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Principal Investigator: Wendy G. Lichtenthal
Organization: UNIVERSITY OF MIAMI SCHOOL OF MEDICINE
Fiscal Year: 2024
Award: $585,321
Funding agency: National Institute of Nursing Research
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.
Terms: <0-11 years old><Access to Care><Address><Advanced Cancer><Advanced Malignant Neoplasm><Anxiety><Bereavement><Blinded><COVID-19><CV-19><Cancer Patient><Cancers><Cannot see a future><Cardiac Diseases><Cardiac Disorders><Care Givers><Caregivers><Caring><Cessation of life><Child><Child Youth><Children (0-21)><Communities><Complement><Complement Proteins><Coronavirus Infectious Disease 2019><Data><Death><Diagnostic><Dissemination and Implementation><Distress><Emotional><Emotional Depression><Evaluation><Evidence based intervention><Face><Fathers><Feeling hopeless><Feels there is no future><Goals><Grief><Grief reaction><Health Services Accessibility><Health behavior><Healthcare><Heart Diseases><Home><Institution><Intervention><Intervention Strategies><Intervention Studies><Interview><Investigators><Left><Life><Loss of hope for the future><Malignant Neoplasms><Malignant Tumor><Manuals><Measurable><Measures><Mediating><Mediator><Mental Depression><Mental Health><Mental Hygiene><Methods><Mothers><Negative about the future><No hope for the future><Outcome><Outcome Study><Pain><Painful><Palliative Care><Palliative Therapy><Palliative Treatment><Parents><Patient Self-Report><Population><Productivity><Psychological Health><Psychotherapy><QOL><Quality of life><Randomized><Randomized, Controlled Trials><Reporting><Research><Research Personnel><Researchers><Risk><Role><Sampling><Self-Report><Services><Site><Structure><Symptoms><Therapeutic><Time><Treatment Efficacy><Underserved Population><Videoconferencing><Work><access to health services><access to services><access to treatment><accessibility to health services><arm><availability of services><barrier to care><barrier to health care><barrier to healthcare><barrier to treatment><care access><care as usual><comfort care><community setting><comparable efficacy><comparative efficacy><compare efficacy><complementation><coronavirus disease 2019><coronavirus disease-19><coronavirus infectious disease-19><depression><depression symptom><depressive><depressive symptoms><design><designing><develop therapy><evidence base><experience><faces><facial><fighting><health care><health related behavior><health service access><health services availability><heart disorder><high risk><homes><hopelessness><improved><innovate><innovation><innovative><intervention arm><intervention development><intervention effect><intervention efficacy><intervention research><interventional research><interventional strategy><interventional study><interventions research><kids><malignancy><neglect><neoplasm/cancer><novel><obstacle to care><obstacle to healthcare><parent><physical conditioning><physical health><post intervention><primary outcome><public health priorities><randomisation><randomization><randomized control trial><randomly assigned><recruit><response><secondary outcome><service availability><social role><sound><telehealth><therapeutic efficacy><therapy development><therapy efficacy><treatment access><treatment arm><treatment as usual><treatment development><treatment effect><trial comparing><under served group><under served individual><under served people><under served population><underserved group><underserved individual><underserved people><usual care><video conferencing><youngster>