title: Do we need to change our understanding of anticipatory grief in caregivers? A systematic review of caregiver studies during end-of-life caregiving and bereavement.
abstract: OBJECTIVE
  Caregivers of terminally ill patients may experience anticipatory grief or low levels of preparedness for the patient's impending death. Both concepts are related to a forewarning of the impending loss. Anticipatory grief has been suggested to be grief work before the loss, which would improve bereavement outcome, but recent studies indicate a negative impact. Hence, this review systematically investigates key issues relating to anticipatory grief and preparedness for the death; definitions, measurement tools, and potential effects on caregiver outcome.
  
  
  METHODS
  We used a systematic approach (PRISMA statement). Databases were searched for publications during 1990-2015. Studies on adult caregivers of terminally ill adult patients were included if anticipatory grief or preparedness was assessed by a measurement tool.
  
  
  RESULTS
  Anticipatory grief was captured in the definition "pre-loss grief." High levels of grief and low levels of preparedness during caregiving were associated with poor bereavement outcome such as complicated grief.
  
  
  CONCLUSIONS
  The assumptions that grief work before the loss would alleviate bereavement outcome was not confirmed. Thus, the concept of anticipatory grief is questioned. High preparedness was associated with improved caregiver outcome. Additional support should be given to caregivers with pre-loss grief and low preparedness.
authors.affiliation: Research Unit for General Practice, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark. Electronic address: mette.k.nielsen@ph.au.dk.
authors.forename: Mette Kjaergaard
authors.initials: MK
authors.lastname: Nielsen
authors.affiliation: The Palliative Team, Department of Oncology, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark.
authors.forename: Mette Asbjoern
authors.initials: MA
authors.lastname: Neergaard
authors.affiliation: Department of Oncology, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark.
authors.forename: Anders Bonde
authors.initials: AB
authors.lastname: Jensen
authors.affiliation: Research Unit for General Practice, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark.
authors.forename: Flemming
authors.initials: F
authors.lastname: Bro
authors.affiliation: Research Unit for General Practice, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark; The Palliative Team, Department of Oncology, Aarhus University Hospital, Nørrebrogade 44, 8000 Aarhus C, Denmark.
authors.forename: Mai-Britt
authors.initials: MB
authors.lastname: Guldin
mesh_terms: D001601:Bereavement; D017028:Caregivers / Q000523:psychology*; D006117:Grief; D006801:Humans; D012944:Social Support
keywords: Anticipatory grief; Bereavement; Caregivers; Forewarning; Pre-loss grief; Preparedness