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A qualitative exploration of the feasibility and acceptability of Meaning-Centered Psychotherapy for Cancer Caregivers

Published online by Cambridge University Press:  26 January 2022

A. J. Applebaum Open the ORCID record for A. J. Applebaum [Opens in a new window] ,
K. E. Roberts ,
K. Lynch ,
R. Gebert ,
M. Loschiavo ,
M. Behrens ,
L. E. Walsh Open the ORCID record for L. E. Walsh [Opens in a new window] ,
L. C. Polacek Open the ORCID record for L. C. Polacek [Opens in a new window] ,
E. L. Diamond  and
W. S. Breitbart
A. J. Applebaum*
Affiliation:
Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
K. E. Roberts
Affiliation:
Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY
K. Lynch
Affiliation:
Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
R. Gebert
Affiliation:
Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
M. Loschiavo
Affiliation:
Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
M. Behrens
Affiliation:
Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
L. E. Walsh
Affiliation:
Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
L. C. Polacek
Affiliation:
Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
E. L. Diamond
Affiliation:
Department of Neurology, Memorial Sloan Kettering Cancer Center, New York, NY
W. S. Breitbart
Affiliation:
Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
*
Author for correspondence: Allison J. Applebaum, Caregivers Clinic, Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7th Floor, New York, NY 10022, USA. E-mail: applebaa@mskcc.org
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Abstract

Objective

Caregivers of patients with cancer are at significant risk for existential distress. Such distress negatively impacts caregivers’ quality of life and capacity to serve in their role as healthcare proxies, and ultimately, contributes to poor bereavement outcomes. Our team developed Meaning-Centered Psychotherapy for Cancer Caregivers (MCP-C), the first targeted psychosocial intervention that directly addresses existential distress in caregivers.

Method

Nine caregivers of patients with glioblastoma multiforme (GBM) enrolled in a pilot randomized controlled trial evaluating the feasibility, acceptability, and effects of MCP-C, and completed in-depth interviews about their experience in the therapy. One focus group with three MCP-C interventionists was also completed.

Results

Four key themes emerged from interviews: (1) MCP-C validated caregivers’ experience of caregiving; (2) MCP-C helped participants reframe their “caregiving identity” as a facet of their larger self-identity, by placing caregiving in the context of their life's journey; (3) MCP-C enabled caregivers to find ways to assert their agency through caregiving; and (4) the structure and sequence of sessions made MCP-C accessible and feasible. Feedback from interventionists highlighted several potential manual changes and overall ways in which MCP-C can help facilitate caregivers’ openness to discussing death and engaging in advanced care planning discussions with the patient.

Significance of results

The overarching goal of MCP-C is to allow caregivers to concurrently experience meaning and suffering; the intervention does not seek to deny the reality of challenges endured by caregivers, but instead to foster a connection to meaning and purpose alongside their suffering. Through in-depth interviews with caregivers and a focus group with MCP interventionists, we have refined and improved our MCP-C manual so that it can most effectively assist caregivers in experiencing meaning and purpose, despite inevitable suffering.

Keywords

CaregiverCaregiver distressExistential distressMeaning-Centered PsychotherapyMeaning-Centered Psychotherapy for Cancer CaregiversPsychosocial intervention

Information

Type
Original Article
Information
Palliative & Supportive Care , Volume 20 , Issue 5 , October 2022 , pp. 623 - 629
Copyright
Copyright © The Author(s), 2022. Published by Cambridge University Press

