Pathway to Equity: Feasibility and Proof of Concept of Meaning-Centered Psychotherapy for Chinese Patients with Advanced Cancer

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PROJECT ABSTRACT Asians are the fastest growing racial/ethnic group in the United States and the only group for which cancer, not heart disease, is the leading cause of death. The largest Asian subgroup is of Chinese origin, many of whom are foreign-born (76%) and limited English proficient (LEP) (48%). Foreign-born Chinese are more likely to be diagnosed with cancer at an advanced stage than U.S. born Chinese. Many advanced cancer patients suffer from spiritual and emotional distress, end-of-life despair, and hopelessness, complicating their illness management. Meaning-Centered Psychotherapy (MCP) is a manualized intervention with demonstrated success in enhancing advanced cancer patients’ sense of meaning to improve their spiritual well-being and quality of life. However, MCP’s efficacy was tested in a randomized controlled trial with an English speaking, predominantly White (76%) sample, and did not examine the impact of the intervention on Asians as a group. Studies have shown culturally adapted treatments tailored for a specific cultural group are four times more effective than interventions provided to participants from a variety of cultural backgrounds, and those conducted in LEP participants’ native language are twice as effective as interventions conducted in English. This may be especially important for Chinese cancer patients because of unique sociocultural risk factors for untreated distress that require treatment adaptation, including self-stigma about cancer and stigma associated with seeking mental health services. For Chinese patients with stigma concerns in addition to potential physical mobility and transportation issues that all cancer patients may face, telehealth-delivered mental health interventions—which reduce public visibility—may be of great utility. There is thus a critical need to develop culturally tailored, remotely accessible psychosocial interventions for Chinese patients with advanced cancer. To address this gap, in our preliminary work, we conducted formative research to assess the psychosocial and meaning-centered needs of Chinese patients with advanced cancer. This work resulted in the initial development of a 6-session MCP intervention manual for Chinese patients with advanced cancer (MCP-Ch) in Simplified Chinese and generated areas for additional inquiry, namely, the need to review and refine therapeutic content with input from mental health experts and to identify contextual factors that may affect implementation of telehealth-delivered MCP-Ch in future trials. In this study, we will (1) refine MCP-Ch materials to enhance cultural and linguistic acceptability and comprehensibility and assess factors that may affect MCP-Ch’s implementation, based on stakeholder feedback from 15 mental health providers who work with Chinese cancer patients. We will then (2) determine the feasibility and preliminary pre-post effectiveness of telehealth-delivered MCP-Ch among 27 Mandarin-speaking Chinese patients with Stage III/IV solid tumor cancers of any type (n=20 completers with expected attrition). Results from this study will fill a critical gap in current psychosocial care for this large, growing, and underserved group.