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.

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).

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.

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.

The aim of the present cross-sectional study was to investigate the associations between caregivers’ attachment styles, family functioning, the care setting and pre-loss grief symptoms, the burden, and the caregivers’ belief of patients’ awareness of the terminal cancer diagnosis.

A total of 101 caregivers of patients with terminal cancer in residential hospice care and home care were interviewed and completed self-report questionnaires.

Insecure attachment style and home care setting were associated with worse psychological effects in caregivers of patients with terminal cancer. Moreover, family cohesion can promote low social burden and the patient’s awareness of their terminal condition.

This study highlighted the importance of evaluating the caregiver’s attachment style, family functioning, and the setting of care during the terminal phase of the patient’s life. These findings will be useful to planning interventions to prevent burden and the pre-loss grief symptoms in the caregivers.