Objective-This study examined grief and mental health service use among 86 bereaved caregivers of advanced cancer patients.Methods-Caregivers were assessed before (median=3.1 months) and after (median=6.6 months) patients' deaths for prolonged grief disorder, axis I psychiatric disorders, mental health service use, suicidality, and health-related quality of life.Results-Sixteen percent of the bereaved sample met criteria for prolonged grief disorder, which was significantly associated with suicidality and poorer health-related quality of life, but not with mental health service use. The majority of bereaved caregivers with prolonged grief disorder did not access mental health services. In multivariable analyses, having discussed psychological concerns with a health care professional when the patient was ill was the only significant predictor of mental health service use during bereavement.
Objective
This study examines the relationships between methods of coping with advanced cancer, completion of advance care directives, and receipt of intensive, life-prolonging care near death.
Methods
The analysis is based on a sample of 345 patients interviewed between January 1, 2003, and August 31, 2007, and followed until death as part of the Coping with Cancer Study, an NCI/NIMH-funded, multi-site, prospective, longitudinal, cohort study of patients with advanced cancer. The Brief COPE was used to assess active coping, use of emotional-support, and behavioral disengagement. The Brief RCOPE was used to assess positive and negative religious coping. The main outcome was intensive, life-prolonging care near death, defined as receipt of ventilation or resuscitation in the last week of life.
Results
Positive religious coping was associated with lower rates of having a living will (AOR=0.39, p=0.003) and predicted higher rates of intensive, life-prolonging care near death (AOR, 5.43; p<0.001), adjusting for other coping methods and potential socio-demographic and health status confounds. Behavioral disengagement was associated with higher rates of DNR order completion (AOR, 2.78; p=0.003) and predicted lower rates of intensive life-prolonging care near death (AOR, 0.20; p=0.036). Not having a living will partially mediated the influence of positive religious coping on receipt of intensive, life-prolonging care near death.
Conclusion
Positive religious coping and behavioral disengagement are important determinants of completion of advance care directives and receipt of intensive, life-prolonging care near death.
Objective
This study examined grief and mental health service use among 86 bereaved caregivers of advanced cancer patients.
Methods
Caregivers were assessed before (median=3.1 months) and after (median=6.6 months) patients’ deaths for prolonged grief disorder, axis I psychiatric disorders, mental health service use, suicidality, and health-related quality of life.
Results
Sixteen percent of the bereaved sample met criteria for prolonged grief disorder, which was significantly associated with suicidality and poorer health-related quality of life, but not with mental health service use. The majority of bereaved caregivers with prolonged grief disorder did not access mental health services. In multivariable analyses, having discussed psychological concerns with a health care professional when the patient was ill was the only significant predictor of mental health service use during bereavement.
Conclusions
Because bereaved caregivers with prolonged grief disorder underutilize mental health services, connecting them with services while the patient is still alive may be beneficial.
Little is known about how young adults (YAs) cope with cancer or the relationship between coping and psychological distress in YAs with advanced cancer. Structured clinical interviews with 53 YAs (20–40 years) with advanced cancer assessed coping methods, depression, anxiety, and grief. A principal components factor analysis identified underlying coping factors. Regression analyses examined the relationship between these coping factors and depression, anxiety, and grief. Six coping factors emerged and were labeled as: Proactive, Distancing, Negative Expression, Support-seeking, Respite-seeking, and Acceptance coping. Acceptance and Support-seeking coping styles were used most frequently. Coping by Negative Expression was positively associated with severity of grief after controlling for depression, anxiety, and confounding variables. Support-seeking coping was positively associated with anxiety after controlling for depression and grief. This study was limited by cross-sectional design, small sample size, and focus on YAs with advanced cancer. YAs with advanced cancer utilize a range of coping responses that are uniquely related to psychological distress.
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