Defense Date


Document Type


Degree Name

Doctor of Philosophy


Social Work, Ph.D.

First Advisor

Dr. Pamela J. Kovacs


This research explored the social and psychological needs of caregivers of advanced cancer patients, and their subsequent bereavement adjustment. The study focuses exclusively on informal caregivers who provide assistance to patients receiving hospice care for end-stage cancer. Those individuals living furthest from the dying care recipient, the long distance caregivers, were of particular interest. This study used a prospective design to explore how a caregiver's geographic proximity impacted their social support and bereavement adjustment. A 2 x 3 repeated measures design was used to gather data from caregivers before a patient's death (using a pre-death questionnaire) as well as after the death (by post-death questionnaire). This design allowed for an examination of differences between three groups of caregivers over time: long distance caregivers (who live an hour or more from the care recipient), proximate caregivers (who live less than an hour away) and co-residing caregivers. One hundred and six (N = 106) caregivers were recruited to participate from Covenant Hospice, a large Gulf Coast-based palliative care organization. Validated instruments were used to measure levels of social support and bereavement adjustment. A repeated measures MANCOVA procedure explored the impact of geographic proximity on measures of social support and adjustment. Results did not support the proposed multivariate model. However, quality of dying (as measured by the QOD-Hospice) was identified as an influential between-groups covariate within the model. Further exploration of the QOD-Hospice revealed a negative correlation with levels of emotional grief, and positive correlations with length of stay in hospice, and pre-loss and post-loss levels of social support. Overall results seem to suggest that timely referrals to hospice, improvements in care for the dying, and increased attention to quality of dying, may have a beneficial impact for survivors during bereavement. Furthermore, findings from this study suggest that the quality of a person's final days may play an important role in how the surviving caregivers adjust to the loss. Not only can high quality end-of-life care benefit dying patients, but it may also facilitate bereavement adjustment for those who participated in their care network. However, findings were limited and further investigation of these relationships is warranted.


© The Author

Is Part Of

VCU University Archives

Is Part Of

VCU Theses and Dissertations

Date of Submission

June 2008

Included in

Social Work Commons