Grant Number:	1R01CA315610-01 Interpret this number
Primary Investigator:	Saracino, Rebecca
Organization:	Sloan-Kettering Inst Can Research
Project Title:	A Pragmatic Randomized Controlled Trial of Brief Meaning Centered Psychotherapy for Patients with Advanced Cancer Receiving Homecare
Fiscal Year:	2026

Project Summary/Abstract One in three patients with serious illness such as advanced cancer experience significant symptoms of depression and anxiety which have a profound, negative impact on quality-of-life (QOL). These individuals often experience existential distress (i.e., feelings of hopelessness, demoralization, loss of meaning and dignity, desire for death or the decreased will to live) that can exacerbate depression and anxiety and result in unnecessary suffering and despair. Despite these significant needs, patients face numerous barriers to receiving appropriate psychological care - especially those who are homebound, a historically underserved group even less likely to engage in treatment. One potential solution to this gap in care is to utilize frontline home health clinicians to deliver evidence-based psychosocial care. In the U.S., approximately 12,200 home health agencies provide care to over 4.5 million patients annually. Most of this care is provided by Registered Nurses (RNs), who comprise 53% of home health care employees. Mental health interventions in this setting are typically beyond RNs’ scope of training. However, given the volume of nurses and their frequent contact with homebound patients, they are uniquely positioned to deliver evidence-based interventions to address emotional suffering for this otherwise difficult-to-reach patient population. Meaning Centered Psychotherapy (MCP) is an empirically supported psychotherapeutic intervention designed to target existential distress and improve spiritual well-being, hopelessness, and QOL in patients with advanced cancer, but clinicians often report it is too long to implement in community practice. To address these implementation challenges and increase the reach of MCP (i.e., 7-sessions), we developed an abbreviated version of MCP for patients with advanced cancer in acute care settings (3-session MCP-Home, Hospital, Hospice, “MCP-H”). In a pilot RCT of telehealth MCP-H (N=71) we partnered with the Visiting Nurse Service (VNS Health) to demonstrate its excellent feasibility, acceptability, and initial superiority to treatment as usual for improving meaning (Cohen’s d=0.59), depression (d=-0.37), anxiety (d=-0.73), and all other secondary outcomes with effects largely maintained at 1-month follow-up. While this demonstrated the promise of 3-session MCP-H for improving meaning and secondary psychosocial outcomes, we need to ensure its efficacy in a fully powered trial and identify mediators and moderators of change. We will continue to partner with VNS Health for this NIH Stage II RCT (N=226) of telehealth MCP-H compared to a nurse-led time and attention control, Client Centered Care with 2-month follow-up. We have three aims: 1) Determine the efficacy of MCP-H for improving meaning; 2) Determine the efficacy of MCP-H for improving depression, anxiety, hopelessness, loneliness, QOL, pain, and desire for hastened death; 3) Identify moderators and mediators of outcomes of the intervention arms. By expanding viable, evidence-based telehealth treatment options for homebound patients, these results will ultimately improve the QOL and decrease the suffering of patients living with advanced cancer at home.





None