Design: Randomised controlled trial
Population: 111 family caregivers of patients with advanced cancer
Primary outcome: Grief, guilt, anxiety, depression, post-traumatic growth and quality of life
Effect: Anticipatory grief estimate −9.31 (P<0.001); no difference in anxiety, depression or guilt

A randomised trial assigned 111 family caregivers of patients with advanced cancer to structured grief counselling or written psychological material alone. Counselling began in the patient's terminal phase and continued for three months after the death.

Counselling was associated with lower anticipatory grief scores over time (estimate −9.31) and higher post-traumatic growth and quality-of-life scores. There were no significant differences in bereavement guilt, anxiety or depression.

The trial was small and from one setting, and the outcomes were questionnaire scores. But it supports starting bereavement support before death rather than after it, which oncology and palliative teams can begin to build into family meetings.

Consider offering caregivers structured support before the patient dies, not only afterwards
Ask caregivers directly how they are coping at family meetings
Signpost to bereavement services as part of end-of-life planning
Do not expect counselling alone to resolve anxiety or depression; screen and refer where needed

Why it matters

Bereavement support usually starts after death; this suggests the weeks before may matter more.

The statistics, in plain English

The scale estimates are differences in questionnaire scores over time; without knowing what change is meaningful on each scale, the clinical size of the benefit is hard to judge. Non-significant results for anxiety and depression may reflect the small sample.