Holly G Prigerson

Harvard University | Harvard · Department of Psychology

Importance Private equity firms and publicly traded companies have been acquiring US hospice agencies; an estimated 16% of US hospice agencies are owned by private equity (PE) firms or publicly traded companies (PTC). Objective To examine the association of PE and PTC acquisitions of hospices with Medicare patients’ site of care and clinical diagn...

Purpose: Most patients with cancer lack the prognostic understanding necessary to make informed decisions. We tested the feasibility and acceptability of the Oncolo-GIST ("Giving Information Strategically and Transparently, GIST") intervention and explored its associations with patients' improved prognostic understanding. Methods: The Oncolo-GIS...

Objectives: Accurate prognostic understanding among patients with advanced cancer and their caregivers is associated with greater engagement in advance care planning (ACP) and receipt of goal-concordant care. Poor prognostic understanding is more prevalent among racial and ethnic minority patients. The purpose of this study was to examine the feas...

Background: The goal of this study was to develop and optimize an intervention designed to address barriers to engagement in advance care planning (ACP) among Latino patients with advanced cancer. The resulting intervention, titled Planning Your Advance Care Needs (PLAN), is grounded in theoretical models of communication competence and sociocultu...

Key Points Prognostic understanding among advanced cancer patients is associated with higher levels of engagement in advance care planning (ACP), preference for comfort over aggressive care, and receipt of goal‐concordant care, but few patients have accurate prognostic understanding. Talking about Cancer (TAC) is a communication‐based intervention...

Background/Objective Bereaved family surrogates from intensive care units (ICU) are at risk of comorbid anxiety, depression, and post-traumatic stress disorder (PTSD), but the temporal reciprocal relationships among them have only been examined once among veterans. This study aimed to longitudinally investigate these never-before-examined temporal...

6634 Background: Suicide rates are elevated acutely after cancer diagnosis. We sought to create a unifying theory that explains variations in suicide risk across cancer sites, stages, and demographics. Based on the stress-diathesis model, we hypothesized that suicide risk correlates with cancer prognosis and that the impact of prognosis on suicide...

12031 Background: A cancer diagnosis and subsequent treatment can cause significant psychosocial distress, including fear about the end of life (EoL). Although distress is common, it often goes unrecognized due to the challenge of routine psychosocial distress screening. This study sought to determine patient characteristics associated with EoL-rel...

e18676 Background: Therapeutic alliances (TA) are bonds between patients and their oncologists characterized by mutual caring, trust, understanding, and respect. They lay the foundation for the provision of high-quality cancer care. We here relate oncologist characteristics to TA in Latino vs. non-Latino advanced cancer patients. Results will infor...

Objectives: Grief-related psychological distress often co-occurs to conjointly impair function during bereavement. Knowledge of comorbid grief-related psychological distress is limited: no longitudinal study has examined dynamic patterns of co-occurring prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), and depression, and previ...

Objectives The PG‐13‐Revised (PG-13-R) is a self-report measure to assess prolonged grief disorder (PGD) in terms of Diagnostic and Statistical Manual of Mental Disorders, fifth revision, Text Revision. This measure has been shown to yield good psychometric properties in Western samples. This study aimed to evaluate the psychometric properties of t...

Objectives: Latino patients have been shown to engage in advance care planning (ACP) at much lower rates than non-Latino White patients. Coping strategies, such as the use of emotional support, may differentially relate to engagement in ACP among Latino and non-Latino patients. The present study sought to examine the moderating effect of ethnicity...

Objective: With Huntington disease (HD), a fatal neurodegenerative disease where the prevalence of suicidal thoughts and behavior (STB) remains elevated as compared to other neurological disorders, it is unknown whether STB and health-related quality of life (HRQoL) affect plans for the end of life or more broadly, advance care planning (ACP). Con...

Background: Scan-related anxiety (“scanxiety”) is distressing to people living with and beyond cancer. We conducted a scoping review to promote conceptual clarity, identify research practices and gaps, and guide intervention strategies for adults with a current or prior cancer diagnosis. Methods: Following a systematic search, we screened 6820 titl...

Background Physicians treating similar patients in similar care-delivery contexts vary in the intensity of life-extending care provided to their patients at the end-of-life. Physician psychological propensities are an important potential determinant of this variability, but the pertinent literature has yet to be synthesized.Objective Conduct a revi...

