Themes of Meaning: Intervention Development for Parents Bereaved by Cancer

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使他们的损失有意义方面面临着独特的挑战。他们很容易受到许多有害的结果，包括长期悲伤障碍（PGD）。尽管有这些事实，父母对丧亲心理社会服务利用不足。显然，需要为失去亲人的父母制定得到精神支持的概念上合理的干预措施。我们已经发现，一个手动意义为中心的心理治疗（MCP）是有效的，在提高意义和目的感的晚期癌症患者。虽然先前的研究已经描述了丧亲父母面临的意义危机，但关于癌症丧亲父母意义创造受到挑战的具体方式的研究有限。此外，关于是否针对高危人群（例如，PGD），用于悲伤干预结局研究。这项研究计划的长期目标是开发和评估一个理论驱动的意义为中心的悲伤干预丧亲父母，以提高意义，并最终减少他们的痛苦。为了修改MCP成为一个可行的，可接受的，有效的干预癌症丧亲父母，这是至关重要的，以获得他们独特的丧亲之痛的经验，干预偏好，心理社会服务的使用障碍的全面了解。本研究的总体目标是通过实现以下具体目标来帮助发展以意义为中心的悲伤干预：（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，以告知概念上合理的干预内容的发展;（2）确定父母在高、低PGD亚组中意义主题的差异，以帮助选择目标人群;及（3）找出与丧亲父母使用心理社会服务相关的因素，包括介入偏好及知觉障碍，以指导发展可接受的介入模式。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。父母将首先完成一系列定量评估：1）意义和目的，2）PGD，3）不安全的依恋（PGD的一个关键风险因素），4）整体调整，5）心理社会服务使用，偏好和感知的使用障碍。使用PGD的测量，我们将识别得分高于正常值至少一个标准差（n = 12，“高PGD亚组”）和低于正常值至少一个标准差（n = 12，“低PGD亚组”）的父母。我们将进行深入的半结构化定性访谈的主题的意义。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亚组在发现意义方面将报告主题不同和更严峻的挑战。对于目标3，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，基于治疗恐惧的概念。

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.