Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY.
Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY.
Palliat Support Care. 2022 Oct;20(5):623-629. doi: 10.1017/S1478951521002030.
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.
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.
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.
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.
癌症患者的照顾者存在明显的存在性困扰风险。这种困扰会对照顾者的生活质量和担任医疗代理人的能力产生负面影响，最终导致悲伤结局不佳。我们的团队开发了针对癌症照顾者的以意义为中心的心理疗法（MCP-C），这是第一种直接针对照顾者存在性困扰的靶向心理社会干预方法。
九名胶质母细胞瘤（GBM）患者的照顾者参加了一项试点随机对照试验，评估 MCP-C 的可行性、可接受性和效果，并完成了关于他们在治疗中的体验的深入访谈。还完成了一个由三名 MCP-C 干预者组成的焦点小组。
访谈中出现了四个关键主题：（1）MCP-C 验证了照顾者的照顾经验；（2）MCP-C 通过将照顾放在生活历程的背景下，帮助参与者重新构建他们的“照顾身份”作为其更大自我认同的一个方面；（3）MCP-C 使照顾者能够通过照顾找到表达自己能动性的方法；（4）课程的结构和顺序使 MCP-C 易于接受和实施。干预者的反馈强调了几个潜在的手册更改和整体方法，这些方法可以帮助促进照顾者对讨论死亡和与患者进行高级护理计划讨论的开放性。
MCP-C 的总体目标是让照顾者同时体验意义和痛苦；该干预方法并不试图否认照顾者所承受的挑战的现实，而是培养与意义和目的的联系，同时应对他们的痛苦。通过对照顾者进行深入访谈和对 MCP 干预者进行焦点小组讨论，我们对 MCP-C 手册进行了改进和完善，以便它能够最有效地帮助照顾者体验意义和目的，尽管不可避免地会感到痛苦。
