Research
My program of research is organized around interacting themes that have successfully garnered federal and private foundation support, including awards from the National Cancer Institute, the National Institute of Nursing Research, the American Cancer Society, and the T.J. Martell Foundation.
Caregiver-Specific Psychosocial Intervention Development. A primary focus of my research is the development of feasible, acceptable, and targeted psychosocial interventions for caregivers, such as Meaning-Centered Psychotherapy for Caregivers (MCP-C). Despite being a source of suffering, the caregiving experience is concurrently an opportunity to connect to a sense of meaning and purpose, in both caregiving and in life. While caregivers rarely choose to step into the role, once assumed, caregiving allows for the realization of new strengths and capacities, for healing of relationships, refinement of life goals, and an enhanced sense of meaning and purpose. I developed MCP-C to help caregivers connect to a sense of meaning and purpose in caregiving and in life more generally. Through seven sessions that include didactics and structured reflection prompts, caregivers explore how they may continue to connect to what is meaningful to them despite suffering brought on by caregiving. The MCP-C manual will be published by Oxford University Press in late 2024.
Additional interventions for caregivers currently under development include Emotion Regulation Therapy for Caregivers, Cognitive Behavioral Therapy for PTSD in Caregivers, and a Caregiver Communication Skills Training Program to assist caregivers in engaging in difficult but necessary advance care planning discussions with loved ones and healthcare providers.
Prognostic Understanding and Healthcare Communication. A secondary focus of my research is on prognostic understanding among patients with advanced cancer and their caregivers, and the role of this understanding on patients’ and caregivers’ willingness to engage in advance care planning (ACP) discussions. My research has highlighted a significant discrepancy in reported awareness between patients and caregivers, and caregivers’ strong desire to obtain skills that will assist them in facilitating ACP conversations with patients and healthcare providers. This work has inspired the development of a communication skills training program for caregivers to assist them in navigating their roles as healthcare proxies and in engaging in these difficult but necessary conversations.
Representative publications:
Caregiver Identification, Screening, and Documentation. The distress experienced by caregivers has the potential to be mitigated or prevented with proper psychosocial support. However, too often, access-to-care barriers interfere with caregivers receiving critical support services. Although there are many systemic contributors to caregiver underutilization of mental health services, infrastructure such as the establishment of separate medical records for caregivers at the time that patients’ records are generated is needed to facilitate caregiver support. Additionally, while distress screening is a standard practice among patients, there are no routine, comprehensive, distress screening programs in practice for caregivers, who typically report higher distress than patients themselves. In our already overburdened healthcare system, distress screening will allow for the identification and triaging of caregivers based on level of need. In collaboration with the Cancer Support Community, I am currently evaluating the benefits of the CancerSupportSource-Caregiver™ (CSS-CG), the first and only validated, comprehensive distress screening system that addresses caregivers’ multifaceted supportive care needs, including their own emotional and physical needs, as well as their concerns regarding the patient. The long-term goal of this research is to make distress screening for caregivers a standard of care and to assist healthcare systems to identify caregivers early and provide them with necessary support to protect against the negative effects of caregiving.