Themes of Meaning: Intervention Development for Parents Bereaved by Cancer

意义主题：针对癌症失去亲人的父母的干预发展

• 批准号: 7679235
• 负责人: Wendy G. Lichtenthal
• 金额: $ 9.48万
• 依托单位: SLOAN-KETTERING INST CAN RESEARCH
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-09-01 至 2011-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7679235
• 关键词: Advanced Malignant Neoplasm; Bereavement; Cancer Care Facilities; Cancer Patient; Caregivers; Cessation of life; Child; Clinical Trials; Confusion; Data; Development; Disease; Face; Family; Feeling; Funding; Goals; Grief reaction; Institute of Medicine (U.S.); Intervention; Interview; Left; Life; Malignant Childhood Neoplasm; Malignant Neoplasms; Manuals; Measures; Methods; Outcome; Outcome Study; Pain; Parents; Patients; Phase; Pilot Projects; Population; Population Intervention; Psychiatric Social Work; Psychotherapy; Recruitment Activity; Reporting; Research; Research Personnel; Resources; Risk; Risk Factors; Role; Severities; Shapes; Structure; Subgroup; Symptoms; Target Populations; Testing; Therapeutic; Treatment Efficacy; United States National Institutes of Health; Vulnerable Populations; base; clinically significant; effective intervention; end of life care; experience; fighting; high risk; improved; meetings; mortality; palliative; preference; programs; public health priorities; sound; survivorship; theories; therapy development

The loss of a child is the most painful, intense, and devastating type of bereavement. Parents who experience the death of a child to cancer face unique challenges in making meaning of their loss. They are vulnerable to numerous detrimental outcomes, including prolonged grief disorder (PGD). Despite these facts, parents underutilize bereavement psychosocial services. The need to develop empirically-supported conceptually sound interventions for bereaved parents is clear. We have found that a manualized meaning- centered psychotherapy (MCP) is efficacious in enhancing meaning and sense of purpose among advanced cancer patients. Although prior studies have described the crisis in meaning that bereaved parents face, research on the specific ways in which meaning-making is challenged in parents bereaved by cancer is limited. Furthermore, there has been debate about whether to target high-risk populations (e.g., PGD), for grief intervention outcome studies. The long-term goal of this research program is to develop and evaluate a theory- driven meaning-centered grief intervention for bereaved parents in order to enhance meaning and ultimately reduce their suffering. In order to modify MCP into a feasible, acceptable, and effective intervention for parents bereaved by cancer, it is critical to acquire a comprehensive understanding of their unique bereavement experience, intervention preferences, and barriers to psychosocial service use. The overall objective of this mixed-methods pilot study is to aid in the development of a meaning-centered grief intervention by achieving the following specific aims: (1) identify the unique themes related to finding meaning among parents who lose a child to cancer to inform development of conceptually sound intervention content; (2) determine differences in themes of meaning in parents in the high and low PGD subgroups to help select a target population; and (3) identify factors associated with bereaved parents' psychosocial service use, including intervention preferences and perceived barriers, to guide the development of an acceptable intervention format. We will recruit parents bereaved 6 months to 3 years ago from 75 families. Parents will first complete a set of quantitative assessments of 1) meaning and purpose, 2) PGD, 3) insecure attachment (a key risk factor for PGD), 4) overall adjustment, and 5) psychosocial service use, preferences, and perceived barriers to use. Using the measure of PGD, we will identify parents who scored at least one standard deviation above the norm (n = 12, "high PGD subgroup") and at least one standard deviation below the norm (n = 12, "low PGD subgroup"). We will conduct in-depth semi-structured qualitative interviews about themes of meaning-making. We will use thematic content analysis to compare parents with high vs. low levels of PGD. We expect that the high PGD subgroup will report thematically different and more severe challenges in finding meaning when compared to the low PGD subgroup. For Aim 3, we hypothesize that parents with higher levels of PGD will be less likely to use psychosocial services following the loss of their child, based on the concept of treatment fearfulness.

失去孩子是最痛苦、最强烈、最具毁灭性的丧亲之痛。经历过孩子死于癌症的父母在理解他们的损失时面临着独特的挑战。他们很容易受到许多有害后果的影响，包括长期悲伤障碍（PGD）。尽管有这些事实，父母仍然没有充分利用丧亲社会心理服务。显然，有必要为失去亲人的父母制定有经验支持、概念合理的干预措施。我们发现，以意义为中心的手动心理治疗（MCP）可以有效增强晚期癌症患者的意义和使命感。尽管之前的研究已经描述了失去亲人的父母所面临的意义危机，但对因癌症失去亲人的父母的意义建构受到挑战的具体方式的研究仍然有限。此外，关于是否针对高危人群（例如，PGD）进行悲伤干预结果研究一直存在争议。该研究项目的长期目标是为失去亲人的父母开发和评估一种以理论为驱动、以意义为中心的悲伤干预措施，以增强意义并最终减少他们的痛苦。为了将 MCP 修改为针对癌症失去亲人的父母可行、可接受且有效的干预措施，全面了解他们独特的丧亲经历、干预偏好以及使用心理社会服务的障碍至关重要。这项混合方法试点研究的总体目标是通过实现以下具体目标来帮助制定以意义为中心的悲伤干预措施：（1）确定与在因癌症失去孩子的父母中寻找意义相关的独特主题为制定概念上合理的干预内容提供信息； （2）确定高PGD亚组和低PGD亚组中父母意义主题的差异，以帮助选择目标人群； (3) 确定与失去亲人的父母使用心理社会服务相关的因素，包括干预偏好和感知障碍，以指导制定可接受的干预形式。我们将从75个家庭中招募6个月至3年前失去亲人的父母。家长将首先完成一系列定量评估，包括 1) 意义和目的，2) PGD，3) 不安全依恋（PGD 的关键风险因素），4) 整体调整，以及 5) 心理社会服务的使用、偏好和感知障碍使用。使用 PGD 测量，我们将确定得分至少高于正常值 1 个标准差（n = 12，“高 PGD 亚组”）和至少低于正常值 1 个标准差（n = 12，“低 PGD 亚组”）的父母）。我们将针对意义创造的主题进行深入的半结构化定性访谈。我们将使用主题内容分析来比较 PGD 水平高与低的父母。我们预计，与低 PGD 亚组相比，高 PGD 亚组将报告主题不同且在寻找意义方面面临更严峻的挑战。对于目标 3，基于治疗恐惧的概念，我们假设 PGD 水平较高的父母在失去孩子后不太可能使用心理社会服务。