Aims: Bereaved people are considered both by health-care professionals and by common sense as vulnerable persons. Recent research also suggests that spouse-caregivers of cancer patients often report considerable distress during the palliative period.  However little is known regarding the display of grief reactions and associated symptoms well in advance of death, and spread in mid- and long-term. This study aims at filling this gap of knowledge, while providing relevant tools to detect particularly vulnerable people.

Methods: In a consecutive cohort of spouses of palliative cancer patients (N =60), we study at T1 (from 1 to 6 months before death) specific predictors of social and emotional adjustment at T2 (6-9 months after death). Attachment (Experiences in Close Relationship Scale); Burden (Montgomery Borgatta Caregiver Burden Scale); Coping and orientation of grief (Inventory of Daily Widowed Life); COPE, are used to predict: depression (BDI); Grief reactions (Inventory of Traumatic Grief); Post-Traumatic Growth; and Social Adjustment. Regression analyses were conducted to predict adjustment at follow-up controlling for baseline scores.

Results: We found three core bereavement patterns in 60 participants as evidenced in follow-up (40 men, mean age=63.4). Recovery was evidenced in 70% of the participants, with decreasing symptomatology across time whereas 15 % experienced increasing symptoms of distress. 15% reported chronic depression and troubles in emotional regulation. Regression analyses controlling for T1 outcome levels reveal that more negative adjustment at follow-up include younger age (<70), being a man and other psychosocial predictors.

Conclusion: The data suggest that vulnerable spouses of cancer patients, especially younger people, and men, could effectively benefit from an early support program targeting coping styles in grief and variability in grief reactions. Implications for future research and for clinical practice are discussed.