The end‐of‐life experience: Modifiable predictors of caregivers' bereavement adjustment
BACKGROUND The objective of the current study was to determine the best set of predictors of psychological disorders, regrets, health‐related quality of life, and mental health function among bereaved caregivers of patients with cancer, thereby identifying promising targets for interventions to impr...
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| Veröffentlicht in: | Cancer 2014-03, Vol.120 (6), p.918-925 |
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| creator | Garrido, Melissa M. Prigerson, Holly G. |
| description | BACKGROUND
The objective of the current study was to determine the best set of predictors of psychological disorders, regrets, health‐related quality of life, and mental health function among bereaved caregivers of patients with cancer, thereby identifying promising targets for interventions to improve bereavement adjustment.
METHODS
Coping with Cancer is a longitudinal study of patients with advanced cancer and their informal caregivers who were enrolled from 2002 to 2008. The main outcome measure was bereavement adjustment of 245 caregivers (eg, depression, anxiety, and regrets) 6 months after the loss of the patient. The Structured Clinical Interview of the Diagnostic and Statistical Manual of Mental Disorders determined whether caregivers met the criteria for major depressive disorder or an anxiety disorder. Changes in health‐related quality of life and mental health function from baseline to after the patient's death were assessed with the Medical Outcomes Study Short Form (SF‐36).
RESULTS
Greater than 50% of the caregivers reported regret about the cancer patient's end‐of‐life care; better patient quality of death (adjusted odds ratio, 0.77; 95% confidence interval, 0.67‐0.88) reduced the risk of bereavement regret. The incidence of major depressive disorder or anxiety among the bereaved caregivers was 12.6% and was less likely for caregivers with better mental health before the loss of the patient (adjusted odds ratio, 0.03; 95% confidence interval, 0.004‐0.25). Better patient quality of death also predicted improved caregiver health‐related quality of life (adjusted standardized beta, .28; P |
| doi_str_mv | 10.1002/cncr.28495 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1504736729</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1504736729</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4615-7b6f8a98003bf2063a7f8357668054a2ac5af0de0fada5aa06d5d178c2b22c2a3</originalsourceid><addsrcrecordid>eNp90M1qGzEQB3BREmrHzaUPEPYSGgLrjrTSap1bMfkCt4XgQKCHZVYapTLrXUey83HrI-QZ-yRZ105zy2U-4McM_Bn7zGHIAcRX05gwFIUcqQ-sz2GkU-BS7LA-ABSpktlNj-3FOOtWLVT2kfWEzIDnUvbZr-lvSqixf_88t64rtXfd_rig4KkxdJJ8b613HquakkUg682yDTFpXWIw0K2_pxC_JBUFwnuaU7NM0M5WcbkeP7Fdh3Wk_W0fsOuz0-n4Ip38PL8cf5ukRuZcpbrKXYGjAiCrnIA8Q-2KTOk8L0BJFGgUOrAEDi0qRMitslwXRlRCGIHZgB1t7i5Ce7eiuCznPhqqa2yoXcWSK5A6y7UYdfR4Q01oYwzkykXwcwxPJYdyHWa5DrP8F2aHD7Z3V9Wc7H_6ml4HDrcAo8HaBWyMj2-u6JwW0Dm-cQ--pqd3XpbjH-OrzfMXiTGOtQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1504736729</pqid></control><display><type>article</type><title>The end‐of‐life experience: Modifiable predictors of caregivers' bereavement adjustment</title><source>Wiley Free Content</source><source>MEDLINE</source><source>Wiley Online Library Journals Frontfile Complete</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Alma/SFX Local Collection</source><creator>Garrido, Melissa M. ; Prigerson, Holly G.</creator><creatorcontrib>Garrido, Melissa M. ; Prigerson, Holly G.</creatorcontrib><description>BACKGROUND
The objective of the current study was to determine the best set of predictors of psychological disorders, regrets, health‐related quality of life, and mental health function among bereaved caregivers of patients with cancer, thereby identifying promising targets for interventions to improve bereavement adjustment.
