1
|
Hammer NM, Bidstrup PE, Olsen M, Hansson H, Abitz M, Larsen HB. The experiences of grandparents involved in the home-based end-of-life care of their grandchild with cancer: A qualitative secondary data analysis. DEATH STUDIES 2024:1-11. [PMID: 38822452 DOI: 10.1080/07481187.2024.2355252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2024]
Abstract
While grandparents are often a valuable resource in home-based pediatric end-of-life care, they may also experience psychological consequences when faced with their grandchild's illness and death. In this qualitative study, we performed semi-structured interviews with seven bereaved grandparents of four children with cancer who received home-based end-of-life care and died at home at age <18. Through qualitative content analysis we identified the overarching theme: "Navigating complex and unclear roles to support the family" and five themes: (1) Providing comfort and support; (2) Balancing and adapting involvement; (3) Worrying silently; (4) Managing difficult emotions; and (5) Calling for support and understanding. The findings underline the often conflicting roles that grandparents undertake of providing support while respecting parents' autonomy and putting aside their own emotional reactions. Involving grandparents in pediatric end-of-life care may enhance family resources, but should also consider grandparents' perspectives and need for support.
Collapse
Affiliation(s)
- Nanna Maria Hammer
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Pernille Envold Bidstrup
- Psychological Aspects of Cancer, Danish Cancer Institute, Copenhagen, Denmark
- Institute of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Marianne Olsen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Pediatrics and Adolescent Medicine, Section of Pediatric Hematology and Oncology, Aalborg University Hospital, Aalborg, Denmark
| | - Helena Hansson
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Maja Abitz
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Hanne Bækgaard Larsen
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
2
|
Schmidt V, Treml J, Brähler E, Kersting A. Psychometric properties of the German version of the Pre-loss Grief Questionnaire (PG-12-R). DEATH STUDIES 2024:1-9. [PMID: 38626113 DOI: 10.1080/07481187.2024.2337201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/18/2024]
Abstract
This study aimed to develop a German version of the revised Pre-loss Grief Questionnaire (PG-12-R) and examine its factor structure, reliability and validity. The PG-12-R was assessed in a representative German sample (N = 2,515). Of these, 362 (14.4%) reported to have a loved one suffering from an incurable disease and 352 provided full data sets. Principal component factor analysis, scree-plot and parallel analysis were conducted. Results supported a one-factor model of PG-12-R with high internal consistency. Convergent validity was confirmed by negative correlations with psychological well-being and time since diagnosis and positive correlations with a more difficult perception of circumstances surrounding the illness and unpreparedness. The German version of the PG-12-R represents a reliable and valid measurement tool of pre-loss grief. It may be used as a screening measure for high levels of pre-loss grief to identify individuals who may need additional support.
Collapse
Affiliation(s)
- Viktoria Schmidt
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Julia Treml
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Elmar Brähler
- University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- Department of Psychiatry and Psychotherapy, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Anette Kersting
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, University of Leipzig, Leipzig, Germany
| |
Collapse
|
3
|
Duran S, Altun A. Prolonged grief, reconstruction of meaning, and posttraumatic growth in nursing home residents who have lost loved ones. Geriatr Gerontol Int 2024; 24:364-370. [PMID: 38406968 DOI: 10.1111/ggi.14843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 01/17/2024] [Accepted: 02/07/2024] [Indexed: 02/27/2024]
Abstract
AIM This study was conducted to determine the relationship between sociodemographic characteristics, prolonged grief, meaning reconstruction, and posttraumatic growth of elderly individuals who have lost loved ones. METHODS A total of 122 elderly individuals who had lost loved ones were included in the research conducted in a nursing home. RESULTS The levels of Prolonged Grief Inventory (PG-13), Grief and Meaning Reconstruction Inventory (GMRI), and Posttraumatic Growth (PTG) scale were found to be high among the individuals in the study. While the PG-13 scores of single individuals who have lost their spouses are statistically significantly higher compared to married individuals, the scores for GMRI are higher for elderly individuals with chronic illness and expected death compared to those who have experienced sudden loss. A significant negative correlation was also determined between PG-13, GMRI, and PTG scores. CONCLUSION Counseling to reconstruct grief and meaning is recommended for at-risk groups. Geriatr Gerontol Int 2024; 24: 364-370.
Collapse
Affiliation(s)
- Songül Duran
- .Department of Elderly Care, Health Services Vocational College, Izmir Demokrasi University, Izmir, Türkiye
| | - Aydın Altun
- Institute of Health Sciences, Master Student of Elderly Health Program, Izmir Democracy University, Izmir, Türkiye
| |
Collapse
|
4
|
Høeg BL, Guldin MB, Høgh J, Volkmann JE, Wolfe J, Larsen HB, Bidstrup PE. Improving family grief outcomes: A scoping review of family-based interventions before and after the death of a child. Palliat Med 2024; 38:389-395. [PMID: 38506273 DOI: 10.1177/02692163241233958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
BACKGROUND Experiencing the illness and death of a child is a traumatic experience for the parents and the child's siblings. However, knowledge regarding effective grief interventions targeting the whole family is limited, including how to integrate age-appropriate support for siblings. AIM We aimed to synthesize the empirical literature regarding grief interventions that target the whole family before and/or after the death of a child. DESIGN A scoping review following the Joanna Briggs Institute and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. DATA SOURCES We searched PubMed, PsycINFO, Embase, CINAHL, and Scopus covering January 1998-May 2022. We included studies describing any type of structured intervention targeting the whole family (i.e. parents and siblings) before or/and after the death of a child (below 18 years), with pre-post assessments of grief-related symptoms in the family as an outcome. RESULTS After removal of duplicates, we screened the titles and abstracts of 4078 publications and identified 30 publications for full-text screening. None of the studies met the inclusion criteria. Most of the studies were excluded because they either did not target the whole family or did not target families who had lost a child below 18 years. Bereavement camps were a popular form of family intervention, but none were evaluated in a pre-post design. No grief interventions offering support pre-death were found. CONCLUSIONS There is great need for research to improve bereavement outcomes for the entire family and to potentially integrate this in pediatric palliative care.
Collapse
Affiliation(s)
- Beverley Lim Høeg
- Psychological Aspects of Cancer, Danish Cancer Institute, Copenhagen, Denmark
| | - Mai-Britt Guldin
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Julie Høgh
- Department of Pediatrics and Adolescent Medicine, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Joanne Wolfe
- Mass General Hospital for Children, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Hanne Bækgaard Larsen
- Department of Pediatrics and Adolescent Medicine, The Juliane Marie Center, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Pernille Envold Bidstrup
- Psychological Aspects of Cancer, Danish Cancer Institute, Copenhagen, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
5
|
Wen FH, Hou MM, Su PJ, Shen WC, Chou WC, Chen JS, Chang WC, Tang ST. Factors of preparedness for loss from cancer among Taiwanese family caregivers. DEATH STUDIES 2024; 48:630-639. [PMID: 38236991 DOI: 10.1080/07481187.2024.2305340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
This cohort study investigated factors associated with 336 Taiwanese family caregivers' emotional and cognitive preparedness for death of a loved one with terminal cancer. Caregivers' death-preparedness states (no-death-preparedness [as reference], cognitive-death-preparedness-only, emotional-death-preparedness-only, and sufficient-death-preparedness states) were previously identified. Associations of factors with these states were determined by a hierarchical generalized linear model. Financial hardship decreased caregivers' likelihood for the emotional-death-preparedness-only and sufficient-death-preparedness states. Physician prognostic disclosure increased membership in the cognitive-death-preparedness-only and sufficient-death-preparedness states. The better the quality of the patient-caregiver relationship, the higher the odds for the emotional-death-preparedness-only and sufficient-death-preparedness states, whereas the greater the tendency for caregivers to communicate end-of-life issues with their loved one, the lower the odds for emotional-death-preparedness-only state membership. Stronger coping capacity increased membership in the emotional-death-preparedness-only state, but perceived social support was not associated with state membership. Providing effective interventions tailored to at-risk family caregivers' specific needs may facilitate their death preparedness.
