Feasibility and Outcomes of Therapist-led Online Cancer Bereavement Groups

Background: The loss of loved one to cancer brings unique difficulties that impact on the bereavement experience. Mixed support exists for the effectiveness of in-person group interventions for bereaved caregivers, with barriers to accessing support including perceived stigmatisation and geographical constraints. Online bereavement interventions offer an accessible and effective means of providing grief support to various populations at the individual and group level. Research supports the effectiveness of online groups for those bereaved by cancer, although most of these studies are peer-led as opposed to therapist-led. Despite a growing rationale for the use of online groups for bereavement, there is little empirical evidence for therapist led groups, or for those bereaved by cancer. Objectives: This paper describes the protocol for a pilot feasibility trial evaluating the feasibility, potential effectiveness and acceptability of delivering online therapy groups for those bereaved by cancer. Methods and analysis: It will use a longitudinal pilot and feasibility methodology to evaluate a randomised controlled trial (RCT) design and its suitability for a future definitive RCT. Participants: A total of 100 adults who have lost a loved one to cancer will be randomised to receive the intervention immediately or after a delay three months later. Interventions: An eight-session online therapeutic group intervention led over 12 weeks based on models of cognitive behavioural therapy, compassion focused therapy and coping with bereavement. Primary outcome measures: Cancer- bereaved adults' grief intensity, depression, anxiety, PTSD, self-compassion and social disconnection. Acceptability of the intervention will also be measured including what participants found most helpful or unhelpful about the groups and any adverse outcomes. Data collection will occur at baseline, intervention completion and at follow up, 3 months after intervention completion. Results: The feasibility of trial procedures and the effect of the intervention on the outcomes will be tested,. Conclusions: At intervention completion, it is hoped that participants will show reductions across all outcomes measures with improvements remaining at follow up, compared to the waitlist-control group, warranting the need for a full-scale RCT to establish efficacy. Trial registration (intended registry): Protocol version: 1 (No amendments currently), Issued:

Sex

All

Minimum age

18 Years

Inclusion Criteria:

* (1) Adults (aged 18 or over) who are bereaved by cancer, for example losing a partner, family member or friend
* (2) The time since death must have been more than 6 months, so as not to interfere with a natural recovery process (Henk Schut \& Stroebe, 2010)
* (3) Self-referral to The Loss Foundation or via a related organisation
* (4) Have the means to access the therapeutic group online
* (5) Participants consent to attending the intervention with the risk of a delay (e.g. by being randomised to the waitlist or non-waitlist group).

Exclusion Criteria:

1. Adults at high risk to themselves or others in regard to suicide and/or self-harm
2. Significant substance or alcohol misuse which would interfere with participants' ability to take part in the research
3. Cannot be involved in other therapy at the same time elsewhere.

• RESULTJerome H, Smith KV, Shaw EJ, Szydlowski S, Barker C, Pistrang N, Thompson EH. Effectiveness of a Cancer Bereavement Therapeutic Group. J Loss Trauma. 2019 Jan 7;23(7):574-587. doi: 10.1080/15325024.2018.1518772. PMID 30983910
• DERIVEDKing L, Smith KV, Cole CL, Thompson EH. A protocol for a pilot randomised controlled trial of an online cancer bereavement group. Pilot Feasibility Stud. 2026 Feb 26;12(1):46. doi: 10.1186/s40814-026-01785-y. PMID 41749396