Factors associated with attrition from a randomized controlled trial of meaning‐centered group psychotherapy for patients with advanced cancer

Abstract

Objective The generalizability of palliative care intervention research is often limited by high rates of study attrition. This study examined factors associated with attrition from a randomized controlled trial comparing meaning-centered group psychotherapy (MCGP), an intervention designed to help advanced cancer patients sustain or enhance their sense of meaning to the supportive group psychotherapy (SGP), a standardized support group. Methods Patients with advanced solid tumor cancers (n = 153) were randomized to eight sessions of either the MCGP or SGP. They completed assessments of psychosocial, spiritual, and physical well-being pretreatment, midtreatment, and 2 months post-treatment. Attrition was assessed in terms of the percent of participants who failed to complete these assessments, and demographic, psychiatric, medical, and study-related correlates of attrition were examined for the participants in each of these categories. Results The rates of attrition at these time points were 28.1%, 17.7%, and 11.1%, respectively; 43.1% of the participants (66 of 153) completed the entire study. The most common reason for dropout was patients feeling too ill. Attrition rates did not vary significantly between study arms. The participants who dropped out pretreatment reported less financial concerns than post-treatment dropouts, and the participants who dropped out of the study midtreatment had poorer physical health than treatment completers. There were no other significant associations between attrition and any demographic, medical, psychiatric, or study-related variables. Conclusions These findings highlight the challenge of maintaining advanced cancer patients in longitudinal research and suggest the need to consider alternative approaches (e.g., telemedicine) for patients who might benefit from group interventions but are too ill to travel.

The Effectiveness of a Meaning-Centered Psychoeducational Group Intervention for Chinese College Students

“…Our findings also expand those of previous studies on enhancing positive meaning (Applebaum et al, 2012;Breitbart et al, 2010;Nicholson, Belcastro, & Duncan, 1989). Breitbart et al reported the enhancement of a sense of meaning among participants in their meaning-centered group intervention.…”

Mixed Methods Research in the Development and Evaluation of Complex Interventions in Palliative and End-of-Life Care: Report on the MORECare Consensus Exercise

“…18,24 Attrition Attrition (including drop-out, nonresponse, withdrawal, and protocol deviation) is a major issue in studies with a follow-up element. [11][12][13][25][26][27][28] Some attrition is inevitable in end-of-life care research due to deterioration in a patient's condition or death, but might also result from respondent burden and changes, such as in respondents' circumstances (e.g., relocation) or contextual changes (e.g., changes in local services or treatments). This can lead to missing data that can affect validity.…”

Acceptability and Feasibility of a Meaning-Based Intervention for Patients With Advanced Cancer and Their Spouses

“…Notably, the attrition rate in a recent randomized trial of an 8-session meaning-centered group intervention in cancer was 57%. 44 This raises the question of the optimal number of sessions to maximize benefit and minimize drop-out from meaning-based interventions in seriously ill adults and their partners. Given the differential dropout between the individually focused and couples-based interventions described here, the possibility also exists that involving both members of the couple may help increase engagement in the intervention and reduce drop-out.…”