Acute and long-term grief reactions and experiences in parentally cancer-bereaved teenagers

Background Previous research shows that many cancer-bereaved youths report unresolved grief several years after the death of a parent. Grief work hypothesis suggests that, in order to heal, the bereaved needs to process the pain of grief in some way. This study explored acute grief experiences and reactions in the first 6 months post-loss among cancer-bereaved teenagers. We further explored long-term grief resolution and potential predictors of having had “an okay way to grieve” in the first months post-loss. Methods We used a population-based nationwide, study-specific survey to investigate acute and long-term grief experiences in 622 (73% response rate) bereaved young adults (age > 18) who, 6–9 years earlier, at ages 13–16 years, had lost a parent to cancer. Associations were assessed using bivariable and multivariable logistic regression. Results Fifty-seven per cent of the participants reported that they did not have a way to grieve that felt okay during the first 6 months after the death of their parent. This was associated with increased risk for long-term unresolved grief (odds ratio (OR): 4.32, 95% confidence interval (CI): 2.99–6.28). An association with long-term unresolved grief was also found for those who reported to have been numbing and postponing (42%, OR: 1.73, 95% CI: 1.22–2.47), overwhelmed by grief (24%, OR: 2.02, 95% CI: 1.35–3.04) and discouraged from grieving (15%, OR: 2.68, 95% CI: 1.62–4.56) or to have concealed their grief to protect the other parent (24%, OR: 1.83, 95% CI: 1.23–2.73). Predictors of having had an okay way to grieve included being male, having had good family cohesion, and having talked about what was important with the dying parent. Conclusion More than half of the cancer-bereaved teenagers did not find a way to grieve that felt okay during the first 6 months after the death of their parent and the acute grief experiences and reaction were associated with their grief resolution long-term, i.e. 6–9 years post-loss. Facilitating a last conversation with their dying parent, good family cohesion, and providing teenagers with knowledge about common grief experiences may help to prevent long-term unresolved grief.

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

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.

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

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 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.

Concrete and symbolic continuing bonds with a deceased person: The psychometric properties of the continuing bonds scale in bereaved surviving family members

Based on the research on continuing bonds (CB) with a deceased person to date, the reports of clinicians, and the contemporary theory of attachment, two dimensions of CB were distinguished: (i) a concrete CB, essentially characteristic of unresolved and prolonged grief, and (ii) a symbolic CB, specific to grief resolution. The psychometric properties of the Continuing Bonds Scale (CBS) were examined in a sample of persons from Poland ( N = 244) bereaved after the death of a family member from 0.5 to 18 years before the survey ( M = 3.45, SD = 2.25). In the first sub-sample ( n = 141), the exploratory factor analysis revealed a two-factor structure of the CBS: the concrete and the symbolic dimension of the CB with the deceased. In the second sub-sample ( n = 103), a good fit of this two-factor model of the CBS was determined by confirmatory factor analysis. At the bivariate analysis level, the concrete CB with the deceased positively correlated with attachment anxiety, and negatively with grief resolution and time since loss; the symbolic CB negatively correlated with attachment avoidance. When predicting grief resolution for two dimensions of CB (controlling for adult attachment, and sociodemographic and loss-related variables), concrete CB was a negative predictor, and symbolic CB was a positive predictor of the outcome variable. The internal consistency of the CBS subscales was acceptable. The CBS is a valid and reliable measure of two different CB dimensions. The model of concrete and symbolic CB with the deceased was discussed in the light of the current results and contemporary attachment theory.

Naltrexone treatment for prolonged grief disorder: study protocol for a randomized, triple-blinded, placebo-controlled trial

Background There is a lack of effective pharmacotherapy for prolonged grief disorder (PGD). Evidence suggests that the neurobiology of PGD involves the same circuitry as the reward pathway. Based upon this evidence, we hypothesize that PGD can be conceptualized as a disorder of addiction and therefore could benefit from being treated with medications that are currently used to treat such disorders. One such medication is naltrexone, which is currently used to treat alcohol and opioid dependence. Oral naltrexone was chosen for its mechanism of action, safety, and convenience. The primary aim of this study is to establish the efficacy of using oral naltrexone as a pharmacological treatment for PGD. Specifically, we hypothesize that participants receiving naltrexone will demonstrate reduced PGD symptoms when compared to placebo. Methods/design This is a randomized, placebo-controlled, triple-blinded (to healthcare professionals/study staff, participants, and data analysts) study in which we propose to enroll 48 participants who meet criteria for Prolonged Grief Disorder (PGD). Participants will be randomly assigned to the naltrexone 50 mg oral arm or placebo arm; medications will be over-encapsulated to appear identical. Participants will take their assigned medication for 8 weeks, with clinic visits every 4 weeks to assess symptom severity, social closeness, and adverse reactions. Weekly surveys of Prolonged Grief-13-Revised (PG-13-R) will be used to relate naltrexone use to changes in PGD symptom severity. Follow-up 4 weeks after their last visit will assess the longevity of treatment, as well as any lingering adverse reactions. Discussion This study is the first to investigate the use of oral naltrexone as pharmacological treatment for PGD. The acute and debilitating nature of the disorder, in addition to the increased risk of comorbidities, highlights the need for pharmacological treatment like naltrexone that can act more rapidly, may help those for whom psychotherapy may not be effective, and/or may augment psychotherapy to promote PGD symptom grief resolution. Trial registration ClinicalTrials.govNCT04547985. Registered on 8/31/2020.

Grief & Loss Resolution among Birth Mothers in Open Adoption

While research has explored birth parent grief and loss, it has not been thorough in exploring how the experience of having an open adoption affects birth parents’ grief and loss experience and resolution. Previous research has highlighted positive effects of open adoptions to date, but is quite limited in regards to the birth parents’ adjustment in current day, open adoptions. This descriptive, qualitative study explores birth parents’ experiences in current day, open adoptions and seeks to understand their experience of grief and loss and their movement towards grief resolution in the context of an open adoption. Findings of this study confirm that the experience of adoption placement involves grief and loss and that openness in adoption helps to mitigate this painful experience. Most notably, birth parents found meaning, comfort, and peace in knowing of their child’s well-being and by having ongoing involvement in the life of the child and adoptive family. This opens new avenues in thinking about adoption and the meanings participants make of it.

The Possible Effects on Bereavement of Assisted After-Death Communication during Readings with Psychic Mediums: A Continuing Bonds Perspective

Unresolved, complicated, prolonged, or traumatic grief can have detrimental effects on mental and/or physical health. The effects of traditional grief counseling, with its focus on the client's acceptance of separation and integration of loss, are unclear. Within the model of continuing bonds, however, grief resolution includes an ongoing relationship between the living and the deceased. Spontaneous and induced experiences of after-death communication (ADC) have been shown to be beneficial in the resolution of grief by demonstrating these continued bonds. Presently, many bereaved individuals are experiencing assisted ADCs by receiving readings from psychic mediums and though little is known about the effects of this selfprescribed treatment option, anecdotal reports and exploratory data posit a positive outcome. This article aims to inform those who work with the bereaved about the relationships between grief, spontaneous, induced, and assisted ADC experiences, and the continuing bonds paradigm. Suggestions for future research are also included.