Collapse
Affiliation(s)
- Fur-Hsing Wen
- Department of International Business, Soochow University, Taipei, Taiwan, ROC
| | - Ming-Mo Hou
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
| | - Po-Jung Su
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
| | - Wen-Chi Shen
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
| | - Wen-Chi Chou
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
- College of Medicine, Chang Gung University, Tao-Yuan, Taiwan, ROC
| | - Jen-Shi Chen
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
- College of Medicine, Chang Gung University, Tao-Yuan, Taiwan, ROC
| | - Wen-Cheng Chang
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
- College of Medicine, Chang Gung University, Tao-Yuan, Taiwan, ROC
| | - Siew Tzuh Tang
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
- School of Nursing, Chang Gung University, Tao-Yuan, Taiwan, ROC
- Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Taiwan, ROC
- Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan, Taiwan, ROC
| |
Collapse
|
6
|
Costeira C, Dixe MA, Querido A, Rocha A, Vitorino J, Santos C, Laranjeira C. Death Unpreparedness Due to the COVID-19 Pandemic: A Concept Analysis. Healthcare (Basel) 2024; 12:188. [PMID: 38255076 PMCID: PMC10815185 DOI: 10.3390/healthcare12020188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
The COVID-19 pandemic imposed changes upon the capacity of healthcare systems, with significant repercussions on healthcare provision, particularly at end-of-life. This study aims to analyze the concept map of death unpreparedness due to the COVID-19 pandemic, capturing the relationships among the attributes, antecedents, consequences, and empirical indicators. Walker and Avant's method was used to guide an analysis of this concept. A literature search was performed systematically, between May 2022 and August 2023, using the following electronic databases on the Elton Bryson Stephens Company (EBSCO) host platform: Medical Literature Analysis and Retrieval System Online (Medline), Psychological Information Database (PsycINFO), Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete, Cochrane Library, and Nursing and Allied Health Collection. Thirty-four articles were retrieved. The unexpected and unpredictable impositions associated with inexperience and unskillfulness in dealing with COVID-19 configured challenges for healthcare professionals, family/caregivers, and even the dying person. Nine key attributes emerged in three main domains: (1) Individual: (a) disease-related conditions, (b) separation distress, and (c) scarcity of death and grief literacy; (2) Relational: (a) Dying alone, (b) poor communication, and (c) existential issues; and (3) Contextual: (a) disrupted collective mourning and grieving, (b) disrupted compassionate care and, (c) pandemic social stigma. This study contributed a full definition of death unpreparedness in a global pandemic scenario such as COVID-19. In this sense, feeling unprepared or unready for death brought new challenges to the bioecological resources of those affected. It is essential to embrace strategies capable of providing emotional and spiritual support in the dying process and to respect patient wishes. The lessons learned from COVID-19 should be applied to events with a comparable impact to minimize their consequences.
Collapse
Affiliation(s)
- Cristina Costeira
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André-66-68, Campus 5, 13 Polytechnic University of Leiria, 2410-541 Leiria, Portugal; (M.A.D.); (A.Q.); (C.S.)
- School of Health Sciences, Polytechnic University of Leiria, Campus 2—Morro do Lena, Alto do Vieiro—Apart. 4137, 2411-901 Leiria, Portugal;
- The Health Sciences Research Unit: Nursing (UICISA:E), Nursing School of Coimbra (ESEnfC), 3004-011 Coimbra, Portugal
| | - Maria Anjos Dixe
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André-66-68, Campus 5, 13 Polytechnic University of Leiria, 2410-541 Leiria, Portugal; (M.A.D.); (A.Q.); (C.S.)
- School of Health Sciences, Polytechnic University of Leiria, Campus 2—Morro do Lena, Alto do Vieiro—Apart. 4137, 2411-901 Leiria, Portugal;
| | - Ana Querido
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André-66-68, Campus 5, 13 Polytechnic University of Leiria, 2410-541 Leiria, Portugal; (M.A.D.); (A.Q.); (C.S.)
- School of Health Sciences, Polytechnic University of Leiria, Campus 2—Morro do Lena, Alto do Vieiro—Apart. 4137, 2411-901 Leiria, Portugal;
- Center for Health Technology and Services Research (CINTESIS), NursID, University of Porto, 4200-450 Porto, Portugal
| | - Ana Rocha
- Nursing School of Coimbra, Avenida Bissaya Barreto s/n, 3004-011 Coimbra, Portugal;
| | - Joel Vitorino
- School of Health Sciences, Polytechnic University of Leiria, Campus 2—Morro do Lena, Alto do Vieiro—Apart. 4137, 2411-901 Leiria, Portugal;
- Palliative Care Unit, Portuguese Institute of Oncology of Coimbra, 3000-075 Coimbra, Portugal
| | - Cátia Santos
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André-66-68, Campus 5, 13 Polytechnic University of Leiria, 2410-541 Leiria, Portugal; (M.A.D.); (A.Q.); (C.S.)
- School of Health Sciences, Polytechnic University of Leiria, Campus 2—Morro do Lena, Alto do Vieiro—Apart. 4137, 2411-901 Leiria, Portugal;
| | - Carlos Laranjeira
- Centre for Innovative Care and Health Technology (ciTechCare), Rua de Santo André-66-68, Campus 5, 13 Polytechnic University of Leiria, 2410-541 Leiria, Portugal; (M.A.D.); (A.Q.); (C.S.)
