Fattibilità e risultati dei gruppi di lutto del cancro online guidato dal terapeuta

Participants randomised to non-waitlist, accessing the online bereavement group intervention immediately

The intervention uses a transdiagnostic model that incorporates aspects of peer support, psychoeducation, trauma-informed cognitive behavioural therapy (CBT), Compassion focused therapy (CFT) models of distress. It also aligns itself to the Dual Processing Model of coping with bereavement (Stroebe & Schut, 2010) and Tonkin's model of grief (Tonkin, 1996).

participants randomised to waitlist-control accessing the online bereavement group intervention after a delay (three months later) immediate group

The intervention uses a transdiagnostic model that incorporates aspects of peer support, psychoeducation, trauma-informed cognitive behavioural therapy (CBT), Compassion focused therapy (CFT) models of distress. It also aligns itself to the Dual Processing Model of coping with bereavement (Stroebe & Schut, 2010) and Tonkin's model of grief (Tonkin, 1996).

is a 9-item self-report questionnaire that measures the severity of depressive symptoms. Kroenke et al. (2001) reported that the measure has strong psychometric properties: the internal consistency was 0.89 and test-retest reliability between patient self-report and mental health professional administering the measure telephonically 48 hours later was 0.84. The measure also has good convergent validity (r=0.73) with the mental health subscale of the Short- Form General Health Surv. The PHQ-9 has not been validated with bereaved populations.

is a 7-item self-report questionnaire that measures the severity of anxiety symptoms. Spitzer et al., (2006) reported that the measure has strong psychometric properties: the internal consistency was 0.92 and test-retest reliability was 0.83 over a period of a week. The measure has strong convergent validity with the Beck Anxiety Inventory (r=0.72) and the anxiety sub-scale of the Symptom Checklist-90 (r=0.74). The GAD-7 has not been validated with bereaved populations.

13-item self-report measure that examines three facets of prolonged grief disorder: feelings, thoughts and actions, occurring over the past month. The measure has strong psychometric properties. For example, Ashouri et al., (2024) found that this measure demonstrated good internal consistency (omega coefficient of 0.93), and test-retest reliability with an interval of 6 weeks being 0.89. The PG-13 was shown to be a reliable scale for the assessment of individuals at risk for developing PGD with high scores on internal consistency in bereaved Swedish parents (Pohlkamp et al., 2018). However, these properties have been validated with a few studies.

is a 20-item self-report questionnaire that assesses symptoms of PTSD. Blevins et al., (2015) reported that the measure has strong psychometric properties: when tested with trauma-exposed undergraduate students, the internal consistency was 0.94 and the test-retest reliability was 0.82 over a period of a week. There appears to be no validation of the PCL-5 targeting traumatically bereaved individuals.

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. It is beyond the scope of this present study to analyse the qualitative data, however this measure provides valuable feedback, which the facilitators can be aware of and address if appropriate.

Researchers will aim to foster trusting relationships to help the participants to feel engaged in the research process. Participants will be given opportunities to share their thoughts and reflections during the group to facilitate engagement with the content.

is a 26-item self-report questionnaire that measures self-compassion. Raes et al. (2011) reported that the measure has strong psychometric properties: the internal consistency was 0.85 and the test-retest reliability over a period of five months was 0.71. The total score of the SCS-SF correlates highly (r=0.98) with the longer 26-item Self-Compassion Scale. Construct validity of the SCS-SF has not been tested but the long version of the SCS was negatively correlated (r=-0.65) with the self-criticism subscale of the Depressive Experiences Questionnaire. The SCS-SF has not been validated with bereaved populations.

is a 15-item scale developed from interviews with bereaved individuals. Smith et al., (2020) indicate that internal consistency for the total OG-SD and its subscales were good or excellent (Cronbach alpha 0.80). The OG-SD showed a good 7-day-retest reliability across the total and subscales, indicating a temporally stable assessment of perceived social disconnection (test-retest 0.94). However, although overall the OG-SD was deemed stable over time, other two subscales may be less stable over time. The test-retest sample was also relatively small, which means that it is possible that large effects may have been caused within a few individuals.

As part of group therapeutic interventions, The Loss Foundation routinely collects outcome measures and demographic information to evaluate the effectiveness of its services. For therapy groups, the data securely stored.

As part of group therapeutic interventions, The Loss Foundation routinely collects outcome measures and demographic information to evaluate the effectiveness of its services. For therapy groups, the data securely stored.

As part of group therapeutic interventions, The Loss Foundation routinely collects outcome measures and demographic information to evaluate the effectiveness of its services. For therapy groups, the data securely stored.

As part of group therapeutic interventions, The Loss Foundation routinely collects outcome measures and demographic information to evaluate the effectiveness of its services. For therapy groups, the data securely stored.

As part of group therapeutic interventions, The Loss Foundation routinely collects outcome measures and demographic information to evaluate the effectiveness of its services. The data securely stored and we have ethical approval to capture special category data for example ethnicity.

As part of group therapeutic interventions, The Loss Foundation routinely collects outcome measures and demographic information to evaluate the effectiveness of its services. For therapy groups, the data securely stored.

As part of group therapeutic interventions, The Loss Foundation routinely collects outcome measures and demographic information to evaluate the effectiveness of its services. For therapy groups, the data securely stored.

As part of group therapeutic interventions, The Loss Foundation routinely collects outcome measures and demographic information to evaluate the effectiveness of its services. For therapy groups, the data securely stored.

As part of group therapeutic interventions, The Loss Foundation routinely collects outcome measures and demographic information to evaluate the effectiveness of its services. For therapy groups, the data securely stored.

As part of group therapeutic interventions, The Loss Foundation routinely collects outcome measures and demographic information to evaluate the effectiveness of its services. For therapy groups, the data securely stored.

Bereavement characteristics are also routinely collected by the Loss Foundation:

Participants will also be prompted by 2-3 reminder emails to complete the outcome measures post each session

Captured by the zoom meeting report stored on TLF secure server. We let them know as part of the screening process that the programme builds on material session by session and therefore full attendance is required for maximum benefit.

Participants will be asked to complete homework tasks to provide participants with the opportunity to practice and apply the skills and ideas discussed in the sessions as well as develop a sense of self-responsibility. A follow up email will be sent after each session to remind of their home task and self-care.

Satisfaction with therapy group (Likert scale)

Feeling supported in distress both during an outside sessions (Likert scale)

Content preference (open ended)

Experience of online modality of group as opposed to in person (Likert scale)

Facilitator effectiveness in. Likert scale of: Created a safe and supportive space, Treated group members with respect and empathy, Kept the group on track while allowing flexibility, Managed difficult group dynamics effectively, Delivered clear explanations that helped me to learn about my grief and how to manage it

Acceptability- size of the group (Likert scale) impacting on engagement, connection with others, learning effectiveness, comfort expressing self