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

项目概要/摘要 丧亲支持是综合姑息治疗的核心原则。然而， 干预措施有限，特别是对失去亲人的父母。孩子死于癌症是我一生中 父母所能承受的毁灭性经历失去亲人的父母患上许多精神疾病的风险更高。 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 痛苦，工作效率下降，不良健康行为，甚至死亡。尽管他们在受苦， 失去亲人的父母报告说，他们在返回孩子所在的机构时遇到了情感和后勤方面的障碍， 这些妇女不知道如何得到治疗，也不知道在社区中向谁寻求支持，导致服务利用不足。 需要为丧失亲人的人提供得到精神支持的、概念上合理的、可接受的和可获得的干预措施 父母是清楚的。悲伤研究者长期以来一直强调促进意义创造的治疗价值 来改善丧亲之痛然而，基于意义的干预并没有得到经验性的证实。 为悲伤的父母做评估为了解决这个问题，我们开发了一种手动干预，意义中心 悲伤疗法（MCGT），为这一严重的风险和服务不足的人群。我们的试点随机对照 一项比较MCGT与支持性心理治疗（SP）的随机对照试验（RCT），SP是最常接受的悲伤治疗， 表明MCGT优于SP的父母具有较高的基线PG水平，改善PG，抑郁， 焦虑、绝望和生活质量领域。它还表明，在父母家中提供远程保健服务， 这是可行的，可以减少获得护理的障碍。在COVID-19之后，远程医疗悲伤干预措施 现在比以往任何时候都更需要，但证据不足。提高居家姑息治疗质量 通过加强丧亲服务，建议的混合方法的目标，多站点3臂 随机对照试验是建立在我们以前的工作，并检查哪些悲伤干预提供了在家里通过远程医疗 对谁和为什么最有效我们将比较MCGT与SP和加强常规护理（EUC）的疗效， 失去亲人的父母有更严重的PG症状主要结局将是减少PG和抑郁 症状我们将从四个机构和社区随机招募265名丧亲父母， MCGT、SP或EUC。我们将嵌入定性访谈同时定量措施，这是一个 悲伤干预研究的创新。自我报告措施，以及盲法诊断访谈， 增加严格性，将在干预后6个月内的多个时间点给予。我们会进行 定性访谈的干预措施的影响，在一个有目的的抽样子集（n = 48）。具体目标 本试验的主要目的是：1）比较MCGT、SP和EUC在减轻PG和抑郁症状方面的疗效， 丧亲父母，2）将定量结果与定性数据联系起来，3）探索中介因素 和结果的调节者。我们研究的长期目标是确定一种有效的、可获得的 远程医疗悲伤干预，作为综合姑息治疗的一部分，改善丧亲之痛。

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.