Background: Benefits of advance care planning (ACP) have recently been questioned by experts, but ACP is comprised of discrete activities. Little is known about which, if any, ACP activities are associated with patients' greater likelihood of receiving value-concordant end-of-life (EoL) care. Objectives: To determine which ACP activities [Do-Not...

Psychological responses to an impending or recent death have received minimal attention in the research literature. I will present data to demonstrate the high levels of psychological distress (e.g. symptoms of peritraumatic stress, anxiety, depression and grief) reported by caregivers of a loved one with a life-threatening illness. I will report o...

Since the first edition of The Handbook of Psychiatry in Palliative Medicine was released in 2000, it has come to occupy an important and distinctive niche within the literary anthology of palliative medicine. The Handbook is widely regarded as the definitive reference on psychosocial issues affecting patients with life-threatening and life-limitin...

Background Bereaved ICU family surrogates are at risk of comorbid prolonged grief disorder (PGD), posttraumatic stress disorder (PTSD), and depression. Knowledge about temporal relationships between PGD, PTSD, and depression is limited by a lack of relevant studies and diverse or inappropriate assessment time frames given the duration criterion for...

Interventions near patients' deaths in the United States are often expensive, burdensome, and inconsistent with patients' goals and preferences. For patients and their loved ones to make informed care decisions, physicians must share adequate information about prognoses, prospective benefits and harms of specific interventions, and costs. This comm...

Introduction It is estimated that 55 million people are living with dementia worldwide in 2021, and the numbers are expected to rise to 78 million in 2030 and 139 million in 2050 (Siriaraya et al., 2022; World Health Organisation, 2022). Dementia is an umbrella term that describes neurodegenerative disorders that impact memory, cognition, language...

Prolonged Grief Disorder (PGD) is a newly recognized mental disorder in ICD-11 and DSM-5-TR. Several studies using exploratory factor analysis have found a unidimensional structure of the Prolonged Grief-13 (PG-13) measure of PGD. The recently published ICD-11 proposal proposes a distinction between two clusters of symptoms: Separation distress sym...

Objectives: As dementia affects a growing number of older adults, it is important to understand its detection and progression. We identified patterns in dementia classification over time using a longitudinal, nationally representative sample of older adults. We examined the relationship between socioeconomic status and race/ethnicity, and patterns...

Introduction: Bereavement and grief are social phenomena influenced by a multitude of cultural factors. Prior studies of bereavement adjustment have primarily focused on bereaved survivors who identify racially as white; knowledge of the experience of grief and bereavement among racial/ethnic and other minority groups, particularly among Latino/a...

Objectives: We examined associations between the severity of symptoms of prolonged grief disorder (PGD) and depression and recent suicidal ideation among bereaved family members. Methods: Individuals who survived the death of a family member 1-8 year earlier (N = 225) were surveyed using self-report measures in the cross-sectional study. Regress...

Importance: Advance care planning (ACP) can promote patient-centered end-of-life (EOL) care and is intended to ensure that medical treatments are aligned with patient's values. Sexual and gender minority (SGM) people face greater discrimination in health care settings compared with heterosexual, cisgender people, but it is unknown whether such dis...

Background: Cancer patients often prefer to die at home, a location associated with better quality of death (QoD). Several studies demonstrate disparities in end-of-life care among immigrant populations in the United States. This study aimed to evaluate how immigrant status affects location and quality of death among patients with advanced cancer...

Background: Dementia is a leading cause of death for older adults and is more common among persons from racial/ethnic minoritized groups, who also tend to experience more intensive end-of-life care. This retrospective cohort study compared end-of-life care in persons with and without dementia and identified dementia's moderating effects on the rel...

Purpose: We examined the use of advance care planning (ACP) among Medicare beneficiaries who were identified as transgender. Methods: This study is a cross-sectional analysis of Medicare claims from 2016 to 2018, comparing ACP visits between transgender and other beneficiaries. Results: Beneficiaries identified as transgender were slightly more lik...

This study aims to investigate the psychometric properties, stability, and predictive validity of the PG-13-K. Two subsamples were used: the first subsample (N = 153), participated at Time 1 only, and the second subsample (N = 184) participated at both Time 1 and Time 2. At each time point, reliability, test-retest reliability, and validity were ad...

