Pre-loss grief in family caregivers during end-of-life cancer care: a nationwide population-based cohort study.

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Pre-loss grief in family caregivers during end-of-life cancer care: a nationwide population-based cohort study.

Psychooncology. 2017 Mar 07;:

Authors: Nielsen MK, Neergaard MA, Jensen AB, Vedsted P, Bro F, Guldin MB

Abstract
OBJECTIVE: Severe grief symptoms in family caregivers during end-of-life cancer trajectories are associated with complicated grief and depression after the loss. Nevertheless, severe grief symptoms during end-of-life caregiving in caregivers to cancer patients have been scarcely studied. We aimed to explore associations between severe pre-loss grief symptoms in caregivers and modifiable factors such as depressive symptoms, caregiver burden, preparedness for death and end-of-life communication.
METHODS: We conducted a population-based prospective study of caregivers to 9,512 patients registered with drug reimbursement due to terminal illness, and 3,635 caregivers responded. Of these, 2,865 caregivers to cancer patients completed a pre-loss grief scale (Prolonged Grief-13, pre-loss version). Associations with factors measured during end-of-life caregiving were analyzed using logistic regression.
RESULTS: Severe pre-loss grief symptoms were reported by 432 caregivers (15.2%). These symptoms were associated with depressive symptoms (adjusted OR = 12.4; 95% CI: 9.5-16.3), high caregiver burden (adjusted OR = 8.3; 95% CI: 6.3-11.1), low preparedness for death (adjusted OR = 3.3; 95% CI: 2.5-4.4), low level of communication about dying (adjusted OR = 3.2; 95% CI: 2.2-4.4) and "too much" prognostic information (adjusted OR = 2.8; 95%: 1.7-4.6).
CONCLUSIONS: Severe pre-loss grief symptoms were significantly associated with distress, low preparedness and little communication during caregiving. Thus, severe pre-loss grief symptoms may be a key indicator for complications in caregivers of cancer patients in an end-of-life trajectory. Targeted interventions are needed to support family caregivers with severe pre-loss grief symptoms. Development of pre-loss grief assessment tools and interventions should be a priority target in future research.

PMID: 28271588 [PubMed - as supplied by publisher]

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