Background: Medical Aid in Dying is an end-of-life option that allows a physician to provide a patient with a prescription to end their life. Though Medical Aid in Dying intends to reduce suffering for a patient, opponents argue Medical Aid in Dying may increase suffering for the family members during bereavement. To better understand the bereavement outcomes for family members/friends following Medical Aid in Dying, an exhaustive review of the risk and protective factors for bereavement outcomes is warranted. Aim: This systemic review aimed to identify studies that examined bereavement outcomes of family members of individuals who engage in Medial Aid in Dying, identify risk and protective factors for bereavement outcomes, and propose a theoretical model to enhance conceptual clarity. Design: A mixed-method systematic review. Data sources: Ten databases were searched on June 16, 2021 and later conducted two updates (latest April 25, 2022). Results: Thirteen articles met inclusion criteria. Risk and protective factors were identified pre-Medical Aid in Dying and risk factors post-Medical Aid in Dying. Few studies compared bereavement outcomes for family members of individuals utilizing Medical Aid in Dying to family members who lost someone to natural loss. Conclusions: This study provides equivocal results about the effects of Medical Aid in Dying on family members following the loss. The theoretical model outlines potential risk and protective factors. This model provides a greater understanding of possible universal risk and protective factors for family members of individuals who engaged in Medical Aid in Dying.

Objectives This study evaluated whether COVID-19-specific risk factors (e.g., feeling guilty for not being present with the deceased at the time of the loss and feeling emotionally distant from the deceased prior to the loss) were associated with prolonged grief disorder (PGD) symptomatology or diagnosis among young adults bereaved due to any cause (e.g., illness and violent loss). Methods We surveyed 196 young adults who had a family member/close friend die during the COVID-19 pandemic. Participants completed the PGD-12 Questionnaire and the 10-item Pandemic Grief Risk Factors (PGRF) Questionnaire. Results More time spent with the deceased before the loss and greater endorsement of pandemic grief risk factors were associated with increased PGD symptoms and a greater likelihood of meeting the diagnostic criteria for PGD. Significance of results The COVID-19 pandemic created unique risk factors that affected the grieving process for bereaved individuals, regardless of whether the death was related to COVID-19 infection. These findings add to a growing body of literature examining grief and loss within the unique context of the COVID-19 pandemic and suggest that there may be detrimental long-term psychological outcomes for these bereaved individuals, regardless of the cause of death. Routine screening for these unique risk factors in medical and psychological clinics is warranted to help identify those individuals who could benefit from early intervention. Also, it will be important to understand and possibly modify evidence-based interventions and prevention programs to directly address the identified unique PGRF.

e24002 Background: In research, how people act in close relationships is described as “attachment styles” which are composed of multiple attachment style dimensions (ASDs). Attachment avoidance is characterized by the need to isolate from the relationship (i.e. withdrawing and increased independence) while attachment anxiety is defined as needing reassurance and higher dependence. These two insecure ASDs are correlated with reduced quality of life for cancer patients (PT) and the family caregivers (CG). In ovarian cancer, PT and CG ASDs were correlated to dyadic coping, however 27% of PTs were disease-free. Attachment insecurity may be exacerbated by active treatment and uncertain prognosis. Therefore, we investigated the relationship between ASDs, and CG and PT reported dyadic coping and illness-specific communication. Methods: Metastatic sarcoma PTs and their CGs were recruited prospectively for a longitudinal, survey study investigating dyadic coping at Fred Hutchinson Cancer Center from Feb. 2022 – Dec. 2022. Participation rate for eligible PTs was 42% and 68% for CGs. Results are of participants who identified as intimate partners (individuals and dyads were allowed to participate). Attachment avoidance and attachment anxiety were measured via Relationship Structures Questionnaire. Dyadic coping and communication were measured via Dyadic Coping Inventory and Illness-Specific Relationship Talk (ISRT), respectively. Results: Sixty-nine participants enrolled: 43 PTs and 26 CGs (25 dyads). Participants were primarily non-Hispanic and white (91% PTs; 85% CG) with mean age 64 years ( SD= 13.1; range = 26-89). 61% of PTs identified as men; 60% of CGs identified as women. CGs with attachment anxiety were more likely to report worse coping and less ISRT, while PTs with attachment anxiety were more likely to report only worse coping (See Table 1). However, PTs with attachment avoidance were more likely to report both worse coping and ISRT. Conclusions: Advance cancer PTs and their CGs with insecure ASDs report worse coping and communication. Screening for insecure ASDs may identify PTs and CGs who would benefit from supportive care, including psychotherapy. Future research should investigate this in a larger, more heterogenous population at earlier in the rare cancer trajectory and the effect of ASDs on PT, CG, and clinician communication. [Table: see text]