The Role of Advance Care Planning in Cancer Patient and Caregiver Grief Resolution: Helpful or Harmful?

Abstract

Cancer patients and their family caregivers experience various losses when patients become terminally ill, yet little is known about the grief experienced by patients and caregivers and factors that influence grief as patients approach death. Additionally, few, if any, studies have explored associations between advance care planning (ACP) and grief resolution among cancer patients and caregivers. To fill this knowledge gap, the current study examined changes in grief over time in patients and their family caregivers and whether changes in patient grief are associated with changes in caregiver grief. We also sought to determine how grief changed following the completion of advance directives. The sample included advanced cancer patients and caregivers (n = 98 dyads) from Coping with Cancer III, a federally funded, multi-site prospective longitudinal study of end-stage cancer care. Participants were interviewed at baseline and at follow-up roughly 2 months later. Results suggest synchrony, whereby changes in patient grief were associated with changes in caregiver grief. We also found that patients who completed a living will (LW) experienced increases in grief, while caregivers of patients who completed a do-not-resuscitate (DNR) order experienced reductions in grief, suggesting that ACP may prompt “grief work” in patients while promoting grief resolution in caregivers.

Advance Care Planning and Health-Related Quality of Life in Huntington Disease: Results from a Multicenter National Study

“…Corroborating such a hypothesis in the future would perhaps recapitulate a recently published longitudinal observation among people with advanced cancer: those who completed a living will or resuscitation preference predicted negative mental HRQoL at two months—specifically increased grief. 35 …”

Advance care planning in oncology: a scoping review and some recommendations

“…Thirty-eight studies [15–52] and three reviews were identified [6 ▪ ,8 ▪▪ ,13 ▪▪ ]. Studies were heterogeneous in terms of cancer care contexts, population size and characteristics, research designs, and assessment methods (Table 1).…”

“…Fourteen articles that were not included in these categories are reported in Table 1. They address two topics: ACP uptake rates [39–44]; and ACP outcomes [45–52].…”

“I wanna live and not think about the future” what place for advance care planning for people living with severe multiple sclerosis and their families? A qualitative study

“…ACP may also reduce inappropriate emergency hospital admissions, lead to fewer interventions of limited or futile clinical value, lead to earlier access to palliative care, result in fewer hospital deaths and may increase rates of hospice admission or appropriate care at home [ 8 , 24 , 25 ]. ACP is thought to help families prepare for the death of a loved one, to resolve family conflict and lead to better bereavement outcomes [ 26 ]. Although primarily concerned with improving the appropriateness and quality of care, ACP may contribute to controlling important health spending and making more appropriate and considered use of scarce resources in end of life [ 27 ].…”