Skip to main content
Top
Published in: Supportive Care in Cancer 10/2010

01-10-2010 | Original Article

Determinants of complicated grief in caregivers who cared for terminal cancer patients

Authors: Yu-Wen Chiu, Chia-Tsuan Huang, Shao-Min Yin, Yung-Cheng Huang, Ching-hsin Chien, Hung-Yi Chuang

Published in: Supportive Care in Cancer | Issue 10/2010

Login to get access

Abstract

Purpose

There is little research on determinants and the grief that caregivers experience after their relatives die of cancer. This study evaluated factors which influence complicated grief among caregivers who cared for patients who died of cancer in Taiwan.

Methods

This prospective study recruited 668 caregivers who cared for terminally ill cancer patients in the hospice ward or who received shared-care consultation. Caregivers were interviewed on the telephone an average 8.9 months after the cancer patients passed away. The Inventory of Complicated Grief (ICG), modified for use in a Chinese population, was used to assess the grief status of caregivers. ICG >25 was defined as complicated grief.

Results

Our study found that female gender (odds ratio (OR), 2.27; 95% confidence interval (CI), 1.75–2.82), spouse relationship (OR, 1.20; 1.01–1.40), parents–children relationship (OR, 1.70; 1.11–2.31), lack of religious belief (OR, 1.47; 1.19–1.75), unavailable family support (OR, 1.42; 1.03–1.83), and history of mood co-morbidity (OR, 1.41; 1.02–1.83) were risk factors that would predispose towards complicated grief; whereas, longer duration of caring (months, OR, 0.79; 0.69–0.91), medical disease history in the carer (OR, 0.77; 0.57–0.99), and patients being cared for on the hospice ward (OR, 0.60; 0.44–0.77) were factors that would mitigate against complicated grief.

