Anticipatory Grief Among Family Caregivers of Patients With Advanced Cancer, Congestive Heart Failure, and Chronic Obstructive Pulmonary Disease (751)

Abstract

Overall Objectives 1. Identify risk factors for caregiver anticipatory grief. 2. Become aware of differences in caregiver reactions to advanced chronic illness. Background. Anticipatory grief (AG) is associated with depression and anxiety and may have implications for post-death bereavement. Most AG research has focused on progressive and somewhat predictable diseases such as dementia or cancer, which contrast with the slow decline and unpredictable exacerbations of congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD). Research Objective. Our objective was to examine whether AG is lower among CHF and COPD caregivers compared to cancer caregivers. Method. Data are from a prospective, observational study of 141 patient-caregiver dyads living with advanced cancer, CHF, and COPD. Dyads were interviewed monthly for up to two years. Measures included the Anticipatory Grief Scale which measures anger, guilt, anxiety, irritability, sadness, feelings of loss, and decreased ability to function at usual tasks. We dichotomized AG scores and used logistic regression to examine differences in likelihood of highAGby diagnosis, patient, and caregiver factors. Aggregate growth curve models examined change over time. Result. At baseline, COPD caregivers were significantly less likely to experience high AG compared to caregivers for cancer (OR = 0.04, 95% CI = 0.003, 0.53). CHF caregivers followed a similar pattern, but the difference was not significant (OR = 0.16, 95% CI = 0.13, 1.05). Anticipatory grief levels remained consistent over time for all diagnostic groups. Nonwhite caregivers were significantly more likely to experience high AG compared to white caregivers (OR = 13.04, 95% CI = 10.34, 124.75); adult child caregivers were less likely to experience high AG compared to spousal caregivers (OR = 0.05, 95% CI = 0.01, 0.25). Conclusion. Variation in anticipatory grief is a function of disease differences and is not affected by location in the disease trajectory. Implications for Research, Policy, or Practice. Interventions to address caregiver AG should target specific groups that demonstrate higher levels of AG instead of targeting points in the disease course.