Objective: The study aims to examine the prevalence and common themes of unfinished business (UB) and its associations with distress among advanced cancer patients. Methods: A total of 223 patients from a larger randomized controlled trial of Individual Meaning-Centered Psychotherapy (IMCP) completed self-report questionnaires that assessed UB and UB-related distress, hopelessness, desire for hastened death, anxiety and depression, quality of life, spiritual well-being, and purpose/meaning. Unfinished business themes were identified by qualitative analysis of open-ended data. Results: A total of 161 (72%) patients reported the presence of UB. The mean UB-related distress score was 7.01 (SD = 2.1) out of 10. Results of independent t tests showed that patients with UB reported significantly higher levels of anxiety and lower levels of existential transcendence than patients without UB. Linear regression equations indicated that UB-related distress significantly predicted hopelessness (F1,154 = 9.54, P < 0.05, R2 = 0.058), anxiety (F1,154 = 4.31, P < 0.05, R2 = 0.027), personal meaning (F1,136 = 6.18, P < 0.05, R2 = 0.043), and existential transcendence (F1,119 = 6.7, P < 0.05, R2 = 0.053). Ten UB themes emerged from open-ended responses; UB themes were not associated with UB-related distress or psychological adjustment. Conclusions: Unfinished business was both prevalent and distressing in our sample. Findings underscore the need to develop and implement interventions designed to help patients resolve or find solace with UB.

The authors alone are responsible for the views expressed in this letter and they do not necessarily represent the decisions, policy or views of the World Health Organization. The letter is based in part upon work from Action CA16207 "European Network for Problematic Usage of Internet", supported by the European Cooperation in Science and Technology (COST).

Objective: This qualitative study sought to obtain feedback from stakeholder cancer caregivers and bereaved family members on the implementation of bereavement risk screening in oncology. Methods: Semi-structured interviews were conducted with 38 family members of patients with advanced cancer (n = 12) and bereaved family members (n = 26) on when and how to effectively implement bereavement risk screening. Data were analyzed using thematic analysis. Results: Many participants indicated that they would be open to completing a selfreport screening measure before and after the patient's death. Several suggested screening at multiple timepoints and the importance of follow-up. Participants viewed screening as an opportunity to connect to psychosocial support.

Breast cancer survivors face a number of unique psychosocial challenges following completion of treatment. In particular, having confronted their own mortality, the desire to live meaningful lives is often intensely heightened. However, a significant subset of survivors feel “stuck,” disconnected, and a decreased sense of meaning, identity, and purpose. Although breast cancer survivors have expressed that their greatest unmet need is support for existential issues, there is an absence of empirically supported interventions that focus on enhancing meaning. Meaning-centered group psychotherapy for breast cancer survivors (MCGP-BCS), which has been adapted from meaning-centered group psychotherapy for advanced cancer patients, addresses this need. This chapter describes the rationale for developing MCGP-BCS; presents a description of the intervention adaptation process; and provides an overview of the intervention, including presentation of excerpts from a sample group.

This mixed-method study advances knowledge regarding the practice of grief counseling in a sample of 171 university counseling center therapists. First, several components of therapists’ self-reported work with grieving clients was assessed (e.g., training level, initial responses to a grieving client, principles applied in counseling, therapist comfort, and potential therapist issues related to counseling grieving clients). Second, grounded in the death competence model (Gamino & Ritter, 2012), predictors of perceived grief counseling skills were examined. Cognitive competence and emotional competence predicted perceived grief counseling skills, with training/experience being the most robust predictor. Notably, the participants in this study rarely received education regarding death, dying, and grieving in their graduate programs, and they indicated that their knowledge about grief counseling was insufficient. Moreover, the therapists’ qualitative responses to a case vignette were lacking in many grief-specific domains. Future directions for training, research, and clinical work are discussed.