Association of prolonged grief and depression with end-of-life discussion among bereaved caregivers

To explore the potential of End-of-life discussion (EoLD) as alleviating bereaved caregiver's psychological distress after bereavement, this study aimed to examine the association between EoLD and bereaved family's psychological distress across five major illnesses of death; cancer, heart disease, cerebrovascular disease, pneumonia, and kidney failure.

This cross-sectional, nationwide mortality follow-back survey selected participants from death certificates and received responses via postal mail. EoLD with either physician or patients and the understanding of illness was measured as well as whether patient died at desired place. The outcomes were prolonged grief and depression after bereavement.

A total of 52,698 were included in the analysis. Among caregivers of cancer patients, all EoLD factors were associated with caregiver's prolonged grief and depression. Caregivers of heart disease and stroke syndrome patients reported greater prolonged grief and/or depression when they believed the illness was severe but curable compared with when they were aware that the illness was terminal. Discussion with a physician was associated with less prolonged grief and/or depression in heart disease, stroke syndrome, and pneumonia.

The findings suggest that high quality of EoLD may play a role in alleviating prolonged grief and depression among bereaved family members of cancer and non-cancer patients. Healthcare professionals are expected to help patients and families become aware that the end of life is approaching over time, while supporting them through the fear of facing death.