Purpose: To examine associations between financial hardship and suicidal ideation among bereaved informal caregivers of cancer patients. Design: Longitudinal cohort study. Sample: 173 informal caregivers of advanced cancer patients. Methods: Caregivers were interviewed a median 3.1 months before and 6.5 months after the death of the patient...

Purpose Glioblastoma (GBM) is a devastating neuro-oncologic disease with invariably poor prognosis. Despite this, research shows patients have unrealistic perceptions of their prognosis, which may relate in part to communication patterns between patients, caregivers and oncologists. The purpose of this study was to examine communication processes a...

Background and Aims Patients require a clear understanding of their prognosis to make informed decisions about their care. The aim of this study was to compare the perceptions of prognosis and transplant candidacy between patients with cirrhosis and their hepatologists. Methods Patients with cirrhosis and their hepatologists were prospectively rec...

Background: Little is known about end-of-life intensive care provided to patients with intellectual disabilities (ID). Objectives: To identify differences in receipt of end-of-life cardiopulmonary resuscitation (CPR) and endotracheal intubation among adult patients with and without ID and examine whether do-not-resuscitate orders (DNRs) mediate ass...

With the COVID-19 pandemic prompting predictions of a "grief pandemic," rates and risks for Prolonged Grief Disorder (PGD) warrant further investigation. Data were collected online from 1470 respondents between October 2020 and July 2021. Shorter time since death, deaths of siblings and "others," and deaths from accidents and homicides were positiv...

Suicide among physicians is a longstanding problem, with risk factors exacerbated by the coronavirus disease 2019 (COVID-19) pandemic. In this article, we explore suicidal thoughts and behaviors among physicians and risk factors created or intensified by the work environment, such as overwork and loss of autonomy. We discuss the ways in which the C...

Objective: While the relationship between attachment anxiety and avoidance and the severity of prolonged grief disorder (PGD) has been well-studied, less is known about the relationship between disorganized attachment and PGD. We test the associations between disorganized attachment and the interaction between it and attachment avoidance and anxie...

Background Persons with serious mental illnesses (SMIs) are at increased risk for exposure to trauma and posttraumatic stress disorder (PTSD). Prolonged Grief Disorder (PGD) may also impact this population but has been seldom studied. Aims The present study investigated the rate of both PTSD and PGD among clients receiving community mental health...

Objective: To determine whether distinctive prolonged-grief-disorder- (PGD) and depressive-symptom states emerge among family caregivers of cancer patients over their first 2 years of bereavement. This may extend cross-sectional evidence that PGD and major depressive disorder (MDD) symptoms can co-occur/occur independently and validate their const...

Objective: Informed treatment decision-making necessitates accurate prognostication,including predictions about quality of life. We examined whether oncologists, patients with advanced cancer, and caregivers accurately predict patients' future quality of life and whether these predictions are prospectively associated with end-of-life care and bere...

Background Educational resources and decision aids help patients, their care partners and health care providers prepare for and confidently engage in Advance Care Planning (ACP). Incorporating ACP resources as part of a self-management approach may lead to fuller engagement with ACP beyond identifying a surrogate decision-maker, towards supporting...

Objective Among patients living with advanced, life-limiting illness, reconciling the prospect of disease progression with future goals and expectations is a key psychological task, integral to treatment decision-making and emotional well-being. To-date, this psychological process remains poorly understood with no available measurement tools. The p...

Losing a loved one through death is known to be one of the most challenging life events. To help the bereaved and their therapists monitor and better understand the factors that contribute to Prolonged Grief Disorder (PGD), we co-designed and studied a web-based explainable AI screening system named “Grief Inquiries Following Tragedy (GIFT).” We us...

A retrospective cohort analysis of Medicare administrative claims data from 2016-2018 compared intensive and patient-centered end-of-life care measures in persons with and without dementia, including the moderating effects of race/ethnicity. Over half (53%) of 485,209 Medicare decedents had a dementia diagnosis. Decedents with dementia were 31-34%...

Objective Depression and prolonged grief disorder (PGD) are related but distinct constructs with different risk factors and treatments. We aimed to determine commonality and differences in factors predicting membership in depressive- and PGD-symptom trajectories to highlight uniqueness of each construct to guide further care and treatments. Method...

Objectives Prior studies have shown that pre-loss closeness and conflict with a deceased person are associated with the severity of symptoms of prolonged grief and/or depression. Nevertheless, mechanisms underlying these relationships are not well understood. We propose a theoretical model in which past closeness and conflict are related to prolong...

