Risk factors for developing prolonged grief during bereavement in family carers of cancer patients in palliative care: a longitudinal study

J Pain Symptom Manage. 2014 Mar;47(3):531-41. doi: 10.1016/j.jpainsymman.2013.05.022. Epub 2013 Aug 19.


Context: Family carers of palliative care patients report high levels of psychological distress throughout the caregiving phase and during bereavement. Palliative care providers are required to provide psychosocial support to family carers; however, determining which carers are more likely to develop prolonged grief (PG) is currently unclear.

Objectives: To ascertain whether family carers reporting high levels of PG symptoms and those who develop PG disorder (PGD) by six and 13 months postdeath can be predicted from predeath information.

Methods: A longitudinal study of 301 carers of patients receiving palliative care was conducted across three palliative care services. Data were collected on entry to palliative care (T1) on a variety of sociodemographic variables, carer-related factors, and psychological distress measures. The measures of psychological distress were then readministered at six (T2; n=167) and 13 months postdeath (T3; n=143).

Results: The PG symptoms at T1 were a strong predictor of both PG symptoms and PGD at T2 and T3. Greater bereavement dependency, a spousal relationship to the patient, greater impact of caring on schedule, poor family functioning, and low levels of optimism also were risk factors for PG symptoms.

Conclusion: Screening family carers on entry to palliative care seems to be the most effective way of identifying who has a higher risk of developing PG. We recommend screening carers six months after the death of their relative to identify most carers with PG.

Keywords: Family carer; bereavement; death; distress; dying; end-of-life care; family caregiver; family support; grief; palliative care; prolonged grief; terminal illness.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Bereavement*
  • Caregivers / psychology*
  • Family / psychology*
  • Female
  • Grief*
  • Humans
  • Longitudinal Studies
  • Male
  • Neoplasms / therapy*
  • Palliative Care*
  • Personality
  • Psychiatric Status Rating Scales
  • Risk Factors
  • Socioeconomic Factors
  • Spouses / psychology
  • Time Factors