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References

Applebaum, A (2019a). Improving palliative care for caregivers of patients with glioblastoma multiforme (GBM). In: Annual Kathleen Foley Palliative Care Retreat and Research Symposium, Jackson, Wyoming.Google Scholar
Applebaum, A (2019b) Meaning-Centered Psychotherapy for Cancer Caregivers (MCP-C). In Applebaum, A (ed.), Cancer Caregivers. New York, NY: Oxford University Press, pp. 237–253.CrossRefGoogle Scholar
Applebaum, AJ and Breitbart, W (2013) Care for the cancer caregiver: A systematic review. Palliative and Supportive Care 11(3), 231–252. doi:10.1017/s1478951512000594CrossRefGoogle ScholarPubMed
Applebaum, AJ, Kulikowski, JR and Breitbart, W (2015) Meaning-Centered psychotherapy for Cancer Caregivers (MCP-C): Rationale and overview. Palliative and Supportive Care 13(6), 1631–1641. doi:10.1017/s1478951515000450CrossRefGoogle ScholarPubMed
Applebaum, AJ, Bevans M, Son T, et al. (2016a) A scoping review of caregiver burden during allogeneic HSCT: Lessons learned and future directions. Bone Marrow Transplantation 51(11), 1416–1422. doi:10.1038/bmt.2016.164CrossRefGoogle Scholar
Applebaum, AJ, Kryza-Lacombe M, Buthorn J, et al. (2016b) Existential distress among caregivers of patients with brain tumors: A review of the literature. Neuro-Oncology Practice 3(4), 232–244. doi:10.1093/nop/npv060CrossRefGoogle Scholar
Applebaum, AJ, Buda KL, Schofield E, et al. (2018) Exploring the cancer caregiver's journey through web-based meaning-centered psychotherapy. Psychooncology 27(3), 847–856. doi:10.1002/pon.4583CrossRefGoogle ScholarPubMed
Bauer-Wu, S and Farran, CJ (2005) Meaning in life and psycho-spiritual functioning: A comparison of breast cancer survivors and healthy women. Journal of Holistic Nursing 23(2), 172–190. doi:10.1177/0898010105275927CrossRefGoogle ScholarPubMed
Braun, M, Mikulincer M, Rydall A, et al. (2007) Hidden morbidity in cancer: Spouse caregivers. Journal of Clinical Oncology 25(30), 4829–4834. doi:10.1200/jco.2006.10.0909CrossRefGoogle ScholarPubMed
Breitbart, WS (2017) Meaning-Centered Psychotherapy in the Cancer Setting Finding Meaning and Hope in the Face of Suffering: Finding Meaning and Hope in the Face of Suffering. Oxford University Press. doi:10.1093/med/9780199837229.001.0001CrossRefGoogle Scholar
Breitbart, W, Poppito S, Rosenfeld B, et al. (2012) Pilot randomized controlled trial of individual meaning-centered psychotherapy for patients with advanced cancer. Journal of Clinical Oncology 30(12), 1304–1309. doi:10.1200/jco.2011.36.2517CrossRefGoogle ScholarPubMed
Breitbart, W, Rosenfeld B, Pessin H, et al. (2015) Meaning-centered group psychotherapy: An effective intervention for improving psychological well-being in patients with advanced cancer. Journal of Clinical Oncolology 33(7), 749–754. doi:10.1200/jco.2014.57.2198CrossRefGoogle ScholarPubMed
Buyck, JF, Ankri J, Dugravot A, et al. (2013) Informal caregiving and the risk for coronary heart disease: The Whitehall II study. Journals of Gerontology 68(10), 1316–1323. doi:10.1093/gerona/glt025CrossRefGoogle ScholarPubMed
Calhoun, LG and Tedeschi, RG (2006) Handbook of Posttraumatic Growth: Research & Practice. Mahwah, NJ: Lawrence Erlbaum Associates Publishers.Google Scholar
Carter, PA (2003) Family caregivers’ sleep loss and depression over time. Cancer Nursing 26(4), 253–259. doi:10.1097/00002820-200308000-00001CrossRefGoogle ScholarPubMed
Catt, S, Chalmers, A and Fallowfield, L. (2008) Psychosocial and supportive-care needs in high-grade glioma. The Lancet Oncology 9(9), 884–891. doi:10.1016/S1470-2045(08)70230-4CrossRefGoogle ScholarPubMed
Cho, MH, Dodd MJ, Lee KA, et al. (2006) Self-reported sleep quality in family caregivers of gastric cancer patients who are receiving chemotherapy in Korea. Journal of Cancer Education 21(1 Suppl), S37–S41. doi:10.1207/s15430154jce2101s_8CrossRefGoogle ScholarPubMed
Christakis, NA and Allison, PD (2006) Mortality after the hospitalization of a spouse. New England Journal of Medicine 354(7), 719–730. doi:10.1056/NEJMsa050196CrossRefGoogle ScholarPubMed
Cliff, AM and MacDonagh, RP (2000) Psychosocial morbidity in prostate cancer: II. A comparison of patients and partners. BJU International 86(7), 834–839. doi:10.1046/j.1464-410x.2000.00914.xCrossRefGoogle Scholar
Covinsky, KE, Goldman L, Cook EF, et al. (1994) The impact of serious illness on patients’ families. SUPPORT investigators. Study to understand prognoses and preferences for outcomes and risks of treatment. Journal of the American Medical Association 272(23), 1839–1844. doi:10.1001/jama.272.23.1839CrossRefGoogle ScholarPubMed
