title: Randomized Controlled Trial of Family Therapy in Advanced Cancer Continued Into Bereavement.
abstract: 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.
  
  
  
  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.
  
  
  
  On the CGI, a significant treatment effect (Wald χ(2) = 6.88; df = 2; P = .032) and treatment by family-type interaction was found (Wald χ(2) = 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 χ(2) = 8.31; df = 2; P =.048). No significant treatment effects were found on the BDI-II.
  
  
  
  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.
authors.affiliation: David W. Kissane, Talia I. Zaider, Yuelin Li, Shira Hichenberg, Tammy Schuler, Marguerite Lederberg, Rebecca Loeb, and Francesca Del Gaudio, Memorial Sloan Kettering Cancer Center; David W. Kissane, Talia I. Zaider, and Yuelin Li, Weill Medical College of Cornell University; Lisa Lavelle, Ackerman Institute for the Family, New York, NY; and David W. Kissane, Monash University, Victoria, Australia david.kissane@monash.edu.
authors.forename: David W
authors.initials: DW
authors.lastname: Kissane
authors.affiliation: David W. Kissane, Talia I. Zaider, Yuelin Li, Shira Hichenberg, Tammy Schuler, Marguerite Lederberg, Rebecca Loeb, and Francesca Del Gaudio, Memorial Sloan Kettering Cancer Center; David W. Kissane, Talia I. Zaider, and Yuelin Li, Weill Medical College of Cornell University; Lisa Lavelle, Ackerman Institute for the Family, New York, NY; and David W. Kissane, Monash University, Victoria, Australia.
authors.forename: Talia I
authors.initials: TI
authors.lastname: Zaider
authors.affiliation: David W. Kissane, Talia I. Zaider, Yuelin Li, Shira Hichenberg, Tammy Schuler, Marguerite Lederberg, Rebecca Loeb, and Francesca Del Gaudio, Memorial Sloan Kettering Cancer Center; David W. Kissane, Talia I. Zaider, and Yuelin Li, Weill Medical College of Cornell University; Lisa Lavelle, Ackerman Institute for the Family, New York, NY; and David W. Kissane, Monash University, Victoria, Australia.
authors.forename: Yuelin
authors.initials: Y
authors.lastname: Li
authors.affiliation: David W. Kissane, Talia I. Zaider, Yuelin Li, Shira Hichenberg, Tammy Schuler, Marguerite Lederberg, Rebecca Loeb, and Francesca Del Gaudio, Memorial Sloan Kettering Cancer Center; David W. Kissane, Talia I. Zaider, and Yuelin Li, Weill Medical College of Cornell University; Lisa Lavelle, Ackerman Institute for the Family, New York, NY; and David W. Kissane, Monash University, Victoria, Australia.
authors.forename: Shira
authors.initials: S
authors.lastname: Hichenberg
authors.affiliation: David W. Kissane, Talia I. Zaider, Yuelin Li, Shira Hichenberg, Tammy Schuler, Marguerite Lederberg, Rebecca Loeb, and Francesca Del Gaudio, Memorial Sloan Kettering Cancer Center; David W. Kissane, Talia I. Zaider, and Yuelin Li, Weill Medical College of Cornell University; Lisa Lavelle, Ackerman Institute for the Family, New York, NY; and David W. Kissane, Monash University, Victoria, Australia.
authors.forename: Tammy
authors.initials: T
authors.lastname: Schuler
authors.affiliation: David W. Kissane, Talia I. Zaider, Yuelin Li, Shira Hichenberg, Tammy Schuler, Marguerite Lederberg, Rebecca Loeb, and Francesca Del Gaudio, Memorial Sloan Kettering Cancer Center; David W. Kissane, Talia I. Zaider, and Yuelin Li, Weill Medical College of Cornell University; Lisa Lavelle, Ackerman Institute for the Family, New York, NY; and David W. Kissane, Monash University, Victoria, Australia.
authors.forename: Marguerite
authors.initials: M
authors.lastname: Lederberg
authors.affiliation: David W. Kissane, Talia I. Zaider, Yuelin Li, Shira Hichenberg, Tammy Schuler, Marguerite Lederberg, Rebecca Loeb, and Francesca Del Gaudio, Memorial Sloan Kettering Cancer Center; David W. Kissane, Talia I. Zaider, and Yuelin Li, Weill Medical College of Cornell University; Lisa Lavelle, Ackerman Institute for the Family, New York, NY; and David W. Kissane, Monash University, Victoria, Australia.
authors.forename: Lisa
authors.initials: L
authors.lastname: Lavelle
authors.affiliation: David W. Kissane, Talia I. Zaider, Yuelin Li, Shira Hichenberg, Tammy Schuler, Marguerite Lederberg, Rebecca Loeb, and Francesca Del Gaudio, Memorial Sloan Kettering Cancer Center; David W. Kissane, Talia I. Zaider, and Yuelin Li, Weill Medical College of Cornell University; Lisa Lavelle, Ackerman Institute for the Family, New York, NY; and David W. Kissane, Monash University, Victoria, Australia.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Loeb
authors.affiliation: David W. Kissane, Talia I. Zaider, Yuelin Li, Shira Hichenberg, Tammy Schuler, Marguerite Lederberg, Rebecca Loeb, and Francesca Del Gaudio, Memorial Sloan Kettering Cancer Center; David W. Kissane, Talia I. Zaider, and Yuelin Li, Weill Medical College of Cornell University; Lisa Lavelle, Ackerman Institute for the Family, New York, NY; and David W. Kissane, Monash University, Victoria, Australia.
authors.forename: Francesca
authors.initials: F
authors.lastname: Del Gaudio
mesh_terms: D000328:Adult; D001601:Bereavement; D003142:Communication; D005196:Family Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology / Q000628:therapy*