Severity of complicated grief and risk of prolonged grief disorder are reduced in high-risk families that receive family-focused therapy during palliative care and into bereavement, according to a study published in the Journal of Clinical Oncology.1
Certain levels of dysfunction indicate a family may need systematic family-centered cancer care when advanced cancer is diagnosed in a relative. In this randomized controlled trial, researchers assessed the effectiveness of standard care vs manualized family intervention in families at risk from dysfunctional relationships due to an advanced cancer diagnosis in a relative.
After screening 1488 patients or relatives at Memorial Sloan Kettering Cancer Center or 3 related community hospice programs, 620 patients (42%), representing 170 families, were recruited for this study. The families were stratified by 3 levels of family dysfunction (low communicating, low involvement, and high conflict) and randomly assigned to 1 of 3 arms: standard care, 6 sessions of a manualized family intervention, or 10 sessions of the intervention. Primary outcomes were measured with the Complicated Grief Inventory-Abbreviated (CGI) and Beck Depression Inventory-II (BDI-II). Generalized estimating equations allowed for clustered data in an intention-to-treat analysis.
The CGI revealed a significant treatment effect (Wald χ2 = 6.88; df = 2; P = .032) and treatment by family-type interaction (Wald χ2 = 20.64; df = 4; P < .001). Ten sessions of the intervention resulted in better outcomes than did standard care for low-communicating and high-conflict families compared with low-involvement families.
Low-communicating families improved by 6 months of bereavement. At 13 months of bereavement, 15.5% of the bereaved in the standard care arm developed a prolonged grief disorder compared with 3.3% of those who received 10 sessions of the intervention (Wald χ2 = 8.31; df = 2; P =.048). No significant treatment effects were found on the BDI-II.
1. Kissane DW, Zaider TI, Li Y, et al. Randomized Controlled Trial of Family Therapy in Advanced Cancer Continued Into Bereavement [published online ahead of print April 11, 2016]. J Clin Oncol. doi:10.1200/JCO.2015.63.0582.