METHODS
Coping with Cancer is a longitudinal study of patients with advanced cancer and their informal caregivers who were enrolled from 2002 to 2008. The main outcome measure was bereavement adjustment of 245 caregivers (eg, depression, anxiety, and regrets) 6 months after the loss of the patient. The Structured Clinical Interview of the Diagnostic and Statistical Manual of Mental Disorders determined whether caregivers met the criteria for major depressive disorder or an anxiety disorder. Changes in health‐related quality of life and mental health function from baseline to after the patient's death were assessed with the Medical Outcomes Study Short Form (SF‐36).
RESULTS
Greater than 50% of the caregivers reported regret about the cancer patient's end‐of‐life care; better patient quality of death (adjusted odds ratio, 0.77; 95% confidence interval, 0.67‐0.88) reduced the risk of bereavement regret. The incidence of major depressive disorder or anxiety among the bereaved caregivers was 12.6% and was less likely for caregivers with better mental health before the loss of the patient (adjusted odds ratio, 0.03; 95% confidence interval, 0.004‐0.25). Better patient quality of death also predicted improved caregiver health‐related quality of life (adjusted standardized beta, .28; P < .001). The completion of a do‐not‐resuscitate order was found to be predictive of improved mental health from before the death of the patient to after the death (adjusted standardized beta, .29; P < .001).
CONCLUSIONS
Reducing caregiver distress, encouraging advance care planning by patients, and improving patients' quality of death appear to be promising targets of interventions to improve caregiver bereavement adjustment. Cancer 2014;120:918–925. © 2013 American Cancer Society.
Using prospective data from patients with advanced cancer and their primary informal caregivers, the results of the current study demonstrate that reducing caregiver distress, encouraging advance care planning by patients, and improving patients' quality of death appear to be promising targets of interventions to improve caregiver bereavement adjustment.</description><identifier>ISSN: 0008-543X</identifier><identifier>EISSN: 1097-0142</identifier><identifier>DOI: 10.1002/cncr.28495</identifier><identifier>PMID: 24301644</identifier><identifier>CODEN: CANCAR</identifier><language>eng</language><publisher>Hoboken, NJ: Wiley-Blackwell</publisher><subject>Adult ; Adult and adolescent clinical studies ; Advance Directive Adherence ; Advance Directives ; Aged ; Aged, 80 and over ; Attitude to Death ; Bereavement ; Biological and medical sciences ; Caregivers - psychology ; Depression ; Emotions ; end‐of‐life care ; Female ; Humans ; Male ; Medical sciences ; Mental Health ; Middle Aged ; Mood disorders ; Neoplasms - mortality ; Psychology. Psychoanalysis. Psychiatry ; Psychopathology. Psychiatry ; Quality of Life ; regrets ; Religion and Psychology ; Surveys and Questionnaires ; Terminal Care ; Tumors ; Young Adult</subject><ispartof>Cancer, 2014-03, Vol.120 (6), p.918-925</ispartof><rights>2013 American Cancer Society</rights><rights>2015 INIST-CNRS</rights><rights>2013 American Cancer Society.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4615-7b6f8a98003bf2063a7f8357668054a2ac5af0de0fada5aa06d5d178c2b22c2a3</citedby><cites>FETCH-LOGICAL-c4615-7b6f8a98003bf2063a7f8357668054a2ac5af0de0fada5aa06d5d178c2b22c2a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fcncr.28495$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fcncr.28495$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>314,776,780,1411,1427,27901,27902,45550,45551,46384,46808</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=28301720$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24301644$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Garrido, Melissa M.</creatorcontrib><creatorcontrib>Prigerson, Holly G.</creatorcontrib><title>The end‐of‐life experience: Modifiable predictors of caregivers' bereavement adjustment</title><title>Cancer</title><addtitle>Cancer</addtitle><description>BACKGROUND
The objective of the current study was to determine the best set of predictors of psychological disorders, regrets, health‐related quality of life, and mental health function among bereaved caregivers of patients with cancer, thereby identifying promising targets for interventions to improve bereavement adjustment.
METHODS
Coping with Cancer is a longitudinal study of patients with advanced cancer and their informal caregivers who were enrolled from 2002 to 2008. The main outcome measure was bereavement adjustment of 245 caregivers (eg, depression, anxiety, and regrets) 6 months after the loss of the patient. The Structured Clinical Interview of the Diagnostic and Statistical Manual of Mental Disorders determined whether caregivers met the criteria for major depressive disorder or an anxiety disorder. Changes in health‐related quality of life and mental health function from baseline to after the patient's death were assessed with the Medical Outcomes Study Short Form (SF‐36).
