Guilt after the loss of a husband to cancer: Is there a relation with the health care provided?

Figures & data

Table I.  Characteristics of 379 widows who lost a husband in prostate cancer or bladder cancer during the period 1995–1996.

Characteristics	No. of Widows (%)
Age of the widow
45–64	109 (29)
65–74	212 (56)
75	51 (13)
Not stated	7 (2)
Years of marriage with the deceased
< = 10	12 (3)
11–30	61 (16)
> 30	296 (78)
Not stated	10 (3)
Number of children together with the deceased
0	56 (15)
1	68 (18)
2	150 (39)
≥ 3	105 (28)
Widow's education
Elementary school	224 (59)
College	92 (24)
University	51 (14)
Not stated	12 (3)
Widow's source of income
Employed	180 (47)
Retired	145 (38)
Unemployed	7 (2)
On sick leave	40 (11)
Not stated	7 (2)
Widow's religious confession
Swedish church	326 (86)
Other religion	21 (5)
Not religious	25 (7)
Not stated	7 (2)

Table II.  Unadjusted and adjusted relative risks for feeling of guilt among bereaved widows in relation to demographic characteristics at time of the deceased diagnosis.

		Relative Risk
Variable	Feeling of Guilt No./ Total no. (%)	Unadjusted (95% CI)	Adjusted* (95% CI)
Age of the widow
45–64	39/107 (36.0)	1.9 (1.0–3.6)	1.9 (1.0–3.6)
65–74	56/201 (27.9)	1.5 (0.8–2.7)	1.5 (0.8–3.0)
≥ 75	9/47 (19.1)		1.0
Years of marriage with the deceased
≤ 10	4/11 (36.4)	(0.6–2.8)	1.0 (0.5–2.3)
11–30	19/60 (31.7)	1.1 (0.7–1.7)	0.8 (0.5–1.3)
> 30	80/279 (28.7)	1.0	1.0
Number of children together with the deceased
0	15/52 (28.9)	0.8 (0.5–1.4)	0.8 (0.5–1.4)
1	13/64 (20.3)	0.6 (0.3–1.0)	0.6 (0.4–1.1)
2	44/146 (30.1)	0.9 (0.6–1.3)	1.0 (0.7–1.5)
≥ 3	33/95 (34.7)	1.0	1.0
Widow's education
University	17/50 (34.0)	1.2 (0.8–1.9)	1.0 (0.7–1.6)
College	28/91 (30.8)	1.1 (0.8–1.6)	1.0 (0.7–1.5)
Elementary school	57/208 (27.4)	1.0	1.0
Widow's source of income
Unemployed/ On sick leave	11/44 (25.0)	0.8 (0.5–1.4)	0.9 (0.5–1.6)
Retired	40/136 (29.4)	0.9 (0.7–1.3)	1.5 (0.9–2.4)
Employed	54/174 (31.0)	1.0	1.0
Widow's religious confession
Not religious	9/22 (40.9)	1.4 (0.8–2.4)	1.2 (0.7–2.2)
Other religion	4/21 (19.1)	0.6 (0.3–1.6)	0.7 (0.3–1.7)
Swedish church	92/311 (29.6)	1.0	1.0

*Adjusted for age of the widow (as a continuous variable), widow's education when applicable, and widow's self-reported depression (yes/no).

Table III.  Unadjusted and adjusted relative risks for feeling of guilt among bereaved widows in relation to the widow's access to support and information during the husbands last 3 months of life.

		Relative Risk
Variable	Feeling of Guilt No./Total no. (%)	Unadjusted (95% CI)	Adjusted* (95% CI)
Possibility to participate in the care
No, not at all	8/33 (24.2)	0.8 (0.4–1.4)	0.9 (0.5–1.6)
Partly	37/130 (28.5)	0.9 (0.6–1.3)	1.0 (0.7–1.4)
Yes, a lot	60/188 (31.9)	1.0	1.0
Possibility to discuss the husband's care with doctors
Not needed	8/30 (26.7)	0.9 (0.5–1.7)	0.9 (0.5–1.8)
No, not at all or to a certain extent	47/157 (29.9)	1.0 (0.7–1.4)	1.0 (0.7–1.4)
Yes, for most part or entirely	47/162 (29.9)	1.0	1.0
Support from the family
Not needed	12/49 (24.5)	0.8 (0.5–1.4)	0.8 (0.4–1.5)
No, not at all or to a certain extent	40/130 (30.8)	1.0 (0.7–1.4)	0.9 (0.6–1.2)
Yes, for most part or entirely	50/161 (31.1)	1.0	1.0
Help with the husbands pain and symptom relief
Not needed	3/10 (30.0)	1.0 (0.4–2.7)	0.8 (0.2–2.5)
No, not at all or to a certain extent	28/93 (30.1)	1.0 (0.7–1.5)	0.9 (0.6–1.3)
Yes, for most part or entirely	70/237 (29.5)	1.0	1.0
Access to psychological support
Not needed	10/43 (23.3)	0.8 (0.4–1.5)	0.8 (0.4–1.6)
No, not at all or to a certain extent	72/221 (32.6)	1.1 (0.8–1.7)	1.1 (0.7–1.6)
Yes, for most part or entirely	22/76 (28.9)	1.0	1.0
Trust in the doctors
Never	7/15 (46.7)	1.8 (1.0–3.4)	1.6 (0.9–2.9)
Seldom to often	50/153 (32.7)	1.3 (0.9–1.8)	1.1 (0.8–1.6)
Always	42/166 (25.3)	1.0	1.0
Honest information from care givers
Never	20/53 (37.7)	1.6 (1.0–2.5)	1.5 (1.0–2.4)
Seldom to often	48/145 (33.1)	1.4 (1.0–2.1)	1.2 (0.8–1.8)
Always	30/127 (23.6)	1.0	1.0
Opportunity to express my opinions
Never	18/54 (33.3)	1.3 (0.8–2.1)	1.2 (0.7–2.0)
Seldom to often	54/173 (31.2)	1.2 (0.8–1.8)	1.2 (0.8–1.8)
Always	25/96 (26.0)	1.0	1.0
Acknowledgement of worries by care givers in a proper way
Never	14/41 (34.1)	1.4 (0.8–2.4)	1.2 (0.7–2.0)
Seldom to often	52/163 (31.9)	1.3 (0.9–2.0)	1.2 (0.8–1.8)
Always	28/117 (23.9)	1.0	1.0

