title: The intensity of caregiving is a more important predictor of adverse bereavement outcomes for adult-child than spousal caregivers of patients who die of cancer.
abstract: Increasing attention is being paid to specific difficulties experienced by bereaved family caregivers (FCs). Limited capacity within health and social care structures results in high intensity of informal caregiving. The focus of recent research is the identification of specific predictors of adverse FC outcomes, in order to identify those FCs who will benefit most from intervention and support. Research is challenged by multiple influencing and confounding variables. This study aimed to evaluate factors of care associated with higher grief intensity in bereaved adult-child (AC-FCs) and spousal FCs (S-FCs). Data from the Qualycare study, a mortality follow-back study of bereaved FCs of patients who died of cancer, was analyzed. Four hundred eighty-four patient-FC dyads were included: 246 AC-FCs and 238 S-FCs. S-FCs received more formal (SPC) (p = 0.026), and AC-FCs more informal (p < 0.001), support. AC-FCs were more likely to continue to work while caregiving (p < 0.001). Patients with AC-FCs were more likely to spend time in and die in a nursing home (p < 0.001). Higher grief intensity was associated with higher caregiving intensity (p < 0.001), as well as other factors. AC-FCs whose relative died in NH experienced significantly lower grief intensity (p < 0.001). Intensity of caregiving predicted 11.6% of variance in grief intensity for AC-FCs compared to 0.5% for S-FCs. The 'relief model' of bereavement is relevant for AC-FCs. The support needs of AC-FCs and S-FCs differ. AC-FCs should be targeted for practical supports and interventions, in order to support home-death, if desired by patient and FC, and optimize bereavement outcomes.Copyright © 2016 John Wiley & Sons, Ltd.
authors.affiliation: King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, United Kingdom.
authors.forename: Sarah
authors.initials: S
authors.lastname: McLean
authors.affiliation: King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, United Kingdom.
authors.forename: Barbara
authors.initials: B
authors.lastname: Gomes
authors.affiliation: King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, London, United Kingdom.
authors.forename: Irene J
authors.initials: IJ
authors.lastname: Higginson
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D032721:Adult Children / Q000523:psychology*; D000368:Aged; D001294:Attitude to Health; D001601:Bereavement; D017028:Caregivers / Q000523:psychology*; D002648:Child; D005260:Female; D017051:Hospice Care / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000523:psychology* / Q000628:therapy; D013997:Time Factors