Pre-loss grief among family caregivers: An evolutionary concept analysis

This study aimed to clarify the evolving characteristics of pre-loss grief among family caregivers by identifying its attributes, antecedents, consequences, and related concepts.

A comprehensive literature search was conducted across English databases (PubMed, Embase, Web of Science, Scopus, the Cochrane Library, CINAHL, APA PsycInfo, and APA PsycArticles) and Chinese databases (China National Knowledge Infrastructure, SinoMed, VIP, and Wanfang). These databases were searched from inception to April 2026. Rodgers's evolutionary concept analysis method was used to analyze the included literature.

A total of 36 articles were included. Four defining attributes of pre-loss grief among family caregivers were identified: multidimensionality of perceived loss; an emotionally and cognitively complex grief response; temporal and dynamic unfolding; and contextual embeddedness within ongoing caregiving roles. Antecedents were identified at four interrelated levels: illness-related, caregiver-related, relational, sociocultural and contextual levels. Consequences included psychological distress, caregiving strain, relational difficulties, and bereavement-related vulnerability; whereas meaning-making and strengthened relational connections were identified in specific caregiving contexts. The analysis clarified conceptual distinctions between pre-loss grief and related constructs such as anticipatory grief. Pre-loss grief among family caregivers can be understood as a grief-specific, multidimensional, and dynamic response to perceived losses before the care recipient's death. This response is embedded within ongoing caregiving relationships and responsibilities.

This concept analysis provides a clearer conceptual foundation for grief-specific assessment for caregivers, development of measurement tools, and delivery of context-sensitive nursing support across the illness trajectory.