title: Bereavement services for family caregivers: how often used, why, and why not.
abstract: BACKGROUND
  Bereavement services are central to high-quality end-of-life care, however, little is known about how frequently and why such bereavement services are used and not used. We examined family caregiver reports about how often they used bereavement services, predictors of their use, and reported reasons for not using bereavement services.
  
  
  METHODS
  Prospective cohort study of family caregivers (n = 161) of patients with cancer enrolled with hospice between October 1999 and September 2001. We conducted bivariate and multivariable analyses to determine predictors of bereavement service use, adjusted for a broad range of factors including caregiving experiences, major depressive disorder (MDD), relationship with the deceased, and demographic factors. We used content analysis to summarize responses to open-ended questions concerning why individuals did not use bereavement services.
  
  
  RESULTS
  We found that approximately 30% of family caregivers used bereavement services in the year postloss, and the majority of these caregivers used services in the first 6 months postloss. Even among bereaved caregivers with MDD, less than half (47.6%) used bereavement services. Factors associated with using bereavement services included being a spouse caregiver, younger age, having MDD at study enrollment, witnessing highly distressing events pertaining to the patient's death, having assisted the patient with more Instrumental Activities of Daily Living (IADLs) prior to the patient's death, having greater availability of instrumental support for oneself, and physician communication with the caregiver about the patient's prognosis before the patient's death. The most common given reason for nonuse was the perception that bereavement services were not needed or would not help.
  
  
  CONCLUSIONS
  Addressing caregiver receptivity to bereavement services will be an important aspect of increasing appropriate use of such services. Future studies might examine specific interventions for reducing barriers and increasing receptivity to bereavement service use.
authors.affiliation: Department of Epidemiology and Public Health, Yale School of Medicine, 60 College Street, New Haven, CT 06520, USA.
authors.forename: Emily J
authors.initials: EJ
authors.lastname: Cherlin
authors.forename: Colleen L
authors.initials: CL
authors.lastname: Barry
authors.forename: Holly G
authors.initials: HG
authors.lastname: Prigerson
authors.forename: Dena Schulman
authors.initials: DS
authors.lastname: Green
authors.forename: Rosemary
authors.initials: R
authors.lastname: Johnson-Hurzeler
authors.forename: Stanislav V
authors.initials: SV
authors.lastname: Kasl
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Bradley
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D001601:Bereavement; D005190:Family / Q000523:psychology*; D005260:Female; D017051:Hospice Care / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009369:Neoplasms; D011446:Prospective Studies; D011581:Psychological Tests