Holly G Prigerson

Holly G Prigerson
Harvard University | Harvard · Department of Psychology

Ph.D.

About

515
Publications
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33,642
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Publications

Publications (515)
Article
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. Regression...
Article
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...
Article
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...
Article
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...
Article
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...
Article
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...
Article
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...
Article
Full-text available
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...
Article
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...
Article
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...
Article
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...
Article
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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...
Article
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...
Article
Full-text available
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...
Article
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...
Article
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...
Article
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...
Article
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...
Article
Full-text available
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...
Article
Full-text available
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%...
Article
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...
Article
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...
Article
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...
Article
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...
Article
Full-text available
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...
Article
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...
Article
Full-text available
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...
Article
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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...
Article
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...
Article
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...
Method
Full-text available
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...
Article
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...
Article
Full-text available
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...
Article
Full-text available
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...
Article
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...
Preprint
Full-text available
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...
Article
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...
Article
Full-text available
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....
Conference Paper
Full-text available
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...
Article
Full-text available
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...
Article
Full-text available
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...
Chapter
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...
Article
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...
Article
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...
Article
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...
Article
Full-text available
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...
Article
Full-text available
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...
Preprint
Full-text available
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...
Article
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...
Article
Full-text available
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...
Article
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...
Article
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...
Article
Full-text available
Context Patient prognostic understanding is improved by oncologists’ discussions of life expectancy. Most patients deem it important to discuss prognosis with their oncologists, but a minority of cancer patients within months of death report that they had such a discussion with their oncologist. Objectives To query stakeholders about their perspec...
Article
Full-text available
Context Hospice deaths in the U.S. are increasing. Dying hospice patients may have rapidly emerging needs the hospice team cannot immediately meet, exposing family caregivers to fright-inducing (i.e., scary) situations. Objectives To examine relationships between hospice care and family caregiver exposures and psychological responses to witnessing...
Article
Full-text available
Purpose: The quality of the relationship between oncologists and cancer patients has been associated with caregiver bereavement outcomes, but no studies have examined whether the perceived quality of the relationship between cancer caregivers and oncologists is associated with caregiver experiences of end-of-life care or psychological adjustment a...
Article
Full-text available
Prolonged Grief Disorder (PGD) is a debilitating condition affecting between 7% and 10% of bereaved individuals. Past imaging and psychological studies have proposed links between PGD's characteristic symptoms - in particular, profound yearning - and the neural reward system. We conducted a systematic review to investigate this connection. On Decem...
Article
Objective This qualitative study sought to obtain feedback from stakeholder cancer caregivers and bereaved family members on the implementation of bereavement risk screening in oncology. Methods Semi‐structured interviews were conducted with 38 family members of patients with advanced cancer (n=12) and bereaved family members (n=26) on when and ho...
Article
BACKGROUND/OBJECTIVE The Centers for Medicare & Medicaid Services (CMS) reimburses clinicians for advance care planning (ACP) discussions with Medicare patients. The objective of the study was to examine the association of CMS‐billed ACP visits with end‐of‐life (EOL) healthcare utilization. DESIGN Patient‐level analyses of claims for the random 20...
Article
Palliative care (PC) focuses on caring for the whole person, from birth to death, while managing symptoms and helping to navigate medical complexities. Care does not stop at the time of death, however, as assisting patients, families, and fellow clinicians through grief and bereavement is within PC's purview. Unfortunately, many clinicians feel unp...
Article
Full-text available
An examination of Latino advanced cancer patients’ and their informal caregivers’ preferences for communication about advance care planning: A qualitative study – ERRATUM - Volume 18 Issue 3 - Megan Johnson Shen, Cyndi Gonzalez, Benjamin Leach, Paul K. Maciejewski, Elissa Kozlov, Holly G. Prigerson
Article
Background: A majority of hospice care is delivered at home, with significant caregiver involvement. Identifying factors associated with caregiver-reported quality measures could help improve hospice care in the United States. Objectives: To identify correlates of caregiver-reported quality measures: burden, satisfaction, and quality of end-of-lif...
Article
Full-text available
The aim of this study was to validate the Turkish version of the Prolonged Grief Scale (PG-13) and to determine the prevalence and predictors of prolonged grief disorder (PGD). Data were gathered from two independent samples of 306 (Study 1) and 271 (Study 2) bereaved adults to determine if findings in one sample could be replicated in the other. T...
Article
Full-text available
Background The use of Do-Not-Resuscitate (DNR) orders has increased but many are placed late in the dying process. This study is to determine the association between the timing of DNR order placement in the intensive care unit (ICU) and nurses’ perceptions of patients’ distress and quality of death. Methods 200 ICU patients and the nurses (n = 83)...
Article
Full-text available
Importance: Medicare beneficiaries with high medical needs can benefit from Advance Care Planning (ACP). Medicare reimburses clinical providers for ACP discussions, but it is unknown whether high-need beneficiaries are receiving this service. Objective: To compare rates of billed ACP discussions among a cohort of high-need Medicare beneficiaries...
Article
Background Prior research has demonstrated that the presence of regret and unfinished business is associated with poorer adjustment in bereavement. Though there is a growing literature on these constructs among caregivers of adult patients, the literature on regret and unfinished business in bereaved parents has been limited. Aim The aim of this s...
Article
Full-text available
Background: When religious and spiritual (R/S) care needs of patients with advanced disease are met, their quality of life (QoL) improves. We studied the association between R/S support and cancer patients' QoL at end-of-life in Soweto, South Africa. Objectives: To identify R/S needs among advanced cancer patients receiving palliative care servi...
Article
Context: Discordance in prognostic understanding between caregivers of adults with advanced cancer and the oncologist may shape caregivers' views of the oncologist and bereavement outcomes. Objectives: We examined prospective associations of caregiver-oncologist discordance with caregiver-oncologist therapeutic alliance and caregiver anxiety fol...
Article
Objective: Prolonged grief disorder (PGD) and major depressive disorder (MDD) are common syndromes shaping bereaved caregivers' quality of life (QOL). However, distinctiveness of these syndromes warrants confirmation and the temporal relationship of PGD and MDD symptoms has not been established. To fill these knowledge gaps, we conducted this long...
Article
Full-text available
Background: Transitional objects provide security and symbolic connection with valued others when separated from them. Bereaved parents often keep, cherish and visit saved objects of their deceased child. This research examined the hypothesis that these objects behave as transitional objects of grief in bereaved mothers during three years followin...