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面临着独特的挑战，如何让他们的损失变得有意义。他们很容易受到许多有害后果的影响，包括长期悲伤障碍（PGD）。尽管有这些事实，但父母没有充分利用丧亲心理社会服务。显然，需要为失去亲人的父母制定有经验支持的概念上合理的干预措施。本研究发现，手动意义中心心理治疗（MCP）能有效地提高晚期癌症患者的意义感和目的感。虽然先前的研究已经描述了失去亲人的父母所面临的意义危机，但关于失去亲人的父母在意义创造方面受到挑战的具体方式的研究是有限的。此外，关于是否针对高危人群（如PGD）进行悲伤干预结果研究一直存在争议。本研究计划的长期目标是发展并评估一种理论驱动的以意义为中心的哀伤干预，以提升丧亲父母的意义，并最终减少他们的痛苦。为了使MCP成为一种可行、可接受和有效的癌症丧亲父母干预措施，全面了解他们独特的丧亲经历、干预偏好和使用心理社会服务的障碍是至关重要的。本混合方法试点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)确定高、低PGD亚组父母意义主题的差异，以帮助选择目标人群；(3)识别与失亲父母使用心理社会服务相关的因素，包括干预偏好和感知障碍，以指导制定可接受的干预形式。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。父母首先要完成一套定量评估：1)意义和目的，2)PGD, 3)不安全依恋（PGD的一个关键风险因素），4)整体调整，5)心理社会服务的使用，偏好和使用的感知障碍。使用PGD的测量，我们将确定得分至少一个标准差高于规范（n = 12，“高PGD亚组”）和至少一个标准差低于规范（n = 12，“低PGD亚组”）的父母。我们将对意义生成的主题进行深入的半结构化定性访谈。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亚组在寻找意义方面将报告不同的主题和更严峻的挑战。在目标3中，基于治疗恐惧的概念，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。

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.