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  1. Jason Boland
  1. Senior Clinical Lecturer and Honorary Consultant in Palliative Medicine, Hull York Medical School, University Of Hull; and Care Plus Group and St Andrew's Hospice, North East Lincolnshire, UK

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Pre-loss symptoms related to risk of complicated grief in caregivers of terminally ill cancer patients


This study investigated the relationship between pre-loss criteria for complicated grief and post- bereavement diagnosis of complicated grief. This was carried out in a hospice in North East Italy, in which 60 family members of patients who were admitted and who had a 30 day survival of less than 30% as predicted by the Palliative Prognostic Score completed the Pre-Death Inventory of Complicated Grief. This is a 13-item questionnaire which uses a Likert sale to investigating care givers mood and feelings. Six months after the death, family members were interviewed at their home for Complicated Grief using the Inventory of Complicated Grief-Structured Clinical Interview (with 17 criteria required for a diagnosis of complicated grief). 18% of caregivers had complicated grief at 6 months. The scores obtained before the bereavement from the Pre-Death Inventory of Complicated Grief tool were higher among those who developed complicated grief. Pre-loss criteria related to traumatic distress, separation distress and emotional symptoms in general were significantly related to a post-loss diagnosis of complicated grief, while no effect was shown on duration of pre-loss distress. The authors encourage the use of short screening tools, like the Inventory of Complicated Grief, to help identify people at risk of developing complicated grief, although acknowledge their findings need confirmation in larger, multisite studies.

‘Not the ‘grim reaper service’’: an assessment of provider knowledge, attitudes, and perceptions regarding palliative care referral barriers in heart failure.

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  • Competing interests None.

  • Provenance and peer review Commissioned; internally peer reviewed.