Conclusions

These results suggest that clinical professionals who care for terminal cancer patients and their caregivers should pay particular attention to caregivers with these predisposing factors.
Literature
1.
go back to reference Chen CJ, You SL, Lin LH, Hsu WL, Yang YW (2002) Cancer epidemiology and control in Taiwan: a brief review. Jpn J Clin Oncol 32 Suppl:S66–S81CrossRefPubMed Chen CJ, You SL, Lin LH, Hsu WL, Yang YW (2002) Cancer epidemiology and control in Taiwan: a brief review. Jpn J Clin Oncol 32 Suppl:S66–S81CrossRefPubMed
2.
go back to reference Department of Health, Executive Yuan (2008) Health Statistics in Taiwan, 2008. Department of Health, Executive Yuan, ROC, Taipei, Taiwan Department of Health, Executive Yuan (2008) Health Statistics in Taiwan, 2008. Department of Health, Executive Yuan, ROC, Taipei, Taiwan
3.
go back to reference Lai YL, Su WH (1997) Palliative medicine and the hospice movement in Taiwan. Support Care Cancer 5:348–350CrossRefPubMed Lai YL, Su WH (1997) Palliative medicine and the hospice movement in Taiwan. Support Care Cancer 5:348–350CrossRefPubMed
4.
go back to reference Chiu TY, Hu WY, Chen CY (2000) Prevalence and severity of symptoms in terminal cancer patients: a study in Taiwan. Support Care Cancer 8:311–313CrossRefPubMed Chiu TY, Hu WY, Chen CY (2000) Prevalence and severity of symptoms in terminal cancer patients: a study in Taiwan. Support Care Cancer 8:311–313CrossRefPubMed
5.
go back to reference Chiu TY, Hu WY, Lue BH, Yao CA, Chen CY, Wakai S (2004) Dyspnea and its correlates in taiwanese patients with terminal cancer. J Pain Symptom Manage 28:123–132CrossRefPubMed Chiu TY, Hu WY, Lue BH, Yao CA, Chen CY, Wakai S (2004) Dyspnea and its correlates in taiwanese patients with terminal cancer. J Pain Symptom Manage 28:123–132CrossRefPubMed
6.
go back to reference Grassi L (2007) Bereavement in families with relatives dying of cancer. Curr Opin Support Palliat Care 1:43–49CrossRefPubMed Grassi L (2007) Bereavement in families with relatives dying of cancer. Curr Opin Support Palliat Care 1:43–49CrossRefPubMed
7.
go back to reference Zhang B, El-Jawahri A, Prigerson HG (2006) Update on bereavement research: evidence-based guidelines for the diagnosis and treatment of complicated bereavement. J Palliat Med 9:1188–1203CrossRefPubMed Zhang B, El-Jawahri A, Prigerson HG (2006) Update on bereavement research: evidence-based guidelines for the diagnosis and treatment of complicated bereavement. J Palliat Med 9:1188–1203CrossRefPubMed
8.
go back to reference Zisook S (2000) Understanding and managing bereavement in palliative care. In: Chochinov HM, Breitbart W (eds) Handbook of psychiatry in palliative medicine. Oxford University Press, New York, pp 321–334 Zisook S (2000) Understanding and managing bereavement in palliative care. In: Chochinov HM, Breitbart W (eds) Handbook of psychiatry in palliative medicine. Oxford University Press, New York, pp 321–334
9.
go back to reference Prigerson HG, Bierhals AJ, Kasl SV, Reynolds CF 3rd, Shear MK, Newsom JT, Jacobs S (1996) Complicated grief as a disorder distinct from bereavement-related depression and anxiety: a replication study. Am J Psychiatry 153:1484–1486PubMed Prigerson HG, Bierhals AJ, Kasl SV, Reynolds CF 3rd, Shear MK, Newsom JT, Jacobs S (1996) Complicated grief as a disorder distinct from bereavement-related depression and anxiety: a replication study. Am J Psychiatry 153:1484–1486PubMed
10.
go back to reference Prigerson HG, Maciejewski PK, Reynolds CF 3rd, Bierhals AJ, Newsom JT, Fasiczka A, Frank E, Doman J, Miller M (1995) Inventory of Complicated Grief: a scale to measure maladaptive symptoms of loss. Psychiatry Res 59:65–79CrossRefPubMed Prigerson HG, Maciejewski PK, Reynolds CF 3rd, Bierhals AJ, Newsom JT, Fasiczka A, Frank E, Doman J, Miller M (1995) Inventory of Complicated Grief: a scale to measure maladaptive symptoms of loss. Psychiatry Res 59:65–79CrossRefPubMed
11.
go back to reference Bernard LL, Guarnaccia CA (2003) Two models of caregiver strain and bereavement adjustment: a comparison of husband and daughter caregivers of breast cancer hospice patients. Gerontologist 43:808–816PubMed Bernard LL, Guarnaccia CA (2003) Two models of caregiver strain and bereavement adjustment: a comparison of husband and daughter caregivers of breast cancer hospice patients. Gerontologist 43:808–816PubMed
12.
go back to reference Rossi Ferrario S, Cardillo V, Vicario F, Balzarini E, Zotti AM (2004) Advanced cancer at home: caregiving and bereavement. Palliat Med 18:129–136CrossRefPubMed Rossi Ferrario S, Cardillo V, Vicario F, Balzarini E, Zotti AM (2004) Advanced cancer at home: caregiving and bereavement. Palliat Med 18:129–136CrossRefPubMed
13.
go back to reference Burton AM, Haley WE, Small BJ, Finley MR, Dillinger-Vasille M, Schonwetter R (2008) Predictors of well-being in bereaved former hospice caregivers: the role of caregiving stressors, appraisals, and social resources. Palliat Support Care 6:149–158CrossRefPubMed Burton AM, Haley WE, Small BJ, Finley MR, Dillinger-Vasille M, Schonwetter R (2008) Predictors of well-being in bereaved former hospice caregivers: the role of caregiving stressors, appraisals, and social resources. Palliat Support Care 6:149–158CrossRefPubMed
14.
go back to reference Kelly B, Edwards P, Synott R, Neil C, Baillie R, Battistutta D (1999) Predictors of bereavement outcome for family carers of cancer patients. Psycho-oncology 8:237–249CrossRefPubMed Kelly B, Edwards P, Synott R, Neil C, Baillie R, Battistutta D (1999) Predictors of bereavement outcome for family carers of cancer patients. Psycho-oncology 8:237–249CrossRefPubMed
15.
go back to reference Prigerson HG, Maciejewski PK (2006) A call for sound empirical testing and evaluation of criteria for complicated grief proposed by the DSM V. Omega 52:9–19 Prigerson HG, Maciejewski PK (2006) A call for sound empirical testing and evaluation of criteria for complicated grief proposed by the DSM V. Omega 52:9–19
