title: What makes grief difficult? Perspectives from bereaved family caregivers and healthcare providers of advanced cancer patients.
abstract: OBJECTIVE
  Family members who take on the role of caregiving for someone who is dying begin bereavement after being emotionally and physically taxed by the caregiving experience. The course of bereavement is influenced by a number of factors, including health problems, financial concerns, social support, and family relationships. This paper reports on findings from a secondary analysis of qualitative data from a study examining family caregiver coping in end-of-life cancer care, to describe, from the perspectives of bereaved family caregivers, their perspectives on what made their grief difficult.
  
  
  METHODS
  Qualitative data from three focus groups with family caregivers (n = 19) and two focus groups with health professionals (n = 14) were subjected to interpretive thematic analysis.
  
  
  RESULTS
  Our finding suggest three broad areas that make family caregivers' grief difficult: (1) dealing with occurrences in everyday life; (2) dealing with challenges specific to the caregiving situation; and (3) dealing with the healthcare system.
  
  
  CONCLUSIONS
  The findings provide an important beginning point in understanding the types of issues that seem to make grief difficult for family caregivers of cancer patients at the end of life and can help professional groups to understand what is needed by family caregivers in terms of support and delivery of services.
authors.affiliation: School of Nursing and Centre on Aging, University of Victoria, Victoria, British Columbia, Canada. kis@uvic.ca
authors.forename: Kelli I
authors.initials: KI
authors.lastname: Stajduhar
authors.forename: Wanda
authors.initials: W
authors.lastname: Martin
authors.forename: Moira
authors.initials: M
authors.lastname: Cairns
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000488:Allied Health Personnel / Q000523:psychology*; D001293:Attitude to Death; D001294:Attitude to Health; D001601:Bereavement; D017028:Caregivers / Q000523:psychology*; D004645:Empathy; D005190:Family / Q000523:psychology; D005195:Family Relations; D005260:Female; D017144:Focus Groups; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000451:nursing / Q000523:psychology*; D010166:Palliative Care / Q000523:psychology; D036301:Qualitative Research; D012944:Social Support