- School of Health Sciences, Polytechnic University of Leiria, Campus 2—Morro do Lena, Alto do Vieiro—Apart. 4137, 2411-901 Leiria, Portugal;
- Comprehensive Health Research Centre (CHRC), University of Évora, 7000-801 Évora, Portugal
| |
Collapse
|
7
|
Liang HJ, Xiong Q, Remawi BN, Preston N. Taiwanese family members' bereavement experience following an expected death: a systematic review and narrative synthesis. BMC Palliat Care 2024; 23:14. [PMID: 38212776 PMCID: PMC10782629 DOI: 10.1186/s12904-024-01344-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 01/05/2024] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Bereavement experience is shaped by cultural and social contexts. No systematically constructed reviews were identified to explore the bereavement experience for people who are influenced by Chinese culture valuing filial piety and mutual dependence. This review aimed to systematically review the bereavement experience of Taiwanese family members living in Taiwan following an expected death. METHODS MEDLINE, PsycINFO, CINAHL, China Academic Journal Database, and Chinese Electronic Periodical Services were searched with no date restrictions from inception to 20 October 2022. The methodological rigour of studies was assessed using Hawker's appraisal tool. A narrative synthesis approach using Popay's work was employed to synthesise the findings of the studies. Studies investigating Taiwanese family members' bereavement experiences were included. We excluded papers studying bereavement through the death of a child. RESULTS Searches retrieved 12,735 articles (after de-duplication), 17 of which met the inclusion criteria and were included for synthesis: English [9] and Chinese [8], published between 2006 and 2021. The studies varied in quality with scores ranging from 22 to 33 out of 36. The studies differed in the relationship between participants and the deceased, the bereaved time frames, and the definitions of bereavement. Most studies focussed on family members of cancer patients receiving specialist palliative care. Three bereavement theories and four tools were used. Risk factors of bereavement outcomes included family members feeling less prepared for death and deaths where palliative sedative therapy was used. Protective factors were higher caregiving burden and longer caregiving periods. Four themes regarding Taiwanese bereavement experience were generated: multiple impacts of death; problem-based coping strategies; importance of maintaining connections; influential religious beliefs and rituals. CONCLUSION Continuing the relationship with the deceased is a key element of Taiwanese bereavement experience and it is influenced by religious and cultural beliefs. Suppressing or hiding emotions during bereavement to connect with the deceased and maintain harmonious relationships needs to be acknowledged as culturally acceptable and encouraged by some religions in Taiwan. The findings could be potentially relevant for other Chinese populations, predominantly Buddhist countries or other East Asian societies. The role of preparing for death in bereavement outcomes is little understood and requires further research.
Collapse
Affiliation(s)
- Hui-Ju Liang
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Health Innovation One, Sir John Fisher Drive, Lancaster, LA1 4AT, UK.
| | - Qian Xiong
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Health Innovation One, Sir John Fisher Drive, Lancaster, LA1 4AT, UK
| | - Bader Nael Remawi
- Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Health Innovation One, Sir John Fisher Drive, Lancaster, LA1 4AT, UK
| | - Nancy Preston
- International Observatory on End of Life Care, Division of Health Research, Lancaster University, Health Innovation One, Sir John Fisher Drive, Lancaster, LA1 4AT, UK
| |
Collapse
|
8
|
Manevich A, Yehene E, Rubin SS. A case for inclusion of disordered Non-Death Interpersonal Grief as an official diagnosis: rationale, challenges and opportunities. Front Psychiatry 2023; 14:1300565. [PMID: 38161721 PMCID: PMC10757611 DOI: 10.3389/fpsyt.2023.1300565] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 11/28/2023] [Indexed: 01/03/2024] Open
Affiliation(s)
- Alexander Manevich
- Department of Psychology, Kinneret Academic College, Tzemach, Israel
- Department of Behavioral Sciences, Kinneret Academic College, Tzemach, Israel
- International Laboratory for the Study of Loss, Bereavement and Human Resilience and the School of Psychological Sciences, University of Haifa, Haifa, Israel
| | - Einat Yehene
- School of Behavioral Sciences, Academic College Tel Aviv-Yaffo, Tel Aviv, Israel
| | - Simon Shimshon Rubin
- International Laboratory for the Study of Loss, Bereavement and Human Resilience and the School of Psychological Sciences, University of Haifa, Haifa, Israel
- Department of Psychology, Max Stern Academic College of Emek Yezreel, Jezreel Valley, Israel
| |
Collapse
|
9
|
Boven C, Dillen L, Dierickx S, Van den Block L, Piers R, Van Den Noortgate N, Van Humbeeck L. Relatives' Experiences of Being Involved in Assisted Dying: A Qualitative Study. QUALITATIVE HEALTH RESEARCH 2023; 33:1154-1164. [PMID: 37791685 PMCID: PMC10626978 DOI: 10.1177/10497323231196827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Recent literature demonstrates an interdependence between relatives and healthcare providers throughout euthanasia processes. Yet, current guidelines and literature scarcely specify the interactions between healthcare providers and bereaved relatives. The aim of this work consisted of providing an insight into bereaved relatives' experiences (1) of being involved in euthanasia processes and (2) of their interactions with healthcare providers before, during, and after the euthanasia. The research process was guided by the principles of constructivist grounded theory. Nineteen Dutch-speaking bereaved relatives of oncological patients, who received euthanasia at home or in a hospital less than 24 months ago, participated via semi-structured interviews. These interviews were conducted between May 2021 and June 2022. Due to the intensity of euthanasia processes, relatives wanted to be involved as early as possible, in order to receive time, space, and access to professionals' support whilst preparing themselves for the upcoming loss of a family member with cancer. Being at peace with the euthanasia request facilitated taking a supportive attitude, subsequently aiding in achieving a serene atmosphere. A serene atmosphere facilitated relatives' grief process because it helped them in creating and preserving good memories. Relatives appreciated support from healthcare providers, as long as overinvolvement on their part was not occurring. This study advocates for a relational approach in the context of euthanasia and provides useful complements to the existing euthanasia guidelines.
Collapse
Affiliation(s)
- Charlotte Boven
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
| | - Let Dillen
- Department of Geriatric Medicine and Palliative Care Unit, Ghent University Hospital, Ghent, Belgium
| | - Sigrid Dierickx
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Ghent, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Lieve Van den Block
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Ghent, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Ruth Piers
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
| | | | | |
Collapse
|
10
|
Lombardo L, Veneziani G, Giraldi E, Morelli E, Durante S, Aceto P, Lai C. How attachment style, mentalization and preparedness for death are associated with pre-loss grief symptoms' severity: A network analysis study in caregivers of terminally ill cancer patients. DEATH STUDIES 2023; 48:537-549. [PMID: 37565791 DOI: 10.1080/07481187.2023.2246022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/12/2023]
Abstract
Several psychological dimensions influence the psychological adjustment of terminally ill cancer patients' caregivers, during the end-of-life phase. The present study explored the associations between attachment styles, mentalization, preparedness for death, and the severity of pre-loss grief symptoms in 102 caregivers of terminal cancer patients. The results of the network analysis showed that insecure attachment dimensions were positively associated with several central pre-loss grief symptoms. Mentalization and preparedness for death showed negative associations with several pre-loss grief symptoms. Interestingly, bitterness showed a negative association with need for approval and a positive association with mentalization. The results provided insight into the grieving process for palliative care providers to implement effective caregiver support interventions.
