Supportive Care in Cancer

, Volume 18, Issue 10, pp 1321–1327 | Cite as

Determinants of complicated grief in caregivers who cared for terminal cancer patients

  • Yu-Wen Chiu
  • Chia-Tsuan Huang
  • Shao-Min Yin
  • Yung-Cheng Huang
  • Ching-hsin Chien
  • Hung-Yi Chuang
Original Article



There is little research on determinants and the grief that caregivers experience after their relatives die of cancer. This study evaluated factors which influence complicated grief among caregivers who cared for patients who died of cancer in Taiwan.


This prospective study recruited 668 caregivers who cared for terminally ill cancer patients in the hospice ward or who received shared-care consultation. Caregivers were interviewed on the telephone an average 8.9 months after the cancer patients passed away. The Inventory of Complicated Grief (ICG), modified for use in a Chinese population, was used to assess the grief status of caregivers. ICG >25 was defined as complicated grief.


Our study found that female gender (odds ratio (OR), 2.27; 95% confidence interval (CI), 1.75–2.82), spouse relationship (OR, 1.20; 1.01–1.40), parents–children relationship (OR, 1.70; 1.11–2.31), lack of religious belief (OR, 1.47; 1.19–1.75), unavailable family support (OR, 1.42; 1.03–1.83), and history of mood co-morbidity (OR, 1.41; 1.02–1.83) were risk factors that would predispose towards complicated grief; whereas, longer duration of caring (months, OR, 0.79; 0.69–0.91), medical disease history in the carer (OR, 0.77; 0.57–0.99), and patients being cared for on the hospice ward (OR, 0.60; 0.44–0.77) were factors that would mitigate against complicated grief.


These results suggest that clinical professionals who care for terminal cancer patients and their caregivers should pay particular attention to caregivers with these predisposing factors.


Caregivers Complicated grief Hospice Terminal cancer patients 



This work was supported by Kaohsiung Medical University Hospital, and the grant number is Kmuh-96-P07.

Conflicts of interest

The authors declared that they have no conflict interest.


