Attachment insecurities, continuing bonds, and grief among family caregivers of terminally ill cancer patients: A longitudinal study.

Objectives: The present study investigated the associations among pre-loss grief, relational closeness, attachment insecurities, continuing bonds (CBs) with the deceased person, and the post-loss adjustment of the caregivers of patients with terminal cancer.

Methods: Data were collected in the hospice department of a cancer center in northern Taiwan; 66 bereaved caregivers completed both pre-loss and post-loss scales. The measures used for the pre-loss phase included the Hogan Grief Reaction Checklist (HGRC; pre-loss version), the Experiences in Close Relationship - Relationship Structures Questionnaire (ECR-RS), and the Inclusion of Other in the Self Scale. The measures used 6-12 months after the death of the patients were the HGRC (post-loss version) and the Continuing Bond Scale (CBS).

Results: Pre-loss grief and externalized CBs had a significant impact on the amount of post-loss grief, indicating that pre-loss grief and ongoing transformation of relationships after patients' death may be predictors of caregivers' post-loss grieving.

Significance of results: This longitudinal study provides preliminary evidence that pre-loss grief and the relationship with the patient are key to caregivers' post-loss adjustment, suggesting that psychosocial intervention focuses on caregivers' pre-loss grief and relationship quality with the patient during palliative care.