Cognitive behavioral therapy versus supportive counseling in palliative care for caregivers experiencing bereavement: clinical trial successes and challenges

Abstract

Background: Bereavement support can benefit caregivers suffering from the loss of a loved one. We report successes and challenges of a randomized clinical trial comparing cognitive behavioral therapy (CBT) to supportive care counseling for caregivers. Methods: We recruited caregivers of individuals who previously received palliative care treatment and were now deceased. The study was conducted in a public hospital in New York City predominantly serving low-income patients. Treatments were either CBT or supportive care counseling. Treatment consisted of eight sessions over six months. Outcomes were measured at three and six months. Outcomes were the Bereavement Experience Questionnaire-24 (BEQ-24) which contains three subscales of existential loss/emotional needs, guilt/blame/anger, and preoccupation with thoughts of deceased and the Patient Health Questionnaire-9 (PHQ-9) which measures depressive symptoms. Results: Only two people were enrolled in the trial and 101 people declined to participate. For both CBT and supportive care counseling, there were reduced bereavement symptoms for BEQ-24 existential loss/ emotional needs, BEQ-24 preoccupation with thoughts of deceased, and PHQ-9 depressive symptoms from baseline to six months. For supportive care counseling, BEQ-24 guilt/blame/anger increased from baseline to six months while CBT had the same value from baseline to six months. The most common reason (87.1%) for declining to participate was that support was available elsewhere. C onclusions: Both treatment approaches appear beneficial for improving bereavement and depressive symptoms except for BEQ-24 guilt/blame/anger. Clinicians recruiting those with bereavement from public hospitals serving low-income patients may find it challenging to recruit participants.