Collapse
Affiliation(s)
- Luigi Lombardo
- Centro di Cure Palliative, Fondazione Sanità e Ricerca, Rome, Italy
| | - Giorgio Veneziani
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Emanuele Giraldi
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Emanuela Morelli
- Centro di Cure Palliative, Fondazione Sanità e Ricerca, Rome, Italy
| | - Sieva Durante
- Centro di Cure Palliative, Fondazione Sanità e Ricerca, Rome, Italy
| | - Paola Aceto
- Department of Emergency, Anesthesiological and Reanimation Sciences, Università Cattolica del Sacro Cuore di Roma, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Carlo Lai
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| |
Collapse
|
11
|
Häger Tibell L, Årestedt K, Holm M, Wallin V, Steineck G, Hudson P, Kreicbergs U, Alvariza A. Preparedness for caregiving and preparedness for death: Associations and modifiable thereafter factors among family caregivers of patients with advanced cancer in specialized home care. DEATH STUDIES 2023; 48:407-416. [PMID: 37441803 DOI: 10.1080/07481187.2023.2231388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
The purpose of this study was to (1) explore associations between preparedness for caregiving and preparedness for death among family caregivers of patients with advanced cancer and (2) explore modifiable preparedness factors, such as communication and support. Data was derived from a baseline questionnaire collected in specialized home care. The questionnaire included socio-demographics, the Preparedness for Caregiving Scale, and single items addressing preparedness for death, received support and communication about incurable illness. Data was analyzed using descriptive statistics and Spearman correlations. Altogether 39 family caregivers participated. A significant association was found between preparedness for caregiving and preparedness for death. Received support and communication about the illness was associated with higher levels of preparedness for caregiving and death. This study contributes to evidence on the association between preparedness for caregiving and death, but also that communication and support employed by healthcare professionals could improve family caregiver preparedness and wellbeing.
Collapse
Affiliation(s)
- Louise Häger Tibell
- The Department of Health Care Science/Palliative Research Centre, Marie Cederschiöld University, Stockholm, Sweden
- Tema Cancer, BES: Breast-Endocrine Tumours and Sarcoma, Karolinska University Hospital, Stockholm, Sweden
| | - Kristofer Årestedt
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
- Department of Research, Region Kalmar County, Kalmar, Sweden
| | - Maja Holm
- The Department of Health Care Science/Palliative Research Centre, Marie Cederschiöld University, Stockholm, Sweden
- Department of Nursing Science, Sophiahemmet University, Stockholm, Sweden
| | - Viktoria Wallin
- The Department of Health Care Science/Palliative Research Centre, Marie Cederschiöld University, Stockholm, Sweden
| | - Gunnar Steineck
- Department of Clinical Cancer Epidemiology, Karolinska Institutet, Stockholm, Sweden
- Division of Clinical Cancer Epidemiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Peter Hudson
- Centre for Palliative Care, St Vincent´s Hospital and The University of Melbourne, Melbourne, Australia
- Vrije University Brussels, Brussels, Belgium
| | - Ulrika Kreicbergs
- The Department of Health Care Science/Palliative Research Centre, Marie Cederschiöld University, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Anette Alvariza
- Research and Development-Unit/Palliative Care, Stockholms Sjukhem, Stockholm, Sweden
| |
Collapse
|
12
|
Banks H, Webb K, Sharpe L, Shaw J. A qualitative exploration of fear of cancer recurrence in caregivers. Psychooncology 2023. [PMID: 37157172 DOI: 10.1002/pon.6149] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/24/2023] [Accepted: 04/25/2023] [Indexed: 05/10/2023]
Abstract
OBJECTIVE Fear of cancer recurrence (FCR) is one of the most common unmet needs for cancer patients and caregivers. Yet little is known about the potentially unique nature of caregiver FCR. Our research aimed to address this gap by qualitatively exploring the features and impact of caregiver FCR. METHODS Eighteen semi-structured telephone interviews with cancer caregivers were conducted to explore the content and impact of caregiver fears and worries about cancer recurrence or progression. Data analysis used a Framework Approach. RESULTS Qualitative analysis identified three themes (1) fear of the patient suffering, (2) the need to protect the patient from a recurrence and/or cancer-related distress, and (3) caregiver's sense of unpreparedness and uncertainty. Underpinning these themes was an overarching sense of personal responsibility for the life of the patient. This overarching theme was identified as a key driver of caregivers' personal and patient-centred fears. CONCLUSIONS Our findings confirm the conceptual differences between patient and caregiver FCR. Future research must therefore acknowledge the unique experiences of caregivers and prioritise the development of empirically driven theoretical models, instruments, and interventions for caregiver FCR.
Collapse
Affiliation(s)
- Hannah Banks
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
- The Psycho-oncology Co-operative Group (PoCoG), School of Psychology, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
| | - Kyra Webb
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
- The Psycho-oncology Co-operative Group (PoCoG), School of Psychology, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
| | - Louise Sharpe
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
| | - Joanne Shaw
- School of Psychology, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
- The Psycho-oncology Co-operative Group (PoCoG), School of Psychology, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
13
|
Wen FH, Hsieh CH, Chou WC, Su PJ, Hou MM, Shen WC, Chen JS, Chang WC, Tang ST. Factors associated with cancer patients' distinct death-preparedness states. Psychooncology 2023. [PMID: 37114337 DOI: 10.1002/pon.6146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 04/17/2023] [Accepted: 04/19/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND/OBJECTIVE Facilitating death preparedness is important for improving cancer patients' quality of death and dying. We aimed to identify factors associated with the four death-preparedness states (no-preparedness, cognitive-only, emotional-only, and sufficient-preparedness) focusing on modifiable factors. METHODS In this cohort study, we identified factors associated with 314 Taiwanese cancer patients' death-preparedness states from time-invariant socio-demographics and lagged time-varying modifiable variables, including disease burden, physician prognostic disclosure, patient-family communication on end-of-life (EOL) issues, and perceived social support using hierarchical generalized linear modeling. RESULTS Patients who were male, older, without financial hardship to make ends meet, and suffered lower symptom distress were more likely to be in the emotional-only and sufficient-preparedness states than the no-death-preparedness-state. Younger age (adjusted odds ratio [95% confidence interval] = 0.95 [0.91, 0.99] per year increase in age) and greater functional dependency (1.05 [1.00, 1.11]) were associated with being in the cognitive-only state. Physician prognostic disclosure increased the likelihood of being in the cognitive-only (51.51 [14.01, 189.36]) and sufficient-preparedness (47.42 [10.93, 205.79]) states, whereas higher patient-family communication on EOL issues reduced likelihood for the emotional-only state (0.38 [0.21, 0.69]). Higher perceived social support reduced the likelihood of cognitive-only (0.94 [0.91, 0.98]) but increased the chance of emotional-only (1.09 [1.05, 1.14]) state membership. CONCLUSIONS Death-preparedness states are associated with patients' socio-demographics, disease burden, physician prognostic disclosure, patient-family communication on EOL issues, and perceived social support. Providing accurate prognostic disclosure, adequately managing symptom distress, supporting those with higher functional dependence, promoting empathetic patient-family communication on EOL issues, and enhancing perceived social support may facilitate death preparedness.
