Research Unit for General Practice, Aarhus University, Bartholin's Allé 2, 8000, Aarhus, Denmark.
Support Care Cancer. 2012 Aug;20(8):1679-85. doi: 10.1007/s00520-011-1260-3. Epub 2011 Sep 4.
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.
在姑息治疗中，针对丧亲的家庭照护者的复杂性悲伤（CG）研究甚少。本研究旨在评估癌症患者死亡后家庭照护者的 CG 和抑郁程度，确定他们对支持的需求，比较姑息治疗团队对亲属悲伤反应的风险评估与 CG 和抑郁的实际水平，并评估丧亲支持的使用情况。
2006 年，我们邀请了在姑息治疗病房接受治疗的 114 名符合条件的死亡患者的家庭照护者参加研究，其中 87 名（77%）接受了邀请。参与者在失去亲人后 2、6、13 和 18 个月时通过邮寄问卷的方式完成了 CG（修订后的复杂性悲伤量表）、抑郁（贝克抑郁量表第二版）的评估，以及对丧亲服务的使用情况。姑息治疗团队在失去亲人后 1 个月填写表格，对家庭照护者的 CG 水平和支持需求进行临床风险评估。
6 个月时，中重度抑郁和 CG 的患病率分别为 15%和 40%。专业风险评估显示，CG 的敏感性为 55%，抑郁为 27%，抑郁的特异性为 86%，CG 的特异性为 63%。抑郁的阳性预测值为 27%，CG 的阳性预测值为 21%。6 个月时，36%的人使用了丧亲服务。6 个月时，患有 CG 或抑郁的丧亲者中，接受丧亲服务的比例分别为 47%和 64%。
结果表明，大量姑息治疗患者的家庭照护者在失去亲人后有发生 CG 和抑郁的风险。虽然对 CG 风险的早期识别可能有帮助，但专业人员的风险评估可能不够准确。研究结果表明，可以更有针对性、更高效地利用丧亲服务。姑息治疗中的丧亲服务规划指南是必要的。
