Supporting those bereaved by cancer: a service evaluation and investigation of cognitive behavioural mechanisms in the treatment of prolonged grief.

Abstract

Background: Individuals bereaved by cancer face significant emotional challenges, often experiencing prolonged grief disorder (PGD), PTSD, depression, and anxiety. Effective interventions are needed to target these mental health problems. This study evaluates the outcomes of the specialist bereavement charity, The Loss Foundation's therapeutic group intervention designed for individuals grieving a cancer-related loss.Methods: A total of 68 participants, enrolled across five cohorts, received a short-term group intervention targeting cognitive-behavioural factors and self-compassion. Due to recruitment limitations, randomized analyses were underpowered, therefore a broader service evaluation was performed, combining data from 2016 and 2018 cohorts. The primary outcome was PGD symptoms measured by the PG-13, with secondary outcomes examining PTSD, depression, anxiety, and self-compassion. Process measures were memory characteristics, grief appraisals, maladaptive coping strategies, and social disconnection. Data were analysed using linear mixed-effects models.Results: Significant reductions were observed in symptoms of PGD (d = 0.65 at 3-month follow-up), PTSD, depression, and anxiety, with improvements in self-compassion (d = 0.53). Cognitive-behavioural process measures also showed significant changes, particularly in memory characteristics and negative appraisals, though social disconnection did not significantly change. Exploratory analyses indicated that lower baseline negative appraisals predicted better treatment outcomes. Attrition was minimal after the intervention began, though approximately 25% of participants did not provide follow-up data.Conclusions: The group intervention demonstrated positive effects on grief-related and mental health outcomes, supporting the use of cognitive-behavioural approaches in cancer bereavement. However, further randomized trials with larger samples are needed to confirm these findings and address limitations related to randomization and data completeness.