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The Preliminary Development and Content Validation of a Bereavement Risk Screening Tool

Kailey E. Roberts

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National Institutes of Health (NIH)
Cancer is a leading cause of death in the United States [11]. A 2008 report by the American College of Physicians on clinical practice guidelines for end-of-life care emphasized the crucial need to provide psychosocial care for cancer patients' family members and caregivers [13]. Further, the Institute of Medicine has made the development and implementation of recommendations on end of life care a priority since a 1997 [5]. Continuity of care from end-of-life through bereavement for individuals who have lost a family member to cancer has important public health implications. Cancer can result in significant economic and emotional burdens on both the patient and their family members, particularly if the family member engages in caregiving [4]. Moreover, bereaved individuals are at heightened risk for mental and physical health morbidities, including suicidality and stress-related physiological vulnerabilities [3; 14-17]. Yet, surviving family members often "fall throughthe cracks" in the healthcare system, especially as they often become disconnected from healthcare providers after the patient's death [18]. Thus, there is a critical need for a brief, clinically relevant self- report bereavement risk screener in oncology and hospice care settings in order to more effectively identify and triage family members for support before and after the death of their loved one. My long- term goal is to obtain a faculty position in a medical center inorder to conduct clinically relevant, mixed- methods research on the psychosocial needs of patients and their family members in the face of cancer. My learning objectives are designed to enhance my development as an independent clinical researcher in palliative care and bereavement and are as follows: 1) patient-reported outcomes methods, 2) bereavement- related diagnosis, 3) end-of-life psychosocial care, 4) advanced academic skills. In addition to receiving strong mentorship and didactic training, I will gain hands-on experience by executing the proposed research project. {The purpose of the proposed study is to refine a brief, up-to-date, clinically useful PRO-type self- report screening tool that can be easily administered pre- and post-loss to identify family members of cancer patients who are at risk of bereavement-related mental health challenges.} In order to establish content validation of the brief bereavement risk screening tool, this study will incorporate feedback from family members pre- and post-loss. The objectives are to evaluate respondent perceptions of the screening tool, comprehension of its items, and strategies for responding. This will be achieved by conducting cognitive interviews with 44 family members (22 pre-loss, 22 post-loss) to determine their understanding of the preliminary self-report screening tool and increase its usability and emotional sensitivity. Conducting this study will not only advance my training as an independent clinical researcher specializing in palliative care and bereavement, but it will also serve as an essential step in developing a clinically useful tool using rigorous patient-centered methods.

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