RESULTS
Greater than 50% of the caregivers reported regret about the cancer patient's end‐of‐life care; better patient quality of death (adjusted odds ratio, 0.77; 95% confidence interval, 0.67‐0.88) reduced the risk of bereavement regret. The incidence of major depressive disorder or anxiety among the bereaved caregivers was 12.6% and was less likely for caregivers with better mental health before the loss of the patient (adjusted odds ratio, 0.03; 95% confidence interval, 0.004‐0.25). Better patient quality of death also predicted improved caregiver health‐related quality of life (adjusted standardized beta, .28; P < .001). The completion of a do‐not‐resuscitate order was found to be predictive of improved mental health from before the death of the patient to after the death (adjusted standardized beta, .29; P < .001).
CONCLUSIONS
Reducing caregiver distress, encouraging advance care planning by patients, and improving patients' quality of death appear to be promising targets of interventions to improve caregiver bereavement adjustment. Cancer 2014;120:918–925. © 2013 American Cancer Society.
Using prospective data from patients with advanced cancer and their primary informal caregivers, the results of the current study demonstrate that reducing caregiver distress, encouraging advance care planning by patients, and improving patients' quality of death appear to be promising targets of interventions to improve caregiver bereavement adjustment.</description><subject>Adult</subject><subject>Adult and adolescent clinical studies</subject><subject>Advance Directive Adherence</subject><subject>Advance Directives</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Attitude to Death</subject><subject>Bereavement</subject><subject>Biological and medical sciences</subject><subject>Caregivers - psychology</subject><subject>Depression</subject><subject>Emotions</subject><subject>end‐of‐life care</subject><subject>Female</subject><subject>Humans</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Mental Health</subject><subject>Middle Aged</subject><subject>Mood disorders</subject><subject>Neoplasms - mortality</subject><subject>Psychology. Psychoanalysis. Psychiatry</subject><subject>Psychopathology. Psychiatry</subject><subject>Quality of Life</subject><subject>regrets</subject><subject>Religion and Psychology</subject><subject>Surveys and Questionnaires</subject><subject>Terminal Care</subject><subject>Tumors</subject><subject>Young Adult</subject><issn>0008-543X</issn><issn>1097-0142</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp90M1qGzEQB3BREmrHzaUPEPYSGgLrjrTSap1bMfkCt4XgQKCHZVYapTLrXUey83HrI-QZ-yRZ105zy2U-4McM_Bn7zGHIAcRX05gwFIUcqQ-sz2GkU-BS7LA-ABSpktlNj-3FOOtWLVT2kfWEzIDnUvbZr-lvSqixf_88t64rtXfd_rig4KkxdJJ8b613HquakkUg682yDTFpXWIw0K2_pxC_JBUFwnuaU7NM0M5WcbkeP7Fdh3Wk_W0fsOuz0-n4Ip38PL8cf5ukRuZcpbrKXYGjAiCrnIA8Q-2KTOk8L0BJFGgUOrAEDi0qRMitslwXRlRCGIHZgB1t7i5Ce7eiuCznPhqqa2yoXcWSK5A6y7UYdfR4Q01oYwzkykXwcwxPJYdyHWa5DrP8F2aHD7Z3V9Wc7H_6ml4HDrcAo8HaBWyMj2-u6JwW0Dm-cQ--pqd3XpbjH-OrzfMXiTGOtQ</recordid><startdate>20140315</startdate><enddate>20140315</enddate><creator>Garrido, Melissa M.</creator><creator>Prigerson, Holly G.</creator><general>Wiley-Blackwell</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20140315</creationdate><title>The end‐of‐life experience: Modifiable predictors of caregivers' bereavement adjustment</title><author>Garrido, Melissa M. ; Prigerson, Holly G.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4615-7b6f8a98003bf2063a7f8357668054a2ac5af0de0fada5aa06d5d178c2b22c2a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>Adult and adolescent clinical studies</topic><topic>Advance Directive Adherence</topic><topic>Advance Directives</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Attitude to Death</topic><topic>Bereavement</topic><topic>Biological and medical sciences</topic><topic>Caregivers - psychology</topic><topic>Depression</topic><topic>Emotions</topic><topic>end‐of‐life care</topic><topic>Female</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Mental Health</topic><topic>Middle Aged</topic><topic>Mood disorders</topic><topic>Neoplasms - mortality</topic><topic>Psychology. Psychoanalysis. Psychiatry</topic><topic>Psychopathology. Psychiatry</topic><topic>Quality of Life</topic><topic>regrets</topic><topic>Religion and Psychology</topic><topic>Surveys and Questionnaires</topic><topic>Terminal Care</topic><topic>Tumors</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Garrido, Melissa M.