  1. 1.
    Chen CJ, You SL, Lin LH, Hsu WL, Yang YW (2002) Cancer epidemiology and control in Taiwan: a brief review. Jpn J Clin Oncol 32 Suppl:S66–S81CrossRefPubMedGoogle Scholar
  2. 2.
    Department of Health, Executive Yuan (2008) Health Statistics in Taiwan, 2008. Department of Health, Executive Yuan, ROC, Taipei, TaiwanGoogle Scholar
  3. 3.
    Lai YL, Su WH (1997) Palliative medicine and the hospice movement in Taiwan. Support Care Cancer 5:348–350CrossRefPubMedGoogle Scholar
  4. 4.
    Chiu TY, Hu WY, Chen CY (2000) Prevalence and severity of symptoms in terminal cancer patients: a study in Taiwan. Support Care Cancer 8:311–313CrossRefPubMedGoogle Scholar
  5. 5.
    Chiu TY, Hu WY, Lue BH, Yao CA, Chen CY, Wakai S (2004) Dyspnea and its correlates in taiwanese patients with terminal cancer. J Pain Symptom Manage 28:123–132CrossRefPubMedGoogle Scholar
  6. 6.
    Grassi L (2007) Bereavement in families with relatives dying of cancer. Curr Opin Support Palliat Care 1:43–49CrossRefPubMedGoogle Scholar
  7. 7.
    Zhang B, El-Jawahri A, Prigerson HG (2006) Update on bereavement research: evidence-based guidelines for the diagnosis and treatment of complicated bereavement. J Palliat Med 9:1188–1203CrossRefPubMedGoogle Scholar
  8. 8.
    Zisook S (2000) Understanding and managing bereavement in palliative care. In: Chochinov HM, Breitbart W (eds) Handbook of psychiatry in palliative medicine. Oxford University Press, New York, pp 321–334Google Scholar
  9. 9.
    Prigerson HG, Bierhals AJ, Kasl SV, Reynolds CF 3rd, Shear MK, Newsom JT, Jacobs S (1996) Complicated grief as a disorder distinct from bereavement-related depression and anxiety: a replication study. Am J Psychiatry 153:1484–1486PubMedGoogle Scholar
  10. 10.
    Prigerson HG, Maciejewski PK, Reynolds CF 3rd, Bierhals AJ, Newsom JT, Fasiczka A, Frank E, Doman J, Miller M (1995) Inventory of Complicated Grief: a scale to measure maladaptive symptoms of loss. Psychiatry Res 59:65–79CrossRefPubMedGoogle Scholar
  11. 11.
    Bernard LL, Guarnaccia CA (2003) Two models of caregiver strain and bereavement adjustment: a comparison of husband and daughter caregivers of breast cancer hospice patients. Gerontologist 43:808–816PubMedGoogle Scholar
  12. 12.
    Rossi Ferrario S, Cardillo V, Vicario F, Balzarini E, Zotti AM (2004) Advanced cancer at home: caregiving and bereavement. Palliat Med 18:129–136CrossRefPubMedGoogle Scholar
  13. 13.
    Burton AM, Haley WE, Small BJ, Finley MR, Dillinger-Vasille M, Schonwetter R (2008) Predictors of well-being in bereaved former hospice caregivers: the role of caregiving stressors, appraisals, and social resources. Palliat Support Care 6:149–158CrossRefPubMedGoogle Scholar
  14. 14.
    Kelly B, Edwards P, Synott R, Neil C, Baillie R, Battistutta D (1999) Predictors of bereavement outcome for family carers of cancer patients. Psycho-oncology 8:237–249CrossRefPubMedGoogle Scholar
  15. 15.
    Prigerson HG, Maciejewski PK (2006) A call for sound empirical testing and evaluation of criteria for complicated grief proposed by the DSM V. Omega 52:9–19Google Scholar
  16. 16.
    Chu HC, Chow PC (2008) Providing grief counseling to a major depressive elderly widower: a nurse’s experience (article in Chinese). Hu Li Za Zhi/The Journal of Nursing 55:90–96Google Scholar
  17. 17.
    Anderson WG, Arnold RM, Angus DC, Bryce CL (2008) Posttraumatic stress and complicated grief in family members of patients in the intensive care unit. J Gen Intern Med 23:1871–1876CrossRefPubMedGoogle Scholar
  18. 18.
    Ringdal GI, Ringdal K, Jordhoy MS, Kaasa S (2007) Does social support from family and friends work as a buffer against reactions to stressful life events such as terminal cancer? Palliat Support Care 5:61–69CrossRefPubMedGoogle Scholar
  19. 19.
    Chen JH, Bierhals AJ, Prigerson HG, Kasl SV, Mazure CM, Jacobs S (1999) Gender differences in the effects of bereavement-related psychological distress in health outcomes. Psychol Med 29:367–380CrossRefPubMedGoogle Scholar
  20. 20.
    Summers J, Zisook S, Sciolla AD, Patterson T, Atkinson JH (2004) Gender, AIDS, and bereavement: a comparison of women and men living with HIV. Death Stud 28:225–241CrossRefPubMedGoogle Scholar
  21. 21.
    Neria Y, Gross R, Litz B, Maguen S, Insel B, Seirmarco G, Rosenfeld H, Suh EJ, Kishon R, Cook J, Marshall RD (2007) Prevalence and psychological correlates of complicated grief among bereaved adults 2.5–3.5 years after September 11th attacks. J Trauma Stress 20:251–262CrossRefPubMedGoogle Scholar
  22. 22.
    Gilbar O, Ben-Zur H (2002) Bereavement of spouse caregivers of cancer patients. Am J Orthopsychiatry 72:422–432CrossRefPubMedGoogle Scholar
  23. 23.
    Becker G, Xander CJ, Blum HE, Lutterbach J, Momm F, Gysels M, Higginson IJ (2007) Do religious or spiritual beliefs influence bereavement? A systematic review. Palliat Med 21:207–217CrossRefPubMedGoogle Scholar
  24. 24.
    Hebert RS, Dang Q, Schulz R (2007) Religious beliefs and practices are associated with better mental health in family caregivers of patients with dementia: findings from the REACH study. Am J Geriatr Psychiatry 15:292–300CrossRefPubMedGoogle Scholar
  25. 25.
    Wortmann JH, Park CL (2008) Religion and spirituality in adjustment following bereavement: an integrative review. Death Stud 32:703–736CrossRefPubMedGoogle Scholar
  26. 26.
    Groot MH, Keijser J, Neeleman J (2006) Grief shortly after suicide and natural death: a comparative study among spouses and first-degree relatives. Suicide Life Threat Behav 36:418–431CrossRefPubMedGoogle Scholar
  27. 27.
    Horowitz MJ, Siegel B, Holen A, Bonanno GA, Milbrath C, Stinson CH (1997) Diagnostic criteria for complicated grief disorder. Am J Psychiatry 154:904–910PubMedGoogle Scholar
  28. 28.
    Horowitz MJ, Bonanno GA, Holen A (1993) Pathological grief: diagnosis and explanation. Psychosom Med 55:260–273PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Yu-Wen Chiu
    • 1
    • 2
  • Chia-Tsuan Huang
    • 1
    • 2
  • Shao-Min Yin
    • 1
    • 2
  • Yung-Cheng Huang
    • 1
    • 2
  • Ching-hsin Chien
    • 2
    • 3
  • Hung-Yi Chuang
    • 2
    • 4
  1. 1.Department of Family Medicine for Palliative CareKaohsiung Medical University HospitalKaohsiungTaiwan
  2. 2.Department of Community MedicineKaohsiung Medical University HospitalKaohsiungTaiwan
  3. 3.Department of NursingKaohsiung Medical University HospitalKaohsiungTaiwan
  4. 4.Department of Public Health and Center of Excellence for Environmental MedicineKaohsiung Medical UniversityKaohsiung CityTaiwan

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