Incidence and risk factors of prolonged grief in relatives of patients with terminal cancer in French palliative care units: The Fami-Life multicenter cohort study.

Abstract

Psychological consequences of grief among relatives are insufficiently known. We reported incidence of prolonged grief among relatives of deceased patients with cancer. Prospective cohort study of 611 relatives of 531 patients with cancer hospitalized for more than 72hours and who died in 26 palliative care units was conducted. The primary outcome was prolonged grief in relatives 6months after patient death, measured with the Inventory Complicated Grief (ICG>25, range 0-76, a higher score indicates more severe symptoms) score. Secondary outcomes in relatives 6months after patient death were anxiety and depression symptoms based on Hospital Anxiety and Depression Scale (HADS) score (range 0 [best]-42 [worst]), higher scores indicate more severe symptoms, minimally important difference 2.5. Post-traumatic stress disorder symptoms were defined by an Impact Event Scale-Revised score >22 (range 0-88, a higher score indicates more severe symptoms). Among 611 included relatives, 608 (99.5%) completed the trial. At 6months, significant ICG scores were reported by 32.7% relatives (199/608, 95% CI, 29.0-36.4). The median (interquartile range ICG score) was 20.0 (11.5-29.0). The incidence of HADS symptoms was 87.5% (95% CI, 84.8-90.2%) at Days 3-5 and 68.7% (95% CI, 65.0-72.4) 6 months after patient's death, with a median (interquartile range) difference of -4 (-10 to 0) between these 2 time points. Improvement in HADS anxiety and depression scores were reported by 62.5% (362/579) relatives. These findings support the importance of screening relatives having risk factors of developing prolonged grief in the palliative unit and 6months after patient's death.