Efficacy of an online meaning-centered psychotherapy in caregivers of advanced cancer (eMCP-C) : a mixed-method pilot randomized controlled trial

Abstract

Background: Rising advanced cancer incidence globally places profound existential distress and psychological burden on family caregivers. We culturally adapted Meaning-Centered Psychotherapy for Cancer Caregivers (MCP-C) from Western to Chinese context, targeting existential distress through meaning-making processes. Aims: This pilot randomized controlled trial aimed to examine the feasibility, acceptability, and preliminary effects of an online MCP-C (eMCP-C) among caregivers of patients with advanced cancer. Methods: Caregivers of patients with advanced cancer, experiencing distress related to caregiving, were randomly assigned (1:1) to eMCP-C or enhanced usual care groups. Over 7 weeks, participants received weekly individual session of eMCP-C focusing on meaning making and coping with caregiving, whereas enhanced usual care group received resources for mental health treatment and targeted referrals for specific distress problems. Feasibility outcomes were assessed through questionnaires and semi-structured interviews at 7-week. Efficacy outcomes were assessed by questionnaire at baseline, 7, and 19 weeks. Results: Forty-six caregivers enrolled (26–79 years old), among which thirty-seven (80%) completed the study. Intervention attendance, retention rates, and participant satisfaction were satisfactory. Depression, anxiety, meaning, peace, and self-esteem improved from baseline to immediate and 3-month post-intervention in intervention group. Qualitative analysis revealed three key therapeutic mechanisms: (1) Therapeutic Alliance as a Catalyst for Intrapersonal and Interpersonal Healing, (2) Meaning-making Through Acceptance and Action, and (3) Empowering Through Affirmation and Self-Determined Action. Conclusions: For Chinese caregivers of patients with advanced cancer, eMCP-C is feasible, well-accepted, and showed preliminary benefits in psychological distress, meaning, peace, and self-esteem, compared to an enhanced usual care group.