title: Longitudinal changes and predictors of prolonged grief for bereaved family caregivers over the first 2 years after the terminally ill cancer patient's death.
abstract: BACKGROUND
  A significant minority of bereaved caregivers experience prolonged grief. However, few longitudinal studies have examined prolonged grief, especially in an Asian context.
  
  
  OBJECTIVE
  We explored longitudinal changes and factors predicting prolonged grief in bereaved caregivers of terminally ill Taiwanese cancer patients.
  
  
  METHODS
  Observational, prospective, and longitudinal. Prolonged grief symptoms were measured with the PG-13 at 6, 13, 18, and 24 months postloss.
  
  
  METHODS
  A convenience sample of 493 caregivers (83.3% participation rate) of terminally ill cancer patients was recruited from a medical center in Taiwan.
  
  
  RESULTS
  The prevalence of prolonged grief decreased significantly over time from the patient's death (7.73%, 1.80%, 2.49%, and 1.85% at 6, 13, 18, and 24 months postloss, respectively, p < 0.05 at all times in reference to 6 months postloss). Caregivers' likelihood of prolonged grief was significantly higher if they had severe preloss depressive symptoms, negatively perceived their relative's dying situation, and were poorly prepared for the patient's death. However, the likelihood of prolonged grief decreased significantly with greater perceived concurrent social support and subjective caregiving burden right before the patient's death.
  
  
  CONCLUSIONS
  Prolonged grief in bereavement diminished over time and was predicted by modifiable factors before, during, and after bereavement. To facilitate bereavement adjustment and avoid prolonged grief, healthcare professionals should develop and provide at-risk caregivers with effective interventions starting when patients are still alive to improve their dying experience, to facilitate preparedness for the patient's forthcoming death, to alleviate caregivers' preloss depressive symptoms, and to enhance their perceived postloss social support.
authors: School of Nursing, Chang Gung University, Taoyuan, Taiwan, R.O.C.
authors: Wei-I
authors: WI
authors: Tsai
authors: Sociology in Medicine, Weill Cornell Medical College, New York, NY, USA.
authors: Holly G
authors: HG
authors: Prigerson
authors: Department of Public Health, National Cheng Kung University, Tainan, Taiwan, R.O.C.
authors: Chung-Yi
authors: CY
authors: Li
authors: Division of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan, R.O.C.
authors: Wen-Chi
authors: WC
authors: Chou
authors: School of Nursing, Chang Gung University, Taoyuan, Taiwan, R.O.C. Department of Nursing, Yuanpei University, Hsinchu, Taiwan, R.O.C.
authors: Su-Ching
authors: SC
authors: Kuo
authors: School of Nursing, Chang Gung University, Taoyuan, Taiwan, R.O.C. sttang@mail.cgu.edu.tw.
authors: Siew Tzuh
authors: ST
authors: Tang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers / Q000523:psychology*; D003643:Death; D005260:Female; D006117:Grief; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009369:Neoplasms; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D013624:Taiwan; D019452:Terminally Ill; D055815:Young Adult
keywords: Prolonged grief; bereavement; cancer; family caregivers; oncology; terminally ill