Randomized controlled trial of family therapy in advanced cancer continued into bereavement Journal Article


Authors: Kissane, D. W.; Zaider, T. I.; Li, Y.; Hichenberg, S.; Schuler, T.; Lederberg, M.; Lavelle, L.; Loeb, R.; Del Gaudio, F.
Article Title: Randomized controlled trial of family therapy in advanced cancer continued into bereavement
Abstract: Purpose: Systematic family-centered cancer care is needed. We conducted a randomized controlled trial of family therapy, delivered to families identified by screening to be at risk from dysfunctional relationships when one of their relatives has advanced cancer. Patients and Methods: Eligible patients with advanced cancer and their family members screened above the cut-off on the Family Relationships Index. After screening 1,488 patients or relatives at Memorial Sloan Kettering Cancer Center or three related community hospice programs, 620 patients (42%) were recruited, which represented 170 families. Families were stratified by three levels of family dysfunction (low communicating, low involvement, and high conflict) and randomly assigned to one of three arms: standard care or 6 or 10 sessions of a manualized family intervention. Primary outcomes were 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. Results: On the CGI, a significant treatment effect (Wald χ2 = 6.88; df =2;P = .032) and treatment by familytype interaction was found (Wald χ2 = 20.64; df = 4; P < .001), and better outcomes resulted from 10 sessions compared with standard care for low-communicating and high-conflict groups compared with low-involvement families. Low-communicating families improved by 6 months of bereavement. In the standard care arm, 15.5% of the bereaved developed a prolonged grief disorder at 13 months of bereavement compared with 3.3% of those who received 10 sessions of intervention (Wald χ2 =8.31; df = 2; P =.048). No significant treatment effects were found on the BDI-II. Conclusion: Family-focused therapy delivered to high-risk families during palliative care and continued into bereavement reduced the severity of complicated grief and the development of prolonged grief disorder. © 2016 by American Society of Clinical Oncology.
Journal Title: Journal of Clinical Oncology
Volume: 34
Issue: 16
ISSN: 0732-183X
Publisher: American Society of Clinical Oncology  
Date Published: 2016-06-01
Start Page: 1921
End Page: 1927
Language: English
DOI: 10.1200/jco.2015.63.0582
PROVIDER: scopus
PUBMED: 27069071
PMCID: PMC4966341
DOI/URL:
Notes: Article -- Export Date: 1 July 2016 -- Source: Scopus
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MSK Authors
  1. Yuelin Li
    136 Li
  2. David W Kissane
    160 Kissane
  3. Talia I Zaider
    43 Zaider
  4. Tammy Ann Schuler
    27 Schuler
  5. Rebecca Rose Loeb
    13 Loeb