Background: Urinary incontinence is prevalent among patients receiving home hospice and presents multiple care management challenges for nurses and family caregivers. Aim: This study sought to understand how urinary incontinence influences the psychosocial care of patients receiving home hospice and the strategies that nurses employ to maximize pa...

Context Among patients with advanced life-limiting illness, an inaccurate understanding of prognosis is common and associated with negative outcomes. Recent years have seen an emergence of new interventions tested for their potential to improve prognostic understanding. However, this literature has yet to be synthesized. Objectives To identify and...

Importance Advance care planning (ACP) is intended to maximize the concordance of preferences with end-of-life (EOL) care and is assumed to lead to less intensive use of health care services. The Centers for Medicare & Medicaid Services began reimbursing clinicians for ACP discussions with patients in 2016. Objective To determine whether billed AC...

Objective The objectives of this study were to develop and refine EMPOWER (Enhancing and Mobilizing the POtential for Wellness and Resilience), a brief manualized cognitive-behavioral, acceptance-based intervention for surrogate decision-makers of critically ill patients and to evaluate its preliminary feasibility, acceptability, and promise in imp...

Background Several studies have shown that interpersonal dependency is a risk factor for prolonged grief disorder (PGD), a disorder that has been recently approved by the American Psychiatric Association Assembly for inclusion in the Diagnostic and Statistical Manual of Mental Disorders—5—Text Revision (DSM-5-TR). Nevertheless, it remains unclear w...

Although grief is a reaction to a social loss, it has been viewed almost exclusively through the lens of individual psychology and not sociology. In this article, we suggest that more attention to sociological aspects of grief is warranted. We propose a micro-sociological theory of bereavement and grief to complement, not replace, psychological per...

Objective The purpose of this study was to investigate the validity and reliability of the Japanese version of the Peace, Equanimity, and Acceptance in the Cancer Experience questionnaire (PEACE-J) and to evaluate the association between the PEACE subscales and Japanese patient characteristics. Methods A cross-sectional web-based survey was conduc...

12036 Background: Most cancer patients prefer to die at home, a location associated with better quality of death (QoD) and caregiver outcomes. A number of studies demonstrate disparities in end-of-life (EoL) care among immigrant vs non-immigrant populations in the U.S. This study aims to evaluate how immigrant status affects location and QoD among...

Although Prolonged Grief Disorder (PGD) is a mental disorder introduced into both the Diagnostic and Statistical Manual of Mental Disorders-5-Text Revision (DSM-5-RT) and the International Classification of Diseases 11 th Revision (ICD-11), the list of symptoms of this disorder in the two classifications differs slightly. In PGD research, the sever...

The death of a close other is a major life stressor that disrupts mental and physical health. Beta‐blocker medications are indicated treatments for cardiovascular conditions that may also mitigate psychological distress in the context of stressors by reducing adrenergic activity. We sought to examine observational links between beta‐blocker medicat...

Prolonged grief disorder (PGD) is a diagnostic entity now included in the International Classification of Diseases 11th Revision (ICD-11) and soon to appear in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, text revision (DSM-5-TR). A characteristic feature of PGD is distressing, disabling yearning that persists a year or...

Cancer patients and their family caregivers experience various losses when patients become terminally ill, yet little is known about the grief experienced by patients and caregivers and factors that influence grief as patients approach death. Additionally, few, if any, studies have explored associations between advance care planning (ACP) and grief...

Background We know little about the end-of-life suffering and symptoms of intensive care unit (ICU) decedents in general and those who undergo renal replacement therapy (RRT) in particular. Objectives To examine differences in end-of-life suffering and various symptoms’ contribution to suffering between ICU decedents who did not undergo RRT, those...

Cancer patients and their family caregivers experience various losses when patients become terminally ill, yet little is known about the grief experienced by patients and caregivers and factors that influence grief as patients approach death. Additionally, few, if any, studies have explored associations between advance care planning (ACP) and grief...

Objective Anxiety is common in older adults with cancer (OACs) and their caregivers and is associated with poor outcomes including worse physical symptoms, poor treatment adherence and response, and longer hospitalizations. This study examined the feasibility, acceptability, adherence, and preliminary efficacy of a cognitive-behavioral therapy (CBT...

