Caregiver bereavement outcomes in advanced cancer: associations with quality of death and patient age

Purpose We investigated relationships between domains of quality of dying and death in patients with advanced cancer and their caregivers' bereavement outcomes and the moderating effect of patient age at death. Methods Bereaved caregivers of deceased patients with advanced cancer who had participated in an early palliative care trial completed measures of grief (Texas Revised Inventory of Grief [TRIG]), complicated grief (Prolonged Grief Inventory [PG-13]), and depression (Center for Epidemiologic Studies-Depression [CESD-10]). They also completed the Quality of Dying and Death measure (QODD), which assesses patients' symptom control, preparation for death, connectedness with loved ones, and sense of peace with death. Results A total of 157 bereaved caregivers completed the study. When patient age x QODD subscale interactions were included, greater death preparation was related to less grief at patient death (past TRIG: beta = - .25, p = .04), less current grief (present TRIG: beta = - .26, p = .03), less complicated grief (PG-13: beta = - .37, p = .001), and less depression (CESD-10: beta = - .35, p = .005). Greater symptom control was related to less current grief (present TRIG: beta = - .27, p = .02), less complicated grief (PG-13: beta = - .24, p = .03), and less depression (CESD-10: beta = - .29, p = .01). Significant patient age x connectedness interaction effects for current grief (present TRIG: beta = .30, p = .02) and complicated grief (PG-13: beta = .29, p = .007) indicated that, with less connectedness, younger patient age at death was associated with greater caregiver grief. Conclusion Better end-of-life death preparation and symptom control for patients with cancer may attenuate later caregiver grief and depression. Less connectedness between younger patients and their families may adversely affect caregiver grief.