Aims: The psychological outcome of family carers after bereavement is an im
portant issue in evaluating palliative care services. Palliative care servi
ces have the potential to provide preventive psychosocial intervention to f
amily carers prior to bereavement, but are faced with the need to identify
those who may have greatest risk of adverse outcome. This prospective study
examines predictors of psychological outcome for family carers of cancer p
atients following bereavement based on factors identified at referral to a
palliative care agency. Methods: Cancer patients and their family carer wer
e consecutively recruited and assessed on a range of clinical and psycholog
ical measures at referral to a palliative home care service in a metropolit
an centre (Time 1). Carers were again assessed following the death of the p
atient, on average at 4 months post-bereavement (Time 2), using measures of
bereavement symptoms and psychological morbidity. Results: 178 carers were
assessed on both occasions. The chief predictors of carer psychological sy
mptoms and severity of grief at follow-up were psychological symptom scores
at the time of referral (Time 1). Factors also measured at Time 1 were sig
nificant predictors of symptoms and grief scores at Time 2: greater number
of adverse life events, carer's coping responses, past bereavement and sepa
ration experiences, the relationship with the patient, and greater severity
of patient's illness at the time of palliative care referral. Conclusions:
The findings indicate clinical risk factors for adverse short-term bereave
ment outcome that can be identified in family carers during palliative care
treatment, that have implications for identifying the psychological needs
of carers, and that form a potential basis for interventions to enhance the
psychological outcome for family carers. Copyright (C) 1999 John Wiley & S
ons, Ltd.