Pre-loss grief and preparedness for death among caregivers of terminally ill cancer patients: A systematic review

• Published in: Social science & medicine (1982) 2021-09, Vol.284, p.114240-114240, Article 114240
• Main Authors: Treml, Julia, Schmidt, Viktoria, Nagl, Michaela, Kersting, Anette
• Format: Article
• Language: English
• Subjects: Adjustment; Anticipatory grief; Bereavement; Cancer; Cancer patient; Caregiver; Caregivers; Death & dying; Death attitudes; End of life decisions; Forewarning; Grief; Measurement; Medical diagnosis; Mental depression; Operational definitions; Pre-loss grief; Preparedness for death; Psychological aspects; Qualitative research; Quality assessment; Systematic review; Terminal illnesses
• ISSN: 0277-9536; 1873-5347
• DOI: 10.1016/j.socscimed.2021.114240

Cancer is one of the most common causes of death. The period of time between receiving a terminal diagnosis of cancer and the death of a loved one has been operationalized as pre-loss grief and, more recently, as preparedness for death. Originally, grief before loss was thought to have positive effects on the bereavement outcome, but some studies have revealed contradictory findings. This systematic review investigates definitions and measurement tools of pre-loss grief and preparedness for death, as well as the associations of both constructs with caregiver characteristics, pre-loss psychological aspects and post-loss adjustment among caregivers of people living with terminal cancer. PubMed/Medline, PsycINFO and Web of Science were searched for studies published up until October 2020. Quantitative empirical studies from peer reviewed journals were included if a measurement tool for pre-loss grief or preparedness for death was used and if they focused on adult caregivers of adult people with cancer in an end-of-life trajectory and were excluded when they were not written in English or were descriptive/qualitative studies. Quality assessment of all studies was performed. Most studies used convenience samples and had a mean number of 725 participants. Overall, 16,326 participants in 35 articles were included and narratively synthesized. High levels of pre-loss grief, as well as low levels of perceived preparedness for death, were associated with poor post-loss adjustment (e.g., prolonged grief, depressive symptoms, etc.). Caregivers with high levels of pre-loss grief and low levels of preparedness for the death of their loved one would benefit from targeted support for post-loss adjustment. Results are limited by an inconsistent operationalization of both constructs. •High levels of pre-loss grief are associated with poor post-loss adjustment.•High levels of preparedness for death predicted more favorable bereavement outcomes.•Both concepts measure different aspects related to caregiving at the end of life.•Results are limited by an inconsistent terminology and operationalization.