Le deuil des conjoints après un cancer : entre évaluation et expérience subjective

Abstract : In 2011, in France, more than 147 525 men and women died through cancer. This disease doesn’t affect only the oldest: 41 000 untimely deaths, before 65 years, are caused by cancer (FRANCIM, InVS, CIRC). All these persons were supposed to live with a partner. Faced with the patient’s death, more or less sustainable psychological, physical or social upheavals will affect the spouse.The cancer patient’s relatives and family constitute one of the patient’s main sources of support throughout the disease, but this support is not always recognized by physicians. Over recent years, several studies have emphasized the psychological vulnerability of these caregivers especially in terms of anxiety and depression patterns. However, identified sociodemographic risk factors (e.g. being a woman, being older, and having experienced previous grief) do not take into account the socio-affective and cognitive functioning of the patient’s spouse. The relationship with the patient, the caregiver’s personality, or the subjective experience of illness and end of life are considered to be critical by clinicians, but are largely ignored in empirical research. When the outcome of cancer is fatal, among the patient’s family and friends, the spouse appears to encounter the greatest difficulties to cope with her/his grief: the risk of complicated grief is more considerable among this population. Currently, the existence of this disorder (Prolonged Grief Disorder, Prigerson et al, 2009) still remains in debate and the lack of empirical longitudinal data to specify the pathological aspect of grief in the field of cancer, hinders any scientific consensus.Psychological support provided to these intensely requested persons remains poorly known, both by bereaved spouses, who have rarely resort to support facility, and by some healthcare professionals. AimsThis study aims at identifying and understanding the predictors of grief among bereaved spouses of cancer patients, induced from end of life to the mid- and long- term grief period. We also want to describe the “normal” phenomenology of grief, and its complicated manifestations. Finally this research aims at providing reflection tools facilitating the implementation of adapted support programs for bereaved spouses.MethodsTwo complementary studies were conducted. Study 1, a quantitative study, uses a psychometric battery assessing the distress, the social adjustment, the post-trauamtic growth, the styles of attachment and of coping, as well as the personality in spouses of cancer patients. This study consists of following-up of a cohort during the palliative period (N=60)/6 months after death (N=36), to capture correlations between initial personal data and subsequent adjustment. Study 2 is a qualitative study, which provides an investigation of ten spouses’ experience facing the loss of their loved one. This experience and their making sense processes were studied with the Interpretative Phénoménological Analysis (IPA, Smith, Flowers & Larkin, 2009)ResultsThe quantitative analyses showed that the vast majority of the spouses reported during the palliative phase a depressive symptomatology and feelings of burden associated with the caregiving of the patient. Their social adaptation is globally preserved. After the death of the patient, the intensity of the depressive symptoms increase for the majority of the bereaved spouses (53%), while a minority (13%) meet the criteria for a Prolonged Grief Disorder. Above all, the distress of the latter is predicted by their levels of depression assessed before the death. The factors linked to the disease or to the death itself hardly constitute good predictors of the condition of the bereaved spouses. The attachment styles allow us to identify adaptative profiles in this population.....
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Léonor Fasse. Le deuil des conjoints après un cancer : entre évaluation et expérience subjective. Psychologie. Université René Descartes - Paris V, 2013. Français. ⟨NNT : 2013PA05H125⟩. ⟨tel-01088740⟩

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