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.
Improving end-of-life care, including bereavement support, is a public health priority and is part of comprehensive continuity of care for those who lose a loved one to cancer. There is an absence of empirically-supported psychosocial interventions to assist parents who lose a child to cancer, who report numerous barriers to accessing existing professional support services. This study will be used to establish the feasibility and promise of an innovative, theory-driven individual grief intervention, Meaning-Centered Grief Therapy (MCGT), for parents who have lost a child to cancer, delivered via videoconferencing to improve access to support and the potential for dissemination.
|Wiener, Lori; Sweeney, Corinne; Baird, Kristin et al. (2014) What do parents want to know when considering autopsy for their child with cancer? J Pediatr Hematol Oncol 36:464-70|