Meaning-Centered Grief Therapy for Parents Bereaved by Cancer

描述(申请人提供)：癌症是导致儿童疾病死亡的主要原因。因癌症失去孩子的父母面临着许多有害和身体健康后果的高风险，包括长期悲伤障碍(PGD)，这是一种损害精神的综合征，如果不治疗，可能会持续数年。然而，尽管它们增加了风险，但对这一高度脆弱的人群缺乏经验支持的干预措施。此外，他们似乎没有充分利用现有的精神健康服务。迫切需要为因癌症失去亲人的父母开发一种理论驱动的心理社会干预措施，并从经验上加以验证，这种干预措施是可接受和可获得的(例如，通过远程保健)。我的长期目标是成为一名独立的临床科学家，专注于为癌症患者及其家人开发新的心理治疗干预措施，专门从事悲伤干预，以改善从姑息治疗到丧失亲人的护理的连续性。这份申请代表了我职业发展中合乎逻辑的下一步。我在获奖期间的学习目标如下：1)提高我在心理治疗研究和理论方面的培训，2)学习执行远程健康干预所需的核心原则和实用策略，3)在临床试验中增加关于招募/保留少数群体和其他服务不足的人群的知识，4)提高我在悲伤和依恋理论方面的专业知识，以及5)完成与心理治疗研究相关的高级统计方面的培训。除了在一个合适的环境中接受密集的专家指导和授课培训外，我还将通过拟议的研究获得这些领域的实践经验。这项研究的目的是提炼和评估以意义为中心的悲伤治疗(MCGT)的可行性和前景，这是一种新型的一对一心理治疗干预措施，旨在增强失去亲人的父母的意义并减少PGD症状。MCGT将改编自以意义为中心的心理疗法，这是一种针对晚期癌症患者的经验式干预。失去亲人的父母对精神健康服务的利用不足和获得心理健康服务的障碍将通过视频会议提供MCGT来解决，这已被证明与面对面提供一样有效。这项研究将包括4个阶段，使用关键信息者调整MCGT干预手册(阶段1)，亲自完善MCGT的简短公开试验(阶段2)，微调递送的简短公开试验 通过视频会议进行的MCGT试验(第三阶段)和一项试点随机对照试验(RCT)，以比较MCGT与标准化支持性心理治疗(SP)的可行性、耐受性、可接受性和初步效果，两者都通过视频会议提供(第四阶段)。进行这项研究将有助于我发展成为一名独立的悲痛干预研究员，为因癌症失去亲人的个人提供可行性和初步疗效数据，这对于为失去亲人的父母设计更大规模的MCGT随机对照试验至关重要。这项研究的结果将被用于为MCGT的更大规模的疗效RCT寻求NIH R01资金，除了拟议的培训外，这将促进我作为癌症环境中独立心理治疗研究人员的潜力。

DESCRIPTION (provided by applicant): Cancer is the leading cause of death by disease in children. Parents who lose a child to cancer are at heightened risk for numerous detrimental mental and physical health outcomes, including prolonged grief disorder (PGD), an impairing psychiatric syndrome that can persist for years if left untreated. Despite their increased risk, however, there is an absence of empirically-supported interventions for this highly vulnerable population. Furthermore, they appear to underutilize existing mental health services. There is a critical need to develop and empirically validate a theoretically-driven psychosocial intervention for parents bereaved by cancer that is acceptable and accessible (e.g., through telemental health). My long-term goal is to become an independent clinical scientist who focuses on the development of novel psychotherapeutic interventions for cancer patients and their families, specializing in grief interventions to improve continuity of care from palliative care through bereavement. This application represents the logical next step in my career development. My learning objectives during the award period are as follows: 1) to advance my training in psychotherapy research and theory, 2) to learn core principles and practical strategies needed to execute telemental health interventions, 3) to increase knowledge on recruitment/retention of minority and other underserved populations in clinical trials, 4) to advance my expertise in grief and attachment theory, and 5) to complete training in advanced statistics relevant to psychotherapy research. In addition to receiving intensive expert mentorship and didactic training in a well-suited environment, I will gain hands-on experience in these areas through the proposed research. The objective of this study is to refine and evaluate the feasibility and promise of Meaning-Centered Grief Therapy (MCGT), a novel one-on-one psychotherapeutic intervention designed to enhance bereaved parents' sense of meaning and reduce PGD symptoms. MCGT will be adapted from Meaning-Centered Psychotherapy, an empirically-supported intervention for advanced cancer patients. Bereaved parents' underutilization of and barriers to accessing mental health services will be addressed by delivering MCGT via videoconferencing, which has been shown to be as efficacious as in-person delivery. The study will consist of 4 phases, using key informants to adapt the MCGT intervention manual (Phase 1), a brief open trial to refine MCGT in person (Phase 2), a brief open trial to fine-tune delivery of MCGT via videoconferencing (Phase 3), and a pilot randomized controlled trial (RCT) to compare the feasibility, tolerability, acceptability, and preliminary effects of MCGT to a standardized supportive psychotherapy (SP), both delivered via videoconferencing (Phase 4). Conducting this study will contribute to my development into an independent grief intervention researcher for individuals bereaved by cancer while also providing feasibility and preliminary efficacy data that is critical to designing a larger-scale RCT of MCGT for bereaved parents. Findings from this study will be used to seek NIH R01 funding for a larger-scale efficacy RCT of MCGT, which, in addition to the proposed training, will advance my potential as an independent psychotherapy researcher in the cancer setting.