Collapse
Affiliation(s)
- Fur-Hsing Wen
- Department of International Business, Soochow University, Taipei, Taiwan, ROC
| | - Chia-Hsun Hsieh
- Division of Hematology-Oncology, Department of Internal Medicine, New Taipei Municipal TuCheng Hospital, New Taipei City, Taiwan, ROC
- School of Medicine, Chang Gung University, Tao-Yuan, Taiwan, ROC
| | - Wen-Chi Chou
- School of Medicine, Chang Gung University, Tao-Yuan, Taiwan, ROC
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
| | - Po-Jung Su
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
| | - Ming-Mo Hou
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
| | - Wen-Chi Shen
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
| | - Jen-Shi Chen
- School of Medicine, Chang Gung University, Tao-Yuan, Taiwan, ROC
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
| | - Wen-Cheng Chang
- School of Medicine, Chang Gung University, Tao-Yuan, Taiwan, ROC
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
| | - Siew Tzuh Tang
- Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Tao-Yuan, Taiwan, ROC
- School of Nursing, Chang Gung University, Tao-Yuan, Taiwan, ROC
- Department of Nursing, Chang Gung Memorial Hospital at Kaohsiung, Kaohsiung, Taiwan, ROC
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan, ROC
| |
Collapse
|
14
|
Kondo M, Kihira T, Sakaguchi Y, Shimada K, Shirai Y, Tamura K. Growth Experience Bereaved of a Spouse by Cancer: Relying on Merleau-Ponty's Reorganization of the Body Schemes. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231164859. [PMID: 36964705 DOI: 10.1177/00302228231164859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2023]
Abstract
The grief experienced by bereaved families can lead to positive changes, and its relevance to the emerging concept of posttraumatic growth has been explored. However, studies on survivors bereaved of a spouse by cancer are scarce; consequently, the nature of growth remains poorly understood. This study aimed to explore the growth experiences of survivors bereaved of a spouse by cancer. Based on Merleau-Ponty's theory of the body, we phenomenologically analyzed narratives/qualitative data collected through interviews of 21 survivors bereaved of a spouse by cancer. The assessment of the growth of survivors bereaved of a spouse by cancer began before the bereavement, with the questioning of habits with the living spouse because of illness and prognosis announcement and/or bereavement, reaffirming the connection with the spouse, realizing that it provides emotional support, and becoming accustomed to who they are now in the new environment.
Collapse
Affiliation(s)
- Megumi Kondo
- Department of Palliative Nursing, Graduate School of Medicine, Kyoto University, Japan
| | - Tomoki Kihira
- College of Nursing Art and Science, University of Hyogo, Japan
| | | | - Kazuki Shimada
- Department of Palliative Medicine, Kyoto University Hospital
| | - Yuki Shirai
- Department of Palliative Nursing, Graduate School of Medicine, Kyoto University, Japan
| | - Keiko Tamura
- Department of Palliative Nursing, Graduate School of Medicine, Kyoto University, Japan
| |
Collapse
|
15
|
Buckley A, Dodd A, Guerin S. Grief and bereavement in the time of COVID-19: a thematic analysis exploring psychotherapists’ observations of clients’ experiences. COUNSELLING PSYCHOLOGY QUARTERLY 2023. [DOI: 10.1080/09515070.2023.2186834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Affiliation(s)
- Amy Buckley
- School of Psychology, University College Dublin, Belfield, Ireland
| | - Anne Dodd
- School of Psychology, University College Dublin, Belfield, Ireland
| | - Suzanne Guerin
- School of Psychology, University College Dublin, Belfield, Ireland
| |
Collapse
|
16
|
Agosta MT, Tang M, Carmack CL, Bruera E. Social isolation at the end of life: A case report of one person's journey navigating the medical landscape during the COVID-19 pandemic. Palliat Support Care 2022; 20:900-903. [PMID: 35587538 DOI: 10.1017/s1478951522000505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND In addition to physical symptom burden, psychological suffering at end of life (EOL) is quite pervasive. As such, the interdisciplinary team in our Palliative and Supportive Care Unit strives to provide quality care sensitive to the physical and psychosocial needs of patients. Involving and allowing for the presence of family members is one way in which we afford our patients some additional comfort. Unfortunately, the current pandemic has placed limitations on this rather fundamental need for both patients and their family members. Here, we present a case illustrating the effects of visitor restrictions/isolation due to COVID-19 on the suffering of a patient at the EOL. CASE DESCRIPTION A male in his 20s with a refractory hematologic malignancy decided to pursue a comfort-based approach to care after a rapid clinical deterioration. Due to visitor restrictions, he had to face this decision with limited support at the bedside, which caused significant distress. He was forced to choose among several immediate family members who would be at his side through his hospitalization, to be his advocate, at times his voice, his confidant, and the person to relay all information to those on the outside. He expressed a wish to be married before he died, which occurred in our palliative care unit. This life goal was one we would normally encourage those he loved to gather around him, but this was not possible. He passed peacefully two days after he was married. CONCLUSION Although social limitations are necessary to help provide safety to the patients and staff in a hospital, they can have a direct impact on the suffering of patients and families at the EOL. Helping to maintain dignity, reflect on their life, and resolve any conflicts in the presence of family members is a benchmark for providing quality palliative care. Being barred from visitation due to isolation, threatens this care and lays the foundation for complicated grief among family members. Further research is needed to help balance the needs of those at the EOL with public safety. One such measure to help ease distress is to allow for more virtual visitation through electronic measures.
Collapse
Affiliation(s)
- Monica T Agosta
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michael Tang
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Cindy L Carmack
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Eduardo Bruera
- Department of Palliative Care, Rehabilitation and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| |
Collapse
|
17
|
Schmidt V, Kaiser J, Treml J, Kersting A. Factors associated with pre-loss grief and preparedness in relatives of people with cancer during the COVID-19 pandemic: A cross-sectional study. PLoS One 2022; 17:e0278271. [PMID: 36445887 PMCID: PMC9707745 DOI: 10.1371/journal.pone.0278271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 11/13/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Before the loss of a loved one to cancer, relatives have time to adapt to the impending death. However, due to the current COVID-19 pandemic, adjustment to an imminent death may be more difficult. This study investigates factors related to pre-loss grief and preparedness during the COVID-19 pandemic and their relationship with COVID-19 related fears. METHODS Data of 299 participants from a cross-sectional study was used. Participants were included if they were relatives of people with cancer, spoke German and were at least 18 years. Multivariate linear regression analyses were conducted to measure the relationship between predictors (dysfunctional coping, emotion-focused coping, problem-focused coping, attachment anxiety, attachment avoidance, COVID-19 related fears, prognosis, perceived depth of the relationship, perceived conflict in the relationship, health status) and pre-loss grief, preparedness for caregiving and preparedness for death as the dependent variables. RESULTS Perceived depth (β = .365, p < .001), COVID-19 related fears (β = .141, p = .002), prognosis for death (β = .241, p < .001), dysfunctional coping strategies (β = .281, p < .001) and emotion-focused coping strategies (β = -.320, p < .001) significantly predicted pre-loss grief. Prognosis for death (β = .347, p < .001), dysfunctional coping strategies (β = -.229, p < .001), emotion-focused coping strategies (β = .242, p < .001), COVID-19 related fears (β = -.112, p = .037) and health status (β = .123, p = .025) significantly predicted preparedness for death. Dysfunctional coping (β = -.147, p = .009), problem-focused coping (β = .162, p = .009), emotion-focused coping (β = .148, p = .017), COVID-19 related fears (β = -.151, p = .006), attachment anxiety (β = -.169, p = .003), perceived conflict in the relationship with the patient with cancer (β = -.164, p = .004), perceived depth in the relationship (β = .116, p = .048) and health status (β = .157, p = .003) significantly predicted preparedness for caregiving. CONCLUSIONS This study shows COVID-19 pandemic impacts on the grieving process of relatives of patients with cancer. Consequently, screening for pre-loss grief, preparedness and their associated factors may help provide early support for relatives of people with cancer at need. However, further research is needed to help understand the stability of pre-loss grief and preparedness.
