Influential Factors of Complicated Grief of Bereaved Spouses from Cancer Patient

So Myeong Kim; So Hi Kown

doi:10.4040/jkan.2018.48.1.59

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Kim and Kown: Influential Factors of Complicated Grief of Bereaved Spouses from Cancer Patient

Original Article

J Korean Acad Nurs 2018;48(1):59-69.

Published online: 15 January 2018

DOI: https://doi.org/10.4040/jkan.2018.48.1.59

Influential Factors of Complicated Grief of Bereaved Spouses from Cancer Patient

So Myeong Kim¹, So Hi Kown^2,

¹College of Nursing, Taegu Science University, Daegu

²College of Nursing · The Research Institute of Nursing Science, Kyungpook National University, Daegu, Korea

Address reprint requests to : Kown, So Hi College of Nursing · The Research Institute of Nursing Science, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu 41944, Korea Tel: +82-53-420-4924 Fax: +82-53-421-2758 E-mail: sh235@knu.ac.kr

Received 17 August 2017 Revised 30 January 2018 Accepted 30 January 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

Abstract

Purpose

The purpose of this study was to investigate variables and construct paths that affect complicated grief.

Methods

Participants in this cross-sectional, descriptive study were 164 bereaved spouses of cancer patients at least 12 months before the death. Data were collected from October 2016 to February 2017 using self-report structured questionnaires and were analyzed using IBM SPSS 21.0 and AMOS 20.0.

Results

The variables affecting complicated grief of bereaved spouses of cancer patients were the quality of end-of-life care (g=.15, p<.001), preparedness for death (b=-.06, p=.005), and coping with bereavement (b=-.24, p<.001), whereas the quality of death and dying did not show any effects. Preparedness for death had multiple mediating effects in the relationship between the quality of end-of-life care and complicated grief (z=-2.20, p=.028), and in the relationship between the quality of end-of-life care and coping with bereavement (z=2.11, p=.035). Coping with bereavement had a mediating effect on the relationship between preparedness for death and complicated grief (z=-2.39, p=.017).

Conclusion

This study revealed that preparedness for death and coping with bereavement play a prominent role in complicated grief. Therefore, it is important to help in preparing for death and enhancing coping with bereavement of spouses providing end-of-life care to cancer patients. In addition, investigating cultural differences in the relationship between the quality of end-of-life care and complicated grief is recommended.

Keywords: Grief, Bereavement, Terminal Care, Palliative care

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Figure 1.

Hypothetical model and standardized estimation of the modified model.

Table 1.

General Characteristics of Bereaved Spouses and Descriptive Statistics of Measured Variables (N=164)

Characteristics	Categories	n	%	M±SD	Skewness	Kurtosis
Age (yr)	<50	21	12.8	62.86±9.71
	50~59	33	20.1
	60~69	67	40.9
	≥70	43	26.2
Gender	Male	36	22.0
	Female	128	78.0
Religion	Christian	35	21.4
	Catholic	44	26.8
	Buddhist	29	17.7
	None	52	31.7
	Other	4	2.4
Level of education	Elementary school	36	21.9
	Middle school	28	17.1
	High school	54	32.9
	College/university	39	23.8
	Master and above	7	4.3
Monthly income (10,000 KRW)	<100	61	37.2
	100~199	44	26.8
	200~299	38	23.2
	300~399	14	8.5
	≥400	7	4.3
Time since bereavement (month)	12~23	64	39.0	38.57±25.78
	24~57	58	35.4
	58~108	42	25.6
Social activities	Frequently	58	35.4
	Sometimes	62	37.8
	Seldom	44	26.8
Relationship with patient	Very good	44	26.8
	Fairly good	66	40.2
	Hardly good	48	29.3
	Bad	6	3.7
Complicated grief	＜48 point	137	83.5	37.14±9.09	0.87	0.13
	≥48 point	27	16.5
Coping with bereavement	Oscillation balance			−0.59±8.91	−0.39	0.01
	Loss orientation			25.09±7.49
	Restoration orientation			25.68±6.16
Quality of end-of-life care				63.25±13.59	0.77	−0.22
Quality of dying and death				58.89±10.27	−0.03	−0.09
Social support				59.09±12.39	−0.63	0.19
Preparedness for death	Low degree (1~2 score)	29	17.7	4.09±1.55	−0.32	−0.64
	Moderate degree (3~5 score)	102	62.2
	High degree (6~7 score)	33	20.1

KRW=Korean won; M=Mean, SD=Standard deviation.

Table 2.

Comparison of Model Fit of Modified to Hypothetical Model

Fit measure	χ² (p)	Normed χ²	DF	GFI	AGFI	NFI	CFI	SRMR	RMSEA
Optimum standard model	(p>.05)	3		≥.90	≥.90	≥.90	≥.90	<.08	<.05
Hypothetical model	0.00	0.00	0	1.00	−	1.00	1.00	.00	.22
Modified model	1.99 (.920)	0.33	6	.99	.98	.98	1.00	.02	.00

DF=Degree of Freedom; GFI=Goodness of fit index; AGFI=Adjusted goodness of fit index; NFI=Normed fit index; CFI=Comparative fit index;

SRMR=Standardized root mean residual; RMSEA=Root mean square error of approximation.

Table 3.

SE, CR, SMC, Standardized Direct, Indirect and Total Effect of the Modified Model

Endogenous variable	Exogenous variable	SE	CR (p)	SMC	Direct effects	Indirect effects	Total effects
					SE (p)	SE (p)^†	SE (p)
Preparedness for death	Quality of end-of-life care	.52	3.62 (<.001)	.08	.52 (<.001)		.52 (<.001)
Quality of dying and death	Quality of end-of-life care	.16	2.60 (.009)	.29	.16 (.009)	.04 (.010)	.20 (.013)
	Social support	.27	5.76 (<.001)		.27 (<.001)		.27 (<.001)
	Preparedness for death	.09	2.92 (.003)		.09 (.003)		.09 (.003)
Coping with bereavement	Quality of end-of-life care					.05 (.017)	.05 (.017)
	Preparedness for death	.10	2.61 (.009)	.04	.10 (.009)		.10 (.009)
Complicated grief	Quality of end-of-life care	.15	3.74 (<.001)	.27	.15 (<.001)	−.04 (.006)	.10 (.010)
	Preparedness for death	−.06	−2.80 (.005)		−.06 (.005)	−.02 (.012)	−.08 (.007)
	Coping with bereavement	−.24	−6.04 (<.001)		−.24 (<.001)		−.24 (<.001)

SE=Standardized estimate; CR=Critical ratio; SMC=Squared Multiple Correlations.

^†Bootstrap.

Table 4.

Test of Mediator Effect

Exogenous variable		Intervening variable	Endogenous variable	Indirect effect	Sobel#x2019;s test
					z	p
Quality of end-of-life care	→	Preparedness for death	Quality of dying and death	.04	2.25	.024
	→		Coping with bereavement	.05	2.11	.035
	→		Complicated grief	−.03	−2.20	.028
	Preparedness for death	Coping with bereavement	Complicated grief	−.01	−2.00	.046
Preparedness for death	→	Coping with bereavement	Complicated grief	−.02	−2.39	.017

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