</creatorcontrib><creatorcontrib>Prigerson, Holly G.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Cancer</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Garrido, Melissa M.</au><au>Prigerson, Holly G.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>The end‐of‐life experience: Modifiable predictors of caregivers' bereavement adjustment</atitle><jtitle>Cancer</jtitle><addtitle>Cancer</addtitle><date>2014-03-15</date><risdate>2014</risdate><volume>120</volume><issue>6</issue><spage>918</spage><epage>925</epage><pages>918-925</pages><issn>0008-543X</issn><eissn>1097-0142</eissn><coden>CANCAR</coden><abstract>BACKGROUND
The objective of the current study was to determine the best set of predictors of psychological disorders, regrets, health‐related quality of life, and mental health function among bereaved caregivers of patients with cancer, thereby identifying promising targets for interventions to improve bereavement adjustment.
METHODS
Coping with Cancer is a longitudinal study of patients with advanced cancer and their informal caregivers who were enrolled from 2002 to 2008. The main outcome measure was bereavement adjustment of 245 caregivers (eg, depression, anxiety, and regrets) 6 months after the loss of the patient. The Structured Clinical Interview of the Diagnostic and Statistical Manual of Mental Disorders determined whether caregivers met the criteria for major depressive disorder or an anxiety disorder. Changes in health‐related quality of life and mental health function from baseline to after the patient's death were assessed with the Medical Outcomes Study Short Form (SF‐36).
RESULTS
Greater than 50% of the caregivers reported regret about the cancer patient's end‐of‐life care; better patient quality of death (adjusted odds ratio, 0.77; 95% confidence interval, 0.67‐0.88) reduced the risk of bereavement regret. The incidence of major depressive disorder or anxiety among the bereaved caregivers was 12.6% and was less likely for caregivers with better mental health before the loss of the patient (adjusted odds ratio, 0.03; 95% confidence interval, 0.004‐0.25). Better patient quality of death also predicted improved caregiver health‐related quality of life (adjusted standardized beta, .28; P < .001). The completion of a do‐not‐resuscitate order was found to be predictive of improved mental health from before the death of the patient to after the death (adjusted standardized beta, .29; P < .001).
CONCLUSIONS
Reducing caregiver distress, encouraging advance care planning by patients, and improving patients' quality of death appear to be promising targets of interventions to improve caregiver bereavement adjustment. Cancer 2014;120:918–925. © 2013 American Cancer Society.
Using prospective data from patients with advanced cancer and their primary informal caregivers, the results of the current study demonstrate that reducing caregiver distress, encouraging advance care planning by patients, and improving patients' quality of death appear to be promising targets of interventions to improve caregiver bereavement adjustment.</abstract><cop>Hoboken, NJ</cop><pub>Wiley-Blackwell</pub><pmid>24301644</pmid><doi>10.1002/cncr.28495</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| source | Wiley Free Content; MEDLINE; Wiley Online Library Journals Frontfile Complete; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Alma/SFX Local Collection |
| subjects | Adult Adult and adolescent clinical studies Advance Directive Adherence Advance Directives Aged Aged, 80 and over Attitude to Death Bereavement Biological and medical sciences Caregivers - psychology Depression Emotions end‐of‐life care Female Humans Male Medical sciences Mental Health Middle Aged Mood disorders Neoplasms - mortality Psychology. Psychoanalysis. Psychiatry Psychopathology. Psychiatry Quality of Life regrets Religion and Psychology Surveys and Questionnaires Terminal Care Tumors Young Adult |
| title | The end‐of‐life experience: Modifiable predictors of caregivers' bereavement adjustment |
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