DESCRIPTION (provided by applicant): A randomized controlled trial of Family Focused Grief Therapy (FFGT) commenced during palliative care and continued with the surviving relatives into bereavement explores a comprehensive model of family-centered care for hospice and palliative care services. High risk families are targeted in this intervention, which seeks to optimize family functioning and promote adaptive coping with the death of a family member, ultimately reducing the development of complicated grief preventively. In this study design conducted across 3 sites, a routine family educational session is conducted and the families are provided with a Family Carers Guideline Booklet so that the baseline is standardized. A screening procedure is used to identify families considered 'at risk'of complicated bereavement. Following recruitment, families are randomized to one of three study conditions: usual palliative care, usual palliative care plus 6 sessions of FFGT, usual palliative care plus 10 sessions of FFGT. In this manner, dose responsiveness of FFGT is explored. Study objectives are: Aim 1: To demonstrate the efficacy and dose responsiveness of FFGT in preventing complicated bereavement and depression compared with standard palliative care among high risk family members of patients dying from terminal cancer. Aim 2: To examine whether the style of family adaptation and coping mediates the impact of FFGT. Aim 3: To examine the costs of FFGT and standard palliative care, and to assess whether the additional costs associated with FFGT delivery are offset by reductions in community health utilization and lost work days among family members. In demonstrating the efficacy of FFGT, this study has the potential to introduce a comprehensive and yet cost effective approach to family-centered care, where families currently represent a seriously underserved population. Bereavement care will be approached preventively with a continuity of care model.