16.
go back to reference Chu HC, Chow PC (2008) Providing grief counseling to a major depressive elderly widower: a nurse’s experience (article in Chinese). Hu Li Za Zhi/The Journal of Nursing 55:90–96 Chu HC, Chow PC (2008) Providing grief counseling to a major depressive elderly widower: a nurse’s experience (article in Chinese). Hu Li Za Zhi/The Journal of Nursing 55:90–96
17.
go back to reference Anderson WG, Arnold RM, Angus DC, Bryce CL (2008) Posttraumatic stress and complicated grief in family members of patients in the intensive care unit. J Gen Intern Med 23:1871–1876CrossRefPubMed Anderson WG, Arnold RM, Angus DC, Bryce CL (2008) Posttraumatic stress and complicated grief in family members of patients in the intensive care unit. J Gen Intern Med 23:1871–1876CrossRefPubMed
18.
go back to reference Ringdal GI, Ringdal K, Jordhoy MS, Kaasa S (2007) Does social support from family and friends work as a buffer against reactions to stressful life events such as terminal cancer? Palliat Support Care 5:61–69CrossRefPubMed Ringdal GI, Ringdal K, Jordhoy MS, Kaasa S (2007) Does social support from family and friends work as a buffer against reactions to stressful life events such as terminal cancer? Palliat Support Care 5:61–69CrossRefPubMed
19.
go back to reference Chen JH, Bierhals AJ, Prigerson HG, Kasl SV, Mazure CM, Jacobs S (1999) Gender differences in the effects of bereavement-related psychological distress in health outcomes. Psychol Med 29:367–380CrossRefPubMed Chen JH, Bierhals AJ, Prigerson HG, Kasl SV, Mazure CM, Jacobs S (1999) Gender differences in the effects of bereavement-related psychological distress in health outcomes. Psychol Med 29:367–380CrossRefPubMed
20.
go back to reference Summers J, Zisook S, Sciolla AD, Patterson T, Atkinson JH (2004) Gender, AIDS, and bereavement: a comparison of women and men living with HIV. Death Stud 28:225–241CrossRefPubMed Summers J, Zisook S, Sciolla AD, Patterson T, Atkinson JH (2004) Gender, AIDS, and bereavement: a comparison of women and men living with HIV. Death Stud 28:225–241CrossRefPubMed
21.
go back to reference Neria Y, Gross R, Litz B, Maguen S, Insel B, Seirmarco G, Rosenfeld H, Suh EJ, Kishon R, Cook J, Marshall RD (2007) Prevalence and psychological correlates of complicated grief among bereaved adults 2.5–3.5 years after September 11th attacks. J Trauma Stress 20:251–262CrossRefPubMed Neria Y, Gross R, Litz B, Maguen S, Insel B, Seirmarco G, Rosenfeld H, Suh EJ, Kishon R, Cook J, Marshall RD (2007) Prevalence and psychological correlates of complicated grief among bereaved adults 2.5–3.5 years after September 11th attacks. J Trauma Stress 20:251–262CrossRefPubMed
22.
go back to reference Gilbar O, Ben-Zur H (2002) Bereavement of spouse caregivers of cancer patients. Am J Orthopsychiatry 72:422–432CrossRefPubMed Gilbar O, Ben-Zur H (2002) Bereavement of spouse caregivers of cancer patients. Am J Orthopsychiatry 72:422–432CrossRefPubMed
23.
go back to reference Becker G, Xander CJ, Blum HE, Lutterbach J, Momm F, Gysels M, Higginson IJ (2007) Do religious or spiritual beliefs influence bereavement? A systematic review. Palliat Med 21:207–217CrossRefPubMed Becker G, Xander CJ, Blum HE, Lutterbach J, Momm F, Gysels M, Higginson IJ (2007) Do religious or spiritual beliefs influence bereavement? A systematic review. Palliat Med 21:207–217CrossRefPubMed
24.
go back to reference Hebert RS, Dang Q, Schulz R (2007) Religious beliefs and practices are associated with better mental health in family caregivers of patients with dementia: findings from the REACH study. Am J Geriatr Psychiatry 15:292–300CrossRefPubMed Hebert RS, Dang Q, Schulz R (2007) Religious beliefs and practices are associated with better mental health in family caregivers of patients with dementia: findings from the REACH study. Am J Geriatr Psychiatry 15:292–300CrossRefPubMed
25.
go back to reference Wortmann JH, Park CL (2008) Religion and spirituality in adjustment following bereavement: an integrative review. Death Stud 32:703–736CrossRefPubMed Wortmann JH, Park CL (2008) Religion and spirituality in adjustment following bereavement: an integrative review. Death Stud 32:703–736CrossRefPubMed
26.
go back to reference Groot MH, Keijser J, Neeleman J (2006) Grief shortly after suicide and natural death: a comparative study among spouses and first-degree relatives. Suicide Life Threat Behav 36:418–431CrossRefPubMed Groot MH, Keijser J, Neeleman J (2006) Grief shortly after suicide and natural death: a comparative study among spouses and first-degree relatives. Suicide Life Threat Behav 36:418–431CrossRefPubMed
27.
go back to reference Horowitz MJ, Siegel B, Holen A, Bonanno GA, Milbrath C, Stinson CH (1997) Diagnostic criteria for complicated grief disorder. Am J Psychiatry 154:904–910PubMed Horowitz MJ, Siegel B, Holen A, Bonanno GA, Milbrath C, Stinson CH (1997) Diagnostic criteria for complicated grief disorder. Am J Psychiatry 154:904–910PubMed
28.
go back to reference Horowitz MJ, Bonanno GA, Holen A (1993) Pathological grief: diagnosis and explanation. Psychosom Med 55:260–273PubMed Horowitz MJ, Bonanno GA, Holen A (1993) Pathological grief: diagnosis and explanation. Psychosom Med 55:260–273PubMed
Metadata
Title
Determinants of complicated grief in caregivers who cared for terminal cancer patients
Authors
Yu-Wen Chiu
Chia-Tsuan Huang
Shao-Min Yin
Yung-Cheng Huang
Ching-hsin Chien
Hung-Yi Chuang
Publication date
01-10-2010
Publisher
Springer-Verlag
Published in
Supportive Care in Cancer / Issue 10/2010
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI
https://doi.org/10.1007/s00520-009-0756-6

Other articles of this Issue 10/2010

Supportive Care in Cancer 10/2010 Go to the issue
Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras
Prof. Fabrice Barlesi
Developed by: Springer Medicine