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Complicated grief and need for professional support in family caregivers of cancer patients in palliative care: a longitudinal cohort study

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There is little research on complicated grief (CG) in family caregivers in palliative care. The aim of the study was to assess the levels of complicated grief and depression in family caregivers after the death of a relative with cancer, to identify their need for support, to compare the palliative team staff’s risk assessment of the relatives’ grief reaction with measured levels of CG and depression, and to assess the use of bereavement support.


All 114 eligible family caregivers to deceased patients treated in a palliative care unit in the year 2006 were asked to participate in the study, and 87 (77%) accepted. The participants completed a postal questionnaire 2, 6, 13, and 18 months after the loss measuring complicated grief (Inventory of Complicated Grief, Revised), depression (Beck’s Depression Inventory II), and their use of bereavement services. The palliative team staff completed a form 1 month post-loss with their clinical risk assessment of the family caregivers’ levels of complicated grief and need for support.


The prevalence of moderate to severe depression and CG was 15% and 40%, respectively, at 6 months post-loss. Professional risk assessment showed a sensitivity of 55% for CG and of 27% for depression and a specificity of 86% for depression and 63% for CG. The positive predictive value was 27% for depression and 21% for CG. Use of bereavement services was observed in 36% of the cases at 6 months after the loss. The proportion of bereaved with CG or depression at 6 months who had received bereavement services was 47% and 64%, respectively.


The results suggest that a substantial number of family caregivers of diseased palliative care patients are at risk of developing CG and depression following their loss. While early identification of those at risk of developing CG could be helpful, the risk assessment of professionals may lack in precision. The results indicate that bereavement services could be utilized in a more targeted and perhaps more efficient manner. Guidelines for bereavement planning in palliative care are indicated.

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We wish to acknowledge the bereaved caregivers who participated in the study. We are grateful to Secretary Ann Christensen from the Palliative Team in Aarhus University Hospital for her help with record keeping and mailing lists and Helle Mathiesen and the rest of The Palliative Team in Aarhus University Hospital for collecting data and commenting on the study. Furthermore, we thank Anette Fischer Pedersen and Ineta Sokolowski for statistical assistance and Maja O’Connor for inspiring the study and allowing the use of the questionnaire battery that she put together. Last but not least, we are grateful to the Department of Oncology, Aarhus University Hospital, TrygFonden, The Danish Cancer Society and Dæhnfeldt Foundation for funding the project.

Conflict of interest

None of the authors have any conflicts of interest to report. Control over data for this paper resides with the first author, and it is possible for the journal to review data upon request.

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Correspondence to Mai-Britt Guldin.

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Guldin, MB., Vedsted, P., Zachariae, R. et al. Complicated grief and need for professional support in family caregivers of cancer patients in palliative care: a longitudinal cohort study. Support Care Cancer 20, 1679–1685 (2012).

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