PROJECT SUMMARY In 2020, 53 million people in the U.S. served as family caregivers, the partners, relatives, and friends who provide assistance (i.e., physical, emotional) to patients with often life-threatening, incurable illnesses. Caregivers are increasingly tasked with responsibilities once performed by medical professionals, and the availability and health of supportive caregivers is more critical than ever. A growing number of caregivers provide care to patients with advanced, life-limiting cancers, and are tasked with critical patient care responsibilities, and play a significant role in healthcare communication and advanced care planning as healthcare proxies. The burden of these responsibilities is great and is driven largely by existential distress, which contributes to anxiety, depression, poor quality of life, and mental health challenges in bereavement. Concurrently, caregiving is an opportunity to experience a profound sense of meaning and purpose; caregiving allows for the realization of new strengths and capacities, healing of relationships, and refinement of life goals. When existential distress is addressed, caregivers can experience an enhanced sense of well-being despite their challenges. While many interventions have been developed to support cancer caregivers, none directly target existential distress. Our group adapted Meaning-Centered Psychotherapy (MCP), a highly effective intervention in decreasing existential distress and enhancing well-being among patients with advanced cancer, for cancer caregivers. Meaning-Centered Psychotherapy for Cancer Caregivers (MCP-C) is a stakeholder- informed, innovative, manualized intervention designed to assist caregivers to connect to meaning and purpose in life, despite the challenges of caregiving. Results of our pilot randomized controlled demonstrated MCP-C’s feasibility, acceptability, and superiority in improving meaning, benefit-finding, depression, and spiritual wellbeing. In the proposed trial, we