Collapse
Affiliation(s)
- Viktoria Schmidt
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
- * E-mail:
| | - Julia Kaiser
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Julia Treml
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Anette Kersting
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| |
Collapse
|
18
|
Schmidt V, Kaiser J, Treml J, Kersting A. The Relationship Between Pre-Loss Grief, Preparedness and Psychological Health Outcomes in Relatives of People With Cancer. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221142675. [PMID: 36420732 DOI: 10.1177/00302228221142675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023]
Abstract
The aim of this study was to examine the simultaneous effects of pre-loss grief, preparedness for death and preparedness for caregiving on different psychological health outcomes in relatives of people with cancer. Two hundred ninety-nine relatives of people with cancer participated in a cross-sectional online survey. Participants were included if they spoke German and were 18 years or older. Multivariate regression analysis was conducted. Pre-loss grief was significantly associated with depression (β = .388, p < .001), anxiety (β = .429, p < .001), somatization (β = .221, p < .001) and satisfaction with life (β = -.205, p < .001). Preparedness for death was significantly associated with somatization (β = -.247, p < .001). Results suggest that people with high scores in pre-loss grief and low scores in preparedness for death are in need of early support. Interventions should address pre-loss grief and the various aspects of preparedness for death and take into account the psychological health in relatives of people with cancer. Future studies should investigate underlying mechanisms.
Collapse
Affiliation(s)
- Viktoria Schmidt
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Julia Kaiser
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Julia Treml
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Anette Kersting
- Department of Psychosomatic Medicine and Psychotherapy, University of Leipzig, Leipzig, Germany
| |
Collapse
|
19
|
López Pérez Y, Cruzado JA, Lacasta Reverte MA, Lallana-Frías E. Predictors of Complicated Grief in Caregivers of Palliative Care Patients. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221133437. [PMID: 36252273 DOI: 10.1177/00302228221133437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction: It is important to identify the factors s associated with complicated grief (CG) in order to prevent it. Objective: To determine the factors associated with CG in the end-of-life phase within the palliative care context. Method: The PRISMA model was followed for the review. We accessed the following databases: PUBMED, SCOPUS, and PsycoINFO, to review publications from 2006. Results: A total of 17 studies were obtained. A direct relationship between factors prior to bereavement and CG is established: intensity of anticipated grief, previous mental and physical health of the caregiver, social support; quality of patient care, communication at the end-of-life, preparation for death, spirituality, and sociodemographic factors. Conclusions: Previous mental health and level of anticipatory grief in the main caregiver are shown to be the most powerful predictors of CG. Patient age and quality of care are factors considered as strong predictors of CG in almost every study.
Collapse
Affiliation(s)
- Yolanda López Pérez
- EAPS Psychologist at the San Camilo Palliative Care Unit, Centro Asistencial San Camilo, Madrid, Spain
| | - Juan Antonio Cruzado
- Facultad de Psicología, Universidad Complutense de Madrid, Ciudad Universitaria Campus de Somosaguas, Madrid, Spain
| | - María Antonia Lacasta Reverte
- Clinical Psychologist, Unidad de Cuidados Paliativos y Equipo Soporte Hospitalario, Hospital Universitario La Paz, Madrid, Spain
| | - Elena Lallana-Frías
- Palliative Care EAPS Psychologist, Hospital Support Team in Hospital Universitario de Getafe, Home Support Team in ESAD Leganés, at Fundación Instituto San José, Madrid. Spain
| |
Collapse
|
20
|
Ham L, Fransen HP, van Roij J, van den Borne B, Creemers GJ, Hendriks MP, Kuip E, van Laarhoven HW, van Leeuwen L, van der Padt-Pruijsten A, Smilde T, Stellingwerf M, van Zuylen L, van de Poll-Franse L, Raijmakers NJ. Emotional functioning during bereavement after the death of patients with advanced cancer and associated factors. Psychooncology 2022; 31:1719-1727. [PMID: 36097376 DOI: 10.1002/pon.6031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 09/05/2022] [Accepted: 09/05/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The death of a loved one is considered to be the most stressful of all life events. However, the impact of bereavement on quality of life varies between individuals. The aim of our study was to assess emotional functioning, which is a domain of quality of life, of bereaved relatives after the death of their loved one and its associated factors. METHOD A prospective, longitudinal, multicenter, observational study on quality of care and quality of life of patients with advanced cancer and their relatives was conducted (eQuiPe). The association between emotional functioning of relatives during bereavement and the following factors was investigated: gender, type of relationship, educational level, pre-bereavement emotional and social functioning and global quality of life, social support pre- and during bereavement, anticipatory complicated grief, support of healthcare professionals during bereavement, age of patient and bereaved relative and duration of survival after primary cancer diagnosis. RESULTS 150 bereaved relatives completed the bereavement questionnaire. In 41% of the bereaved relatives emotional functioning was ≤71, indicating clinically relevant low emotional functioning. Multivariable logistic regression showed that females experienced more often emotional problems (OR=2.82). Emotional functioning pre-bereavement (OR=0.96) and social support during bereavement (OR=0.97) were associated with low emotional functioning during bereavement. CONCLUSIONS Almost half of the bereaved relatives of patients with advanced cancer experienced low emotional functioning and this was associated with low emotional functioning pre-bereavement and low social support during bereavement. Support for relatives should be initiated before the patient's death. Future research is needed to investigate the impact of such support on relatives' wellbeing during bereavement. This article is protected by copyright. All rights reserved.