Devine, KA, Manne SL, Mee L, et al. (2016) Barriers to psychological care among primary caregivers of children undergoing hematopoietic stem cell transplantation. Supportive Care in Cancer 24(5), 2235–2242. doi:10.1007/s00520-015-3010-4CrossRefGoogle ScholarPubMed
Frankl, VE (1963) Man's Search for Meaning: Revised and Updated. New York: WW Publisher.Google Scholar
Frankl, VE (1967) Psychotherapy and Existentialism: Selected Papers on Logotherapy. With Contributions by James C. Crumbaugh [Et Al.] New York: Washington Square Press.Google Scholar
Frankl, VE (1972) The feeling of meaninglessness: A challenge to psychotherapy. American Journal of Psychoanalysis 32(1), 85–89. doi:10.1007/bf01872487CrossRefGoogle ScholarPubMed
Frankl, VE (1978) The Unheard cry for Meaing. New York: Simon and Schuster.Google Scholar
Guest, G, Bunce A and Johnson L. (2006) How many interviews are enough?: An experiment with data saturation and variability. Field Methods 18(1), 59–82. doi:10.1177/1525822(05279903CrossRefGoogle Scholar
Hearson, B and McClement, S (2007) Sleep disturbance in family caregivers of patients with advanced cancer. International Journal of Palliative Nursing 13(10), 495–501. doi:10.12968/ijpn.2007.13.10.27493CrossRefGoogle ScholarPubMed
Hudson, PL, Hayman-White K, Aranda S, (2006) Predicting family caregiver psychosocial functioning in palliative care. Journal of Palliative Care 22(3), 133–140.CrossRefGoogle ScholarPubMed
Hudson, PL, Thomas K, Trauer T, et al. (2011) Psychological and social profile of family caregivers on commencement of palliative care. Journal of Pain and Symptom Management 41(3), 522–534. doi:10.1016/j.jpainsymman.2010.05.006CrossRefGoogle ScholarPubMed
Jandhyala, R (2020) Delphi, non-RAND modified Delphi, RAND/UCLA appropriateness method and a novel group awareness and consensus methodology for consensus measurement: A systematic literature review. Current Medical Research and Opinion 36(11), 1873–1887. doi:10.1080/03007995.2020.1816946CrossRefGoogle Scholar
Kent, EE, Mollica MA, Buckenmaier S, et al. (2019) The characteristics of informal cancer caregivers in the United States. Semininars in Oncology Nursing 35(4), 328–332. doi:10.1016/j.soncn.2019.06.002CrossRefGoogle ScholarPubMed
Kim, Y, Shaffer KM, Carver CS, et al. (2014) Prevalence and predictors of depressive symptoms among cancer caregivers 5 years after the relative's cancer diagnosis. Journal of Consulting and Clinical Psychology 82(1), 1–8. doi:10.1037/a0035116CrossRefGoogle ScholarPubMed
King, PR Jr, Beehler GP, Donnelly K, et al. (2021) A practical guide to applying the Delphi technique in mental health treatment adaptation: The example of enhanced problem-solving training (E-PST). Professional Psychology: Research and Practice 52(4), 376–386. doi:10.1037/pro0000371CrossRefGoogle Scholar
Kuckartz, U (2014). Qualitative Text Analysis: A Guide to Methods, Practice & Using Software. Available at: https://doi.org/10.4135/9781446288719.CrossRefGoogle Scholar
Mosher, CE, Given, BA and Ostroff, JS. (2015) Barriers to mental health service use among distressed family caregivers of lung cancer patients. European Journal of Cancer Care 24(1), 50–59. doi:10.1111/ecc.12203CrossRefGoogle ScholarPubMed
Niederberger, M and Spranger, J (2020) Delphi technique in health sciences: A map. Frontiers in Public Health 8, 457–457. doi:10.3389/fpubh.2020.00457CrossRefGoogle ScholarPubMed
Pargament, KI and Ano, GG (2006) Spiritual resources and struggles in coping with medical illness. Southern Medical Journal 99(10), 1161–1162. doi:10.1097/01.smj.0000242847.40214.b6CrossRefGoogle ScholarPubMed
Park, CL and Folkman, S (1997) Stability and change in psychosocial resources during caregiving and bereavement in partners of Men with AIDS. Journal of Personality 65(2), 421–447. doi:10.1111/j.1467-6494.1997.tb00960.xCrossRefGoogle ScholarPubMed
Roth, AJ, Kornblith AB, Batel-Copel L, et al. (1998) Rapid screening for psychologic distress in men with prostate carcinoma. Cancer 82(10), 1904–1908. doi:10.1002/(SICI)1097-0142(19980515)82:103.0.CO;2-X>CrossRefGoogle ScholarPubMed
Salander, P (1996) Brain tumor as a threat to life and personality. Journal of Psychosocial Oncology 14(3), 1–18. doi:10.1300/J077v14n03_01CrossRefGoogle Scholar
Sekayi, D and Kennedy, A (2017) Qualitative Delphi method: A four round process with a worked example. The Qualitative Report 22(10), 2755–2763. doi:10.46743/2160-3715/2017.2974Google Scholar
Vitaliano, PP, Scanlan JM, Zhang J, et al. (2002) A path model of chronic stress, the metabolic syndrome, and coronary heart disease. Psychosomatic Medicine 64(3), 418–435. doi:10.1097/00006842-200205000-00006CrossRefGoogle ScholarPubMed
Wen, PY and Kesari, S (2008) Malignant gliomas in adults. New England Journal of Medicine 359(5), 492–507. doi:10.1056/NEJMra0708126CrossRefGoogle ScholarPubMed