A pragmatic randomized controlled pilot trial of brief meaning-centered psychotherapy in home care

Individuals with advanced cancer receiving home health care experience elevated psychosocial and existential distress, yet few interventions address these concerns. This pilot randomized controlled trial examined the feasibility, acceptability, and preliminary efficacy of brief, nurse-delivered, meaning-centered psychotherapy in patients with advanced cancer compared with treatment as usual (TAU).

Distressed patients (aged 18 years and older) were randomized 1:1 to receive either a three-session Meaning-Centered Psychotherapy for Hospitals, Hospice, and Home (MCP-H; n = 33) or TAU (n = 32). Feasibility was based on recruitment, retention, data completion, fidelity, and intervention engagement. Acceptability was based on patients' and nurses' ratings of MCP-H satisfaction. Preliminary efficacy was determined by changes in scores from baseline (T1) to 6 weeks (T2) and 10 weeks (T3) in meaning, and secondary outcomes were assessed using between-group analysis.

Seventy-one patients enrolled. Feasibility was demonstrated by satisfactory recruitment (75% approach-to-consent rate; 92% enroll-to-randomize rate), retention (74% and 75% at T2 and T3, respectively), intervention engagement (94% completed 100% of the sessions), and treatment adherence (87% mean rating). Participants endorsed the intervention's acceptability (96% satisfied or very satisfied). MCP-H participants experienced improvements in meaning using the Cohen's d (d = 0.59 at T2; d = 0.39 at T3) and most other secondary psychosocial outcomes at 6 and 10 weeks compared with TAU participants.

MCP-H is feasible and acceptable among patients with advanced cancer in home care. This intervention demonstrated promising evidence of clinical efficacy. A larger, fully powered randomized controlled trial is needed to test the efficacy of the intervention for patients, nurses, and health system outcomes against an active control group.