A nature-based intervention for bereaved friend and family cancer caregivers: a study protocol

Friend and/or family caregivers (FCGs) of those with terminal cancer are heavily relied upon to address the emotional and physical needs of the patient facing death. Although increasing research has focused on testing supportive interventions for FCGs who deliver home-based care at end of life, limited attention has targeted strategies that support grief processing for bereaved FCGs during the months following the patients' death. Both natural environments and meditation practices are shown to support directed attention, reflection, and the capacity to remain present with painful thoughts and emotions that are essential for grief processing. This mixed-method study assesses the potential of a new tailored online audio nature-meditative intervention to support grief recovery and healing among 70 bereaved cancer caregivers who are in the first year of bereavement. A primary goal is to assess the acceptability and feasibility of both content and delivery methods. Measures for the 6-week intervention include numbers eligible vs. consented; numbers consented vs. completed; number of weeks using the intervention, and self-report feasibility/acceptability. Potential effect size estimate data for future larger scale work will be collected at three time points: baseline (Time 1; study week 0), at the intervention end (Time 2; week 6), and at follow-up (Time 3; study week 12) on quality of life, bereavement (grief), directed attention, anxiety and depressive symptoms. Additionally, semi-structured interviews with a diverse representative subsample of 15 caregivers will be conducted at the end of the 12-week study to further assess acceptability and feasibility in more depth. Data analyses will include descriptive statistics, linear mixed models, and content analysis. Findings will be used to assess and enhance the intervention prior to wider scale testing with the long-term goal of establishing an evidence-based intervention for supporting bereaved cancer caregivers as they process grief and adapt to their loss.