Tsai Wei-I, Prigerson Holly G, Li Chung-Yi, Chou Wen-Chi, Kuo Su-Ching, Tang Siew Tzuh
School of Nursing, Chang Gung University, Taoyuan, Taiwan, R.O.C.
Sociology in Medicine, Weill Cornell Medical College, New York, NY, USA.
Palliat Med. 2016 May;30(5):495-503. doi: 10.1177/0269216315603261. Epub 2015 Aug 26.
A significant minority of bereaved caregivers experience prolonged grief. However, few longitudinal studies have examined prolonged grief, especially in an Asian context.
We explored longitudinal changes and factors predicting prolonged grief in bereaved caregivers of terminally ill Taiwanese cancer patients.
Observational, prospective, and longitudinal. Prolonged grief symptoms were measured with the PG-13 at 6, 13, 18, and 24 months postloss.
SETTING/PARTICIPANTS: A convenience sample of 493 caregivers (83.3% participation rate) of terminally ill cancer patients was recruited from a medical center in Taiwan.
The prevalence of prolonged grief decreased significantly over time from the patient's death (7.73%, 1.80%, 2.49%, and 1.85% at 6, 13, 18, and 24 months postloss, respectively, p < 0.05 at all times in reference to 6 months postloss). Caregivers' likelihood of prolonged grief was significantly higher if they had severe preloss depressive symptoms, negatively perceived their relative's dying situation, and were poorly prepared for the patient's death. However, the likelihood of prolonged grief decreased significantly with greater perceived concurrent social support and subjective caregiving burden right before the patient's death.
Prolonged grief in bereavement diminished over time and was predicted by modifiable factors before, during, and after bereavement. To facilitate bereavement adjustment and avoid prolonged grief, healthcare professionals should develop and provide at-risk caregivers with effective interventions starting when patients are still alive to improve their dying experience, to facilitate preparedness for the patient's forthcoming death, to alleviate caregivers' preloss depressive symptoms, and to enhance their perceived postloss social support.
相当一部分丧亲的照料者经历着持续性悲伤。然而，很少有纵向研究对持续性悲伤进行考察，尤其是在亚洲背景下。
我们探讨了台湾晚期癌症患者丧亲照料者持续性悲伤的纵向变化及预测因素。
观察性、前瞻性和纵向研究。在丧亲后6个月、13个月、18个月和24个月时，使用PG - 13量表测量持续性悲伤症状。
设置/参与者：从台湾一家医疗中心招募了493名晚期癌症患者的照料者作为便利样本（参与率为83.3%）。
从患者死亡起，持续性悲伤的患病率随时间显著下降（丧亲后6个月、13个月、18个月和24个月时分别为7.73%、1.80%、2.49%和1.85%，与丧亲后6个月相比，各时间点p均<0.05）。如果照料者在丧亲前有严重的抑郁症状、对亲属的死亡情况有负面认知且对患者的死亡准备不足，那么他们出现持续性悲伤的可能性显著更高。然而，在患者死亡前，随着感知到的同时期社会支持增加和主观照料负担加重，持续性悲伤的可能性显著降低。
丧亲后的持续性悲伤会随着时间减轻，并且可由丧亲前、丧亲期间和丧亲后的可改变因素预测。为促进丧亲后的适应并避免持续性悲伤，医疗保健专业人员应在患者仍在世时就制定并为有风险的照料者提供有效的干预措施，以改善患者的临终体验，促进对患者即将到来的死亡做好准备，减轻照料者丧亲前的抑郁症状，并增强他们丧亲后的社会支持感。
