Meaning-Centered Psychotherapy to Meet Palliative Care Needs of Cancer Caregivers

PROJECT SUMMARY In 2020, 53 million people in the U.S. served as family caregivers, the partners, relatives, and friends who provide assistance (i.e., physical, emotional) to patients with often life-threatening, incurable illnesses. Caregivers are increasingly tasked with responsibilities once performed by medical professionals, and the

availability and health of supportive caregivers is more critical than ever. A growing number of caregivers provide care to patients with advanced, life-limiting cancers, and are tasked with critical patient care responsibilities, and play a significant role in healthcare communication and advanced care planning as

healthcare proxies. The burden of these responsibilities is great and is driven largely by existential distress, which contributes to anxiety, depression, poor quality of life, and mental health challenges in bereavement. Concurrently, caregiving is an opportunity to experience a profound sense of meaning and purpose; caregiving

allows for the realization of new strengths and capacities, healing of relationships, and refinement of life goals. When existential distress is addressed, caregivers can experience an enhanced sense of well-being despite their challenges. While many interventions have been developed to support cancer caregivers, none directly

target existential distress. Our group adapted Meaning-Centered Psychotherapy (MCP), a highly effective intervention in decreasing existential distress and enhancing well-being among patients with advanced cancer, for cancer caregivers. Meaning-Centered Psychotherapy for Cancer Caregivers (MCP-C) is a stakeholder-

informed, innovative, manualized intervention designed to assist caregivers to connect to meaning and purpose in life, despite the challenges of caregiving. Results of our pilot randomized controlled demonstrated MCP-C’s feasibility, acceptability, and superiority in improving meaning, benefit-finding, depression, and

spiritual wellbeing. In the proposed trial, we will more rigorously evaluate the efficacy of MCP-C through a randomized controlled trial of 200 caregivers of patients with advanced (Stage III/IV solid tumor) cancer who will receive 7 sessions of MCP-C or Supportive Psychotherapy for Caregivers (SP-C), the standard of

community-based caregiver care. Participants will undergo assessments of meaning and spiritual wellbeing (primary outcomes), and anxiety, depression, benefit finding, caregiver burden, and social support (secondary outcomes) at baseline, post-treatment, and at 6- and 12-months follow-up. Bereavement outcomes including

pre- and post-loss grief, preparedness for loss, and regret will also be evaluated at each time point. We predict MCP-C will result in greater improvements in primary and secondary outcomes, and that sense of meaning in life will mediate treatment effects. We also predict that MCP-C will result in better preparedness for loss and

improved pre- and post-loss grief and regret. Our results will enhance our capacity to powerfully target existential distress in caregivers of patients with advance cancer and by extension, improve their capacity to provide critical care to patients at end-of-life.