Unfinished Business and Experiences of Bereaved Families of Patients with Cancer: A Cross-Sectional Survey

Unfinished business (UB) is common among bereaved families of patients with advanced cancer and is associated with poor psychological outcomes, but remains underexplored.

To examine the prevalence, psychological impact, care-related factors, and families' experiences associated with UB using multidimensional assessments.

A cross-sectional survey was conducted.

Bereaved family members of patients with cancer at a Japanese inpatient hospice.

UB was assessed using a one-item scale, the Unfinished Business in Bereavement Scale-Short (UBBS), and the Unfinished Business Scale-Family (UBS-F). Depression and complicated grief were measured using the Patient Health Questionnaire-2 (PHQ-2) and the Brief Grief Questionnaire (BGQ), respectively. Analyses included t tests, chi-square tests, and multivariate logistic regression.

Of 455 bereaved families, 319 (70%) participated. UB was reported by 53.9% (95% confidence interval [CI] = 48.4-59.4%) on the one-item scale and by 34.5-40.8% and 27.9-65.5% using UBBS and UBS-F, respectively. Using the one-item UB scale, families with UB had significantly higher respective depression (PHQ-2 = 1.73 vs. 1.13; p = 0.002) and grief (BGQ = 4.53 vs. 3.06; p < 0.001) scores. UB was more likely among families of younger patients (OR = 0.73 per 10-year increase), spouses (OR = 3.81), children (OR = 4.24), those less prepared for death (OR = 3.69-6.31), and those who felt clinicians were unconcerned about the family's wishes (OR = 1.91). Many (71.8%) expressed a wish to do something for the patient but were preoccupied with daily responsibilities.

UB is prevalent and associated with psychological distress among bereaved families of patients with cancer. Interventions promoting preparedness and supporting patients and families to realize wishes may reduce UB and improve bereavement outcomes.