Collapse
Affiliation(s)
- Laurien Ham
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Eindhoven, the Netherlands.,Netherlands Association for Palliative Care (PZNL), Eindhoven, the Netherlands
| | - Heidi P Fransen
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Eindhoven, the Netherlands.,Netherlands Association for Palliative Care (PZNL), Eindhoven, the Netherlands
| | - Janneke van Roij
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Eindhoven, the Netherlands.,Netherlands Association for Palliative Care (PZNL), Eindhoven, the Netherlands.,Department of Medical and Clinical Psychology, CoRPS - Center for Research on Psychology in Somatic Diseases, Tilburg University, the Netherlands
| | - Ben van den Borne
- Department of Pulmonology, Catharina Hospital, Eindhoven, The Netherlands
| | - Geert Jan Creemers
- Department of Medical Oncology, Catharina Hospital, Eindhoven, The Netherlands
| | - Mathijs P Hendriks
- Department of Medical Oncology, Northwest Clinics, Alkmaar, The Netherlands
| | - Evelien Kuip
- Department of Medical Oncology and Department of Anesthesiology, Pain and Palliative Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hanneke Wm van Laarhoven
- Department of Medical Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - Lobke van Leeuwen
- Department of Internal Medicine, Diakonessenhuis, Utrecht, the Netherlands
| | | | - Tineke Smilde
- Department of Internal Medicine, Jeroen Bosch Hospital, Den Bosch, The Netherlands
| | - Margriet Stellingwerf
- Department of Pulmonology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lia van Zuylen
- Department of Medical Oncology, Amsterdam University Medical Centers, Cancer Center Amsterdam, University of Amsterdam, Amsterdam, The Netherlands
| | - Lonneke van de Poll-Franse
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Eindhoven, the Netherlands.,Department of Medical and Clinical Psychology, CoRPS - Center for Research on Psychology in Somatic Diseases, Tilburg University, the Netherlands.,Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Utrecht, the Netherlands
| | - Natasja Jh Raijmakers
- Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Eindhoven, the Netherlands.,Netherlands Association for Palliative Care (PZNL), Eindhoven, the Netherlands
| |
Collapse
|
21
|
Wallace Chi Ho C, Grace Suk Man L, Miranda Mei Mui L, Molin Kwok Yin L, Clare Tsz Kiu Y, Jody Ka-Wing W. Facing the loss of siblings in childhood: Interactions and dynamics between bereaved siblings and their parents. J Pediatr Nurs 2022; 66:e1-e8. [PMID: 35817622 DOI: 10.1016/j.pedn.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 05/23/2022] [Accepted: 07/02/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION The loss of a child in a family is a painful experience. Despite this, most studies focus on the grieving experience of parents. Our understanding of sibling bereavement therefore remains underexplored. This study aims to address this gap by exploring the bereavement experience of younger bereaved siblings from the perspective of the bereaved child and the parents. METHOD This study is a qualitative study conducted in Hong Kong. We recruited eleven bereaved families from 2019 to 2020. Semi-structured interviews were conducted separately with bereaved children and parents. Thematic analyses were performed. FINDINGS Eleven bereaved siblings, aged 5 to 11, and their parents were interviewed. Four themes were generated: Parents' unawareness of bereaved siblings' grief, protecting parents from grief, comparison with the deceased siblings, and learning how to grieve. CONCLUSION Our findings suggest that the family dynamics and interactions in the grieving experience are complex. The impact of grief on the bereaved child could emanate from the loss of the sibling or from the grief of the parents or from family interactions. PRACTICE IMPLICATIONS This study highlights the importance of viewing the sibling bereavement experience in a family context and of enhancing sibling bereavement services. Helping professionals should not only provide more bereavement support to the bereaved siblings individually, but they should also enhance parents' capacity to support their bereaved children.
Collapse
Affiliation(s)
| | | | - Leung Miranda Mei Mui
- Fellow of the Hong Kong Academy of Nursing (Hong Kong College of Paediatric Nursing), Hong Kong
| | | | - Yu Clare Tsz Kiu
- Department of Social Work, The Chinese University of Hong Kong, Hong Kong.
| | - Wu Jody Ka-Wing
- Department of Social Work, The Chinese University of Hong Kong, Hong Kong
| |
Collapse
|
22
|
Ann-Yi S, Bruera E. Psychological Aspects of Care in Cancer Patients in the Last Weeks/Days of Life. Cancer Res Treat 2022; 54:651-660. [PMID: 35790196 PMCID: PMC9296948 DOI: 10.4143/crt.2022.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/25/2022] [Indexed: 11/30/2022] Open
Abstract
Palliative care is comprised of an interdisciplinary team (IDT) approach with members from different disciplines who collaboratively work together to reduce multidimensional components of pain and suffering and improve quality of life for patients coping with a terminal illness. Psychosocial team members are integral to the palliative care IDT and provide expertise in assessment and empirically validated interventions to address psychological distress. The following paper will provide a review of different facets of psychological distress experienced by advanced cancer patients such as psychological disorders, existential distress, spiritual distress, caregiver distress, parental distress, and grief. Finally, an overview of commonly used screening and assessment tools as well as psychological interventions relevant for the palliative care population is presented.
Collapse
|
23
|
Singer J, Roberts KE, McLean E, Fadalla C, Coats T, Rogers M, Wilson MK, Godwin K, Lichtenthal WG. An examination and proposed definitions of family members' grief prior to the death of individuals with a life-limiting illness: A systematic review. Palliat Med 2022; 36:581-608. [PMID: 35196915 PMCID: PMC10098140 DOI: 10.1177/02692163221074540] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Research has extensively examined family members' grief prior to the death of an individual with a life-limiting illness but several inconsistencies in its conceptualization of related constructs, yet significant conceptualization issues exist. AIM This study aimed to identify and characterize studies published on family members grief before the death of an individual with a life-limiting illness, and propose definitions based on past studies in order to initiate conceptual clarity. DESIGN A mixed-method systematic review utilized six databases and was last conducted July 10, 2021. The search strategy was developed using Medical Subject Headings. This study was prospectively registered on PROSPERO (CRD42020166254). RESULTS One hundred thirty-four full-text articles met inclusion criteria. This review revealed across studies a wide variation in terminology, conceptualization, and characterization of grief before the death. More than 18 terms and 30 definitions have been used. In many cases, the same term (e.g. anticipatory grief) was defined differently across studies. CONCLUSIONS We found grief occurring before the death of a person with a life-limiting illness, which we termed pre-death grief, is comprised of two distinct constructs: anticipatory grief and illness-related grief. Anticipatory grief is future-oriented and is characterized by separation distress and worry about a future without the person with the life-limiting illness being physically present. Illness-related grief is present-oriented and is characterized by grief over current and ongoing losses experienced during the illness trajectory. These definitions provide the field with uniform constructs to advance the study of grief before the death of an individual with a life-limiting illness.
Collapse
Affiliation(s)
- Jonathan Singer
- Department of Psychological Science, Texas Tech University, Lubbock, TX, USA
| | - Kailey E Roberts
- Ferkauf Graduate School of Psychology, Yeshiva University, New York, NY, USA
| | - Elisabeth McLean
- Department of Psychological Science, Texas Tech University, Lubbock, TX, USA
| | - Carol Fadalla
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Taylor Coats
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Madeline Rogers
- Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, NY, USA
| | | | - Kendra Godwin
- Medical Library, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Wendy G Lichtenthal
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| |
Collapse
|
24
|
Park J, Levine H, Galvin JE. Factor structure of Pre‐Loss Grief‐12 in caregivers of people living with dementia. ALZHEIMER'S & DEMENTIA: TRANSLATIONAL RESEARCH & CLINICAL INTERVENTIONS 2022; 8:e12322. [PMID: 35846160 PMCID: PMC9270640 DOI: 10.1002/trc2.12322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 06/01/2022] [Accepted: 06/01/2022] [Indexed: 11/09/2022]
Abstract
Introduction The objective was to develop and refine a version of the Prolonged‐Loss Grief‐12 (PG‐12) specific to caregivers of people living with dementia. Confirmatory factor analysis (CFA) was performed to test the fit of the data from the caregivers and to assess the factor structure of the PG‐12 in order to evaluate pre‐loss grief accurately by identifying relevant items and eliminating items that are not appropriate for caregivers of persons with dementia. Methods A total of 699 eligible caregivers of persons living with dementia (PLWDs) were recruited through relevant dementia associations and organizations. The e‐mail for recruitment provided potential participants with information about the study and detailed instructions on how to participate by following a link to the online survey. Secondary analysis was based on the survey data. CFA was conducted via the Full Information Maximum Likelihood estimation method to test the unidimensional model of PG‐12 in the study population. Standard procedures were used to establish the parameters in the factor loading, factor variance‐covariance, and uniqueness matrices. Results The initial model was modified to develop a better fitting model and to detect misfitting parameters in the PG‐12 by deleting irrelevant items for the PLWD's caregiver. The adjusted dementia‐specific 10‐item version (PG‐10‐D) had significantly improved fit indices. An overall assessment of fit indicated that the model adequately approximated the data. Factor loadings ranged from 0.53 to 0.85. Discussion We found that the dementia‐specific, unidimensional PG‐10‐D, modifying the original PG‐12, may be useful and parsimonious in assessing and quantifying pre‐loss grief in dementia caregivers. Future studies are needed to further test its validity and reliability. Highlights First study to evaluate a dementia‐specific 10‐item version (PG‐10‐D) of the Prolonged‐Loss Grief‐12 (PG‐12). PG‐10‐D is useful in assessing and quantifying pre‐loss grief in caregivers. PG‐10‐D could be an early identifier of caregivers at risk for pre‐loss grief. PG‐10‐D could be the standard measure for effective intervention for caregivers.