The COVID-19 pandemic has caused a wave of death across the U.S., but not all of these deaths have been equal. Unfortunately, amid the COVID-19 pandemic, U.S. immigrants have faced more brutal deaths than their non-immigrant counterparts. These disparities reflect long-standing disparities in the end-of-life care received among immigrant patients....

Prolong Grief Disorder (PGD) is a condition in which mourners are stuck in the grief process for a prolonged period and continue to suffer from an intense, mal-adaptive level of grief. Despite the increased popularity of virtual mourning practices, and subsequently the emergence of HCI research in this area, there is little research looking into ho...

Although the concept of pathological grief dates back at least as far as Freud’s “Mourning and Melancholia”, there has been opposition to its recognition as a distinct mental disorder. Resistance has been overcome by evidence demonstrating that distinctive symptoms of prolonged grief disorder (PGD) – an attachment disturbance featuring yearning for...

Background There is a lack of effective pharmacotherapy for prolonged grief disorder (PGD). Evidence suggests that the neurobiology of PGD involves the same circuitry as the reward pathway. Based upon this evidence, we hypothesize that PGD can be conceptualized as a disorder of addiction and therefore could benefit from being treated with medicatio...

Grieving often begins at the time of cancer diagnosis, continuing as the patient faces numerous role and functional losses, surging when death is anticipated, and typically manifesting most intensely for the relatives after the patient’s death. This chapter focuses on how providers may support those who are grieving, describing common grief reactio...

Background: Hospice patients with dementia are at increased risk for live discharge and long lengths of stay (>180 days), causing patient and family caregiver stress and burden. The location and timing of clinician visits are important factors influencing whether someone dies as expected, in hospice, or experiences a live discharge or long length...

Background Dementia is a leading cause of death among US older adults. Little is known about end-of-life care intensity and do-not-resuscitate orders (DNRs) among patients with dementia who die in hospital. Aim Examine the relationship between dementia, DNR timing, and end-of-life care intensity. Design Observational cohort study. Setting/Partic...

The experience of grief varies across different cultures and contexts. Women in Nepal who lose their husbands confront discrimination, social isolation, and abuse that influence their experience of grief. Through eight focus group discussions with Nepali widows, we elicited socially sanctioned grief reactions and local idioms used to describe commo...

As of 2017, more individuals in the U.S. die at home than in any other location. Hospice care was designed to provide support for people who are dying and their families. However, dying persons may have rapidly emerging needs that home hospice does not immediately meet, thereby, exposing family members to be “first responders.” Thus, home death may...

Persons with dementia comprise up to 50% of hospice patients and face an increased risk of burdensome, disruptive, and costly discharge from hospice due to hospitalization. The relationship between timing, dose and site of hospice care provided, all modifiable factors, and risk of hospitalization is poorly understood. We use a retrospective cohort...

BACKGROUND There is a lack of effective pharmacotherapy for prolonged grief disorder (PGD). Evidence suggests that the neurobiology of PGD involves the same circuitry as the reward pathway. Based upon this evidence, we hypothesize that PGD can be conceptualized as a disorder of addiction, and therefore could benefit from being treated with medicati...

Context: To date, no studies have characterized the impacts of urinary incontinence (UI) at the end of life (EOL) in the home hospice (HH) setting. UI is highly prevalent at the EOL and adversely affects quality of life. Objectives: To characterize HH nurses’ perspectives on UI in HH patients. Methods: We conducted a qualitative descriptive study o...

Despite the substantial research interest in using Virtual Reality (VR) in healthcare in general and in Psychological, Cognitive, and Behavioral (PC&B) interventions in specific, as well as emerging research supporting the efficacy of VR in healthcare, the design process of translating therapies into VR to meet the needs of critical stakeholders su...

Background : Symptoms of grief vary by culture and societal reactions to death may be gender specific. We aimed to validate a Nepali language version of the Prolonged Grief-13 item scale (PG–13) among widows. Methods : We tested two adapted versions of a Prolonged Grief Disorder (PGD) instrument with 204 Nepali-speaking widows: one was a Nepali tr...

Advance Care Planning (ACP) is associated with increased hospice use and palliative care, decreased use of life-sustaining treatments, and greater patient and family satisfaction and peace of mind.The emergence of the COVID-19 pandemic, with its associated high mortality rate and potential need to ration scarce resources, has brought ACP to the for...