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Awareness of husband's impending death from cancer and long-term anxiety in widowhood: a nationwide follow-up

Clinical Cancer Epidemiology, Department of Oncology and Pathology, Karolinska Institutet, Stockholm, The Oncological Centre, M:08:01, Karolinska Hospital, Stockholm and Stockholm Sjukhem Foundation, Mariebergsgatan 22, Stockholm

Ásgeir R Helgason

Clinical Cancer Epidemiology, Department of Oncology and Pathology, Karolinska Institutet, Stockholm and Stockholm Centre for Public Health, Stockholm

Carl-Johan Fürst

Stockholm Sjukhem Foundation, Mariebergsgatan 22, Stockholm

Jan Adolfsson

Clinical Cancer Epidemiology, Department of Oncology and Pathology, Karolinska Institutet, Stockholm, and The Oncological Centre, M:08:01, Karolinska Hospital, Stockholm

Gunnar Steineck

Clinical Cancer Epidemiology, Department of Oncology and Pathology, Karolinska Institutet, Stockholm

Background: We investigated the predictors and long-term consequences of awareness time — the length of time a woman is aware of her husband's impending death from cancer. Methods: All women (n / 506) living in Sweden under 80 years of age who lost their husband/partner owing to cancer of the prostate in 1996 or of the urinary bladder in 1995 or 1996 were followed with an anonymous postal questionnaire, 2–4 years after their loss. Results: We received completed questionnaires from 379 of the widows. Of these, 55 (15%) reported an awareness time of 24 hours or less, 56 (15%) of 3–6 months and 95 (26%) of one year or more. The associations between the awareness time and morbidity were of a reverted ‘J-shape,’ with awareness time of 24 hours or less carrying the highest risk and 3–6/6–12 months the lowest. On comparing the awareness time of 24 hours or less with 3–6 months (preformed response category), the relative risks for anxiety were found to be 1.9 (1.0–3.6) (visual digital scale) and 4.5 (1.0–20.0) for intake of tranquillising drugs. Those not informed of their husband's fatal condition or not provided with psychological support by caregivers during their husband's last months of life had an increased risk of a short awareness time. Conclusions: During a man's terminal cancer illness, the wife's awareness time varies considerably and is influenced by information and psychological support from caregivers. A short awareness time may result in an additional and avoidable psychological trauma.

Key Words: adaptation, psychological • anxiety • bereavement • support, psychological • terminal care • truth disclosure

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