Complicated Grief Symptoms in Caregivers of Persons with Lung Cancer: The Role of Family Conflict, Intrapsychic Strains, and Hospice Utilization

Abstract

Guided by a stress process conceptual model, this study examines social and psychological determinants of complicated grief symptoms focusing on family conflict, intrapsychic strains, and the potential moderating effect of care quality and hospice utilization. Relying on data from 152 spouse and adult child lung cancer caregiver survey respondents, drawn from an ancillary study of the Assessment of Cancer CarE and SatiSfaction (ACCESS) in Wisconsin, hierarchical multiple regression analysis was used to examine determinants of complicated grief. After controlling for contextual factors and time since death, complicated grief symptoms were higher among care-givers with less education, among families with lower prior conflict but higher conflict at the end-of-life, who had family members who had difficulty accepting the illness, and who were caring for patients with greater fear of death. Additionally, hospice utilization moderated the effect of fear of death on complicated grief. Findings suggest that family conflict, intrapsychic strains, and hospice utilization may help to explain the variability found in complicated grief symptoms among bereaved caregivers. Implications for enhancing complicated grief assessment tools and preventative interventions across the continuum of cancer care are highlighted.

Correlates and Predictors of Conflict at the End of Life Among Families Enrolled in Hospice

“…3 Family conflict adversely effects caregiver burden, health, 4 depression, anger, 5 and bereavement. 6,7 In addition, family conflict has a negative effect on the interdisciplinary team's ability to address patient and family needs 8 and is a substantial barrier to providing quality end-of-life care. 9 Despite the palliative care mandate to view family as the unit of care 10 and the myriad negative consequences that result from conflict, relatively little research has been conducted with hospice families to determine what contributes to family conflict at the end of life.…”

Captação de Múltiplos Órgãos: os Desafios do Processo para os Profissionais da Saúde e Familiares

“…De acordo com Kramer et al (2010), é precária a investigação sobre como o conflito familiar e as experiências de prestação de cuidados no final da vida podem influenciar o processo de luto dos familiares.…”

Easing the Burden of Surrogate Decision Making: The Role of a Do-Not-Escalate-Treatment Order

“…18 This extra time may also help improve bereavement outcomes. Families who identify that they have a difficult time accepting the illness have higher rates of complicated grief, 19 whereas a longer duration of caring may be protective. 20 The Effect of a DNET Order on Medical Teams…”