Dyadic death-preparedness concordance states and bereaved caregivers’ health-related quality of life and psychological outcomes: a longitudinal study

Purpose Health-related quality of life (HRQOL), psychological distress, anticipatory grief, and death preparedness are interdependent within patient-caregiver dyads. This study described caregivers' bereavement outcomes over two years across preloss patient-caregiver concordance states in multidimensional death preparedness and exploratorily examined adjusted differences across these states, addressing reliance on caregiver-only, retrospective designs, single-item preparedness measures, and limited outcome assessment.Methods This cohort study followed 496 family caregivers of cancer patients. In exploratory analyses, multivariate hierarchical linear modeling estimated adjusted differences in four bereavement outcomes-physical and mental HRQOL, depressive symptoms, and prolonged grief (PG) symptoms-across preloss dyadic death-preparedness concordance states (unprepared, cognitive [prognostic understanding], emotional [acceptance of approaching death], and sufficient [both] concordant vs. discordant).Results Over two years, mental HRQOL improved, physical HRQOL remained stable, and depressive and PG symptoms declined. Descriptively, sufficient-concordant dyads showed the most favorable mental HRQOL and lowest depressive and PG symptoms, but no statistically significant adjusted differences from discordant dyads. Exploratory adjusted estimates suggested poorer mental HRQOL and higher depressive symptoms in emotional-concordant dyads (n = 4) and better physical HRQOL in unprepared-concordant dyads (n = 3). Caregivers in cognitive-concordant dyads had higher estimated PG symptoms than those in discordant dyads (β = 1.283, 95% CI [- 0.026, 2.592]; p = 0.055).Conclusions Bereavement outcomes showed differing patterns across dyadic death-preparedness concordance states. Adjusted estimates for the sparsely represented unprepared- and emotional-concordant groups are exploratory and hypothesis-generating. These findings highlight the value of examining cognitive and emotional dimensions of dyadic death preparedness jointly while underscoring the need for replication in larger samples.