Outcomes of cancer bereavement therapeutic support groups

All outcome measures will be collected online using Qualtrics, a professional survey software. The following questionnaires will be collected at baseline (registering to the groups), prior to every group session, post the intervention, and at 3 months follow up:

1. The Prolonged Grief Disorder Inventory (PG-13). (Prigerson & Maciejewski, 2008) The PG-13 assesses the prevalence and severity of PGD symptoms (e.g. yearning for the deceased, feelings of emotional numbness/detachment from others, feeling that a part of oneself died along with the deceased). The PG-13 is a subset of 13 items from the Inventory of Complicated Grief (ICG; Prigerson et al., 1995). The ICG has very good internal consistency (α=.85), test-retest reliability (.80), and has excellent incremental validity in predicting a variety of grief-related functional impairments, controlling for depression and anxiety.

2. The Patient Health Questionnaire-9 (PHQ-9; Kroenke, Spitzer, & Williams, 2001) is a 9-item self-report questionnaire that measures the severity of depressive symptoms. A sample item is “Feeling tired or having little energy”. Each item is scored on a 4-point scale with response categories of “0=Not at all” to “3=Nearly every day”; this provides a 0 to 27 severity score. The measure has strong psychometric properties (Kroenke et al., 2001).

3. The Generalized Anxiety Disorder-7 (GAD-7; Spitzer, Kroenke, Williams, & Löwe, 2006) is a 7-item self-report questionnaire that measures the severity of anxiety symptoms. A sample item is “Feeling nervous, anxious or on edge”. Each item is scored on a 4-point scale with response categories of “0=Not at all” to “3=Nearly every day”; this provides a 0 to 21 severity score. The measure has strong psychometric properties (Spitzer et al., 2006).

4. The Self-Compassion Scale-Short Form (SCS-SF; Raes, Pommier, Neff, & Van Gucht, 2011: Appendix I) is a 12-item self-report questionnaire that measures self-compassion. A sample item is “I’m disapproving and judgmental about my own flaws and inadequacies”. Each item is scored on a 5-point scale with response categories of “1=Almost Never” to “5=Almost Always”; this provides a total score of 12-60. The measure has strong psychometric properties (Raes et al., 2011). Cronbach’s alpha in the present study was 0.81.

The following questionnaire will be collected after each group session:

The Helpful Aspects of Therapy (HAT; Llewelyn, 1988) is a post-session self-report questionnaire that asks about perceptions of key change processes in therapy. It is partly qualitative and captures perceptions of helpful and unhelpful aspects of the previous session. An example item is “Of the events which occurred in the last group session, which one do you feel was the most helpful or important for you personally? Please describe what the event was.” Each event is then scored as to how helpful or unhelpful it was on a 5-point scale with response categories of “0=Not at all” to “4=Extremely”. Two questions ask participants to identify, describe and then rate first a helpful and second an unhelpful event. In addition, there are two optional questions for participants to identify, describe and then rate other helpful and unhelpful events.

The following questionnaires will be collected at baseline (registering for the group), prior to the start of the intervention, at the end of the intervention, and at 3 months follow up:

1. The PTSD Checklist for DSM-5 (PCL-5; Weathers et al., 2013) is a 20-item self-report questionnaire that assesses symptoms of PTSD. A sample item is “In the past month, how much were you bothered by repeated, disturbing, and unwanted memories of the stress experience?” Each item is scored on a 5-point scale with response categories of “0=Not at all” to “4=Extremely”; this provides a total severity score of 0-80. The measure has strong psychometric properties (Blanchard, Jones-Alexander, Buckley, & Forneris, 1996).

2. Loss-related memory characteristics (OG-M). This 27-item questionnaire asks participants to rate on a 5-point scale (0 – not at all to 4 – very strongly) the extent to which each statement regarding their memory of the loss applied to them during the last month. Twenty-three items probed memory triggers and their consequences (e.g. ‘I am reminded of the loss for no apparent reason’), qualities of memory (e.g. ‘Memories of things we did together are painful’), the poor availability of positive memories (e.g. ‘I struggle to remember positive times without [-]’), and the physical impact of loss-related memories (e.g. ‘The memories of [-] 's death make my body ache with overwhelming fatigue’). Four further items, taken from the intrusiveness scale of the Trauma Memory Questionnaire (Halligan et al., 2003), asked about unintentional memories of the loss (frequency in the last week, distress, how much they seemed to be happening now instead of in the past, and the extent to which they felt as though they were reliving the memory). These items were originally rated on a different rating scale and rescored to 0 to 4 for equivalency. Factor analyses revealed a unidimensional structure. The total loss-related memory characteristics scale demonstrated excellent internal consistency (ω = .98).

3. Negative grief appraisals (OG-A). This 35-item questionnaire asks participants to indicate on a 7-point scale (1 - totally disagree to 7 - totally agree) the extent to which they agree with the statement. Items pertain to five content domains: 1. Hopelessness of self and life (e.g. Without [-] I can never be strong again), 2. Regret (e.g. I blame myself for things I did or did not do when [-] was alive), 3. Negative interpretation of grief (e.g. If I start to cry I won’t be able to stop), 4. Loss of relationships and future (e.g. I cannot maintain previous relationships without [-]), 5. Fear of losing connection to the deceased (e.g. Letting go of my grief would mean betraying [-]). Factor analyses confirmed these content domains as latent factors and supported a higher order latent factor of total appraisals. The total negative appraisals scale demonstrated excellent internal consistency (ω = .98).

4. Maladaptive coping strategies (OG-CS). This 23-item questionnaire asks participants on a 5-point scale (1 - never to 5–always) to indicate how often they used particular strategies to cope with their loss. Items pertain to four content domains: 1. Avoidance (e.g. I avoid places we went together), 2. Proximity seeking (e.g. I feel compelled to surround myself with things that they liked), 3. Grief rumination (e.g. I dwell on moments that could have changed the outcome), and 4. Injustice rumination (e.g. I think about the unfairness of the loss). Factor analyses confirmed these content domains as latent factors and supported a higher order latent factor of total coping strategies. The total maladaptive coping strategies scale demonstrated excellent internal consistency (ω = .96).

5. Social disconnection (OG-SD). This 15-item questionnaire asks participants to indicate on a 7-point scale (1 - totally disagree to 7 - totally agree) the extent to which they agree with the statement. Items pertain to three content domains: 1. Negative interpretation of others’ reactions (e.g. ‘Others would judge me if I were to speak openly about my grief’), 2. Negative interpretation of social situations (e.g. ‘I can’t be myself around other people the way I used to’), 3. Safety in solitude (e.g. ‘It is easier to be alone than to have to pretend to feel ok’). The total social disconnection scale demonstrated excellent internal consistency (α = .96).