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

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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.