Group therapy for family caregivers of PWD at risk for complicated grief: A feasibility and efficacy analysis of pre‐loss group therapy

Abstract

AbstractBackgroundOur previous evaluation of Complicated Grief Group Therapy (CGGT) in bereaved dementia family caregivers demonstrated efficacy and identified intervention elements suitable for adaption into a preventative care approach.MethodWe adapted CGGT treatment elements into a manualized 10 session pre‐loss group psychotherapy—Pre‐Loss Group Therapy (PLGT)—for dementia caregivers at risk for Complicated Grief (CG). We implemented and evaluated three PLGT cohorts in three long‐term care facilities with family caregivers at‐risk for CG whose care recipient had a life expectancy of 6 months or less and resided in a long‐term care facility (NT = 24).ResultEvaluation of participant preparedness for the death of the person with dementia (PWD), self‐care and grief outcomes showed significant improvement across domains between pre and post‐group. Notably, there was a statistically significant decrease in grief as measured by the Inventory of Complicated Grief score from baseline (M = 25.67, SE=1.80) to post‐group (M = 14.41, SE=1.65) t(21)= 6.280, p<0.001 and a statistically significant increase in meaning making as measured by the Grief and Meaning Reconstruction Inventory score from baseline (M = 111.74, SE=1.96) to post‐group (M = 116.46, SE=1.65) t(21)= ‐3.197, p<0.01. Clinician‐rated grief severity declined (N=22, β = –0.472, SE = 0.018, p < 0.001) per week and grief improvement increased (N=22, β = 0.259, SE = 0.023, p < 0.001) per week, as assessed on the Clinician Global Impressions Scale. We evaluated Early‐Stage intervention feasibility components of recruitment, retention, treatment fidelity, as well as PLGT participant acceptability, tolerability, satisfaction and treatment adherence. Of participants, 75% completed at least 80% of sessions, and 91% completed all assessments. Each feasibility target was achieved.ConclusionThis is the first known application of proven therapeutic strategies to address CG applied to high‐risk dementia caregivers prior to the death of the PWD. Caregivers at risk for CG may benefit from group therapy targeting preparedness and pre‐loss grief experience, as we provide with PLGT. PLGT holds promise for translation into comprehensive caregiver support programs and delivered to active caregivers of living PWD at risk for CG across community and in the settings of hospice and long‐term care.