Meaning-Centered Psychotherapy for Cancer Caregivers: A pilot trial among caregivers of patients with glioblastoma multiforme

Abstract

Caregivers of patients with glioblastoma multiforme (GBM) 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. The purpose of this study was to evaluate the feasibility, acceptability, and preliminary effects of MCP-C among caregivers of patients with GBM via a mixed-method pilot trial. Caregivers were randomized to seven sessions of MCP-C or Enhanced Usual Care (EUC), which included distress screening and the provision of targeted referrals and completed quantitative assessments at baseline (T1), after completion of MCP-C (T2), and at 2-month follow-up (T3). A subset of participants engaged in semistructured interviews at T2. Of 60 caregivers randomized, 55 were evaluable for preliminary efficacy analysis. Constrained linear mixed models indicated the MCP-C arm had statistically significant improvement relative to the EUC arm in the primary outcome of personal meaning and multiple secondary outcomes, including benefit finding, depressive symptomatology, and spiritual wellbeing. MCP-C demonstrated preliminary efficacy in facilitating caregivers' capacity to experience a sense of meaning and purpose despite the challenges and suffering associated with providing care to patients with GBM. Future studies are needed among more diverse samples of caregivers and should include the opportunity for concurrent patient enrollment to allow for a reciprocal and augmented experience of meaning among patient-caregiver dyads.

Keywords: Cancer caregivers; Glioblastoma multiforme; Meaning-Centered Psychotherapy; Meaning-Centered Psychotherapy for Cancer Caregivers; Psychosocial interventions.

Fig 1

Consort diagram.

Fig 2

Primary and key secondary endpoint scores by study arm and assessment time. The model-estimated means and 95% confidence intervals (indicated by the I bars) at each assessment time are presented separately by study arm. For each endpoint, these estimates were calculated from a cLMM in which the two study arms were constrained to have a common baseline mean, reflecting the preintervention nature of the baseline assessment (T1). In each model, the dependent variable vector included the preintervention baseline assessment (T1), as well as the post-treatment (T2), and long-term follow-up assessments (T3). Each model included treatment arm, time point (categorical), and the arm-by-time interaction as fixed effects, and patient-specific random intercepts were included to account for the repeated outcome measurements within patients. Panel A: Life Attitudes Profile-Revised (LAP-R) PMI scores by assessment time and study arm. The PMI is a composite score calculated as the sum of the Purpose and Coherence subscales. Scores for the PMI can range from 16 to 112. Panel B: LAP-R Existential Transcendence (ET) scores by assessment time and study arm. ET is a composite score calculated as the sum of the Purpose, Coherence, Choice/Responsibleness, and Death Acceptance subscales, minus the sum of the Existential Vacuum and Goal Seeking subscales. Scores for the ET composite can range from −80 to 208. Panel C: FACIT-Sp-12 total scores by assessment time and study arm. The FACIT-Sp-12 total score can range from 0 to 48. Panel D: BFS total scores by assessment time and study arm. The BFS total score can range from 17 to 85. BFS Benefit Finding Scale; cLMM constrained linear mixed model; EUC Enhanced Usual Care; FACIT-Sp-12 Functional Assessment of Chronic Illness Therapy—Spiritual Well-Being Scale; LAP-R ET Life Attitudes Profile-Revised Existential Transcendence; LAP-R PMI Life Attitudes Profile-Revised Personal Meaning Index; MCP-C Meaning-Centered Psychotherapy for Cancer Caregivers; PMI Personal Meaning Index.