亲人的父母表示，他们在返回孩子所在机构时面临情感和后勤障碍接受治疗但不知道到哪里寻求社区支持，导致服务利用不足。需要为丧亲者提供有经验支持、概念合理、可接受且易于获得的干预措施父母们很清楚，悲伤研究人员长期以来一直强调促进意义建构的治疗价值。然而，基于意义的干预措施尚未得到实证检验。为了解决这个问题，我们开发了一种以意义为中心的手动干预措施。悲伤疗法（MCGT），针对这一危重人群和服务不足的人群，我们的试点是随机对照的。比较 MCGT 与支持性心理治疗 (SP)（最常用的悲伤疗法）的试验 (RCT)，结果显示，对于基线 PG 水平较高的父母，MCGT 的表现优于 SP，可改善 PG、抑郁症、它还表明，在父母家中提供远程医疗服务。在 COVID-19 发生后，远程医疗悲伤干预措施是可行的，并且可以减少获得护理的障碍。现在比以往任何时候都更需要改善家庭姑息治疗的质量。通过加强丧亲服务提供护理，拟议混合方法的目标，多地点 3 臂 RCT 将以我们之前的工作为基础，研究通过远程医疗在家中提供哪些悲伤干预措施我们将比较 MCGT 与 SP 和强化常规护理 (EUC) 的疗效。 PG 症状升高的失去亲人的父母的主要结果是 PG 降低和抑郁。我们将从四个机构和社区招募的 265 名失去亲人的父母进行随机分组。 MCGT、SP 或 EUC 我们将同时嵌入定性访谈和定量测量。悲伤干预研究的创新。增加严格性，我们将在干预后 6 个月内的多个时间点进行。关于干预措施对有意抽样的子集（n=48）的影响的定性访谈。该试验的目的是：1) 比较 MCGT、SP 和 EUC 在减少 PG 和抑郁症状方面的功效失去亲人的父母，2) 将定量结果与定性数据结合起来，3) 探索中介因素我们研究的长期目标是确定一个有效的、可访问的方法。作为全面姑息治疗的一部分，远程医疗悲伤干预可改善死者家属的痛苦。