Collapse
Affiliation(s)
- Juyoung Park
- Phyllis & Harvey Sandler School of Social Work College of Social Work & Criminal Justice Florida Atlantic University Boca Raton Florida USA
| | - Hannah Levine
- Charles E. Schmidt College of Medicine Florida Atlantic University Boca Raton Florida USA
| | - James E. Galvin
- Comprehensive Center for Brain Health Department of Neurology University of Miami Miller School of Medicine Miami Florida USA
| |
Collapse
|
25
|
Treml J, Brähler E, Kersting A. Prevalence, Factor Structure and Correlates of DSM-5-TR Criteria for Prolonged Grief Disorder. Front Psychiatry 2022; 13:880380. [PMID: 35664467 PMCID: PMC9159802 DOI: 10.3389/fpsyt.2022.880380] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/28/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Prolonged Grief Disorder (PGD) is now included in Section II of the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision (DSM-5-TR). To understand the health burden and then allocate economic and professional resources, it is necessary to provide epidemiological data for this new disorder. This is especially relevant since the new diagnostic criteria differ from its predecessors, which may affect the generalizability of previous findings. More information on the characteristics of people suffering from PGD is also beneficial to better identify individuals at risk. This study, therefore, aimed to estimate the prevalence of the new PGD criteria in a representative population-based sample, evaluate the factor structure, sociodemographic, and loss-related correlates of PGD caseness and explore possible predictors. METHODS Out of a representative sample of the German general population (N = 2,531), n = 1,371 (54.2%) reported to have experienced a significant loss throughout lifetime. Participants provided sociodemographic data and loss-related characteristics. PGD symptoms were measured using items from the German versions of the Prolonged Grief Scale (PG-13) and the Inventory of Complicated Grief (ICG), which could be matched to the DSM-5-TR criteria for PGD. RESULTS The conditional prevalence of PGD was 3.4% (n = 47). The most frequently reported symptoms were intense emotional pain and intense yearning or longing for the deceased. The confirmatory factor analysis confirmed a unidimensional model of PGD. Regression analysis demonstrated that time since the death, the relationship to the deceased, and unpreparedness for the death were significant predictors of PGD. CONCLUSION Although the prevalence of 3.4% using the new diagnostic criteria is lower than the prevalence previously suggested by a meta-analysis, PGD remains a substantial disorder in the general population. In particular, the loss of a partner or child increases the risk for PGD, as does unpreparedness for the death of a loved one. Clinicians should pay particular attention to these high-risk groups. Further clinical implications are discussed.
Collapse
Affiliation(s)
- Julia Treml
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Elmar Brähler
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,Department of Psychiatry and Psychotherapy, Medical Faculty, University of Leipzig, Leipzig, Germany
| | - Anette Kersting
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, University of Leipzig, Leipzig, Germany
| |
Collapse
|
26
|
Pan YC, Lin YS. Systematic Review and Meta-Analysis of Prevalence of Depression Among Caregivers of Cancer Patients. Front Psychiatry 2022; 13:817936. [PMID: 35633789 PMCID: PMC9133351 DOI: 10.3389/fpsyt.2022.817936] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/03/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Caregivers of cancer patients commonly experience depressive symptoms due to the heavy burden of caregiving responsibility. OBJECTIVE This meta-analysis examined the prevalence of depression among caregivers of cancer patients. METHODS We included 85 studies covering 23,317 participants published between 2001 and 2021 (25 countries) that reported the prevalence of depression among caregivers of cancer patients. We examined the pooled prevalence of depression and hypothesized moderators, including year, age, sex, geographic regions, percentage of spousal caregivers, depression measures, and cancer stage. RESULTS All 85 effect sizes included 6,077 caregivers of patients with depression. The weighted average prevalence of depression was 25.14% (95% CI, 21.42-29.27%) among caregivers. The prevalence rates were moderated by geographic region, patients' cancer stage, and measures for depression. The prevalence rates also varied among the different measures assessing depression. The prevalence rate decreased with the mean age of the caregivers and the percentage of spousal caregivers. CONCLUSIONS This study revealed a high prevalence of depression among caregivers of cancer patients. The prevalence rates also varied with the study design, demographics of caregivers, and patients' medical information. These findings highlight that psychological support and intervention may be crucial for patients and their caregivers in clinical practice.
Collapse
Affiliation(s)
- Yuan-Chien Pan
- Department of Psychology, National Taiwan University, Taipei, Taiwan
| | - Yaw-Sheng Lin
- Department of Psychology, National Taiwan University, Taipei, Taiwan
| |
Collapse
|
27
|
Fee A, Hanna J, Hasson F. Pre-loss grief experiences of adults when someone important to them is at end-of-life: A qualitative systematic review. DEATH STUDIES 2021; 47:1-15. [PMID: 34751635 DOI: 10.1080/07481187.2021.1998935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Pre-loss grief can be experienced by relatives before impending death; however, limited understanding exists about the impact of pre-loss grief on bereavement. This systematic review aimed to synthesize qualitative research evidence reporting adults' experiences of pre-loss grief within cancer care. Thirteen studies were selected, and three key themes identified. Findings indicate that relatives transitioned through lived experiences during end-stage cancer, and that meanings attached to these experiences influenced how they experienced pre-loss grief. Limited formal support was identified to navigate these experiences; however, context was seen as important, and skilled healthcare practitioners and physical environment were key to facilitating preparedness.
Collapse
Affiliation(s)
- Anne Fee
- Institute of Nursing and Health Research, Ulster University, Northern Ireland, UK
| | - Jeff Hanna
- School of Nursing and Midwifery, Queen's University Belfast, Northern Ireland, UK
| | - Felicity Hasson
- Institute of Nursing and Health Research, Ulster University, Northern Ireland, UK
| |
Collapse
|