*Adjusted for age of the widow (as a continuous variable), widow's education (categorized as in Table II), and widow's self-reported depression (yes/no).

Table IV.  Unadjusted and adjusted relative risks for feeling of guilt among bereaved widows in relation to the deceased access to support during the last 3 months of life.

		Relative Risk
Variable	Feeling of Guilt No./Total no.(%)	Unadjusted (95% CI)	Adjusted* (95% CI)
Unrelieved symptoms for 4 or more hours due to non-access to support
No, never	64/241 (26.6)	1.0	1.0
Yes, occasionally	26/74 (35.1)	1.3 (0.9–1.9)	1.2 (0.8–1.7)
Yes, more than occasionally	11/25 (44.0)	1.7 (1.0–2.7)	1.3 (0.8–2.2)
Unrelieved symptoms for 4 or more hours despite access to support
No, never	51/194 (26.3)	1.0	1.0
Yes, occasionally	33/101 (32.7)	1.2 (0.9–1.8)	1.3 (0.9–1.8)
Yes, more than occasionally	14/39 (35.9)	1.4 (0.8–2.2)	1.1 (0.6–1.8)
Received medication for depression or anxiety
No	57/196 (29.1)	0.9 (0.7–1.3)	1.1 (0.8–1.5)
Yes	43/140 (30.7)	1.0	1.0
Access to symptom and pain relief
Not needed	3/6 (50.0)	1.7 (0.7–3.7)	1.3 (0.5–4.0)
No, not at all or to a certain extent	6/25 (24.0)	0.8 (0.4–1.6)	0.9 (0.4–1.8)
Yes, for most part or entirely	95/314 (30.3)	1.0	1.0
Information on disease progress
Not needed	7/28 (25.0)	0.9 (0.4–1.7)	0.7 (0.3–1.6)
No, not at all or to a certain extent	41/125 (32.8)	1.1 (0.8–1.6)	1.0 (0.7–1.5)
Yes, for most part or entirely	48/168 (28.6)	1.0	1.0
Access to dietary advice
Not needed	13/60 (21.7)	0.8 (0.4–1.4)	0.7 (0.4–1.4)
No, not at all or to a certain extent	65/192 (33.9)	1.2 (0.8–1.8)	1.2 (0.8–1.7)
Yes, for most part or entirely	20/71 (28.2)	1.0	1.0
Psychological support
Not needed	10/49 (20.4)	0.6 (0.3–1.2)	0.7 (0.3–1.4)
No, not at all or to a certain extent	60/188 (31.9)	1.0 (0.7–1.5)	1.0 (0.7–1.4)
Yes, for most part or entirely	27/85 (31.8)	1.0	1.0
Enough pain relief
Not at all true	8/14 (57.1)	2.3 (1.4–3.9)	1.7 (1.1–2.8)
Les than entirely true	47/144 (32.6)	1.3 (0.9–1.8)	1.1 (0.8–1.5)
Entirely true	47/189 (24.9)	1.0	1.0
Enough support by care givers
Not at all true	10/19 (52.6)	2.1 (1.2–3.5)	1.6 (1.0–2.5)
Les than entirely true	51/174 (29.3)	1.2 (0.8–1.7)	1.0 (0.7–1.3)
Entirely true	35/138 (25.4)	1.0	1.0
Enough information from the care givers
Not at all true	17/42 (40.5)	1.7 (1.0–2.9)	1.6 (1.0–2.6)
Les than entirely true	50/177 (28.2)	1.2 (0.8–1.8)	1.1 (0.7–1.7)
Entirely true	22/93 (23.7)	1.0	1.0
Treated in a respectful way
Not at all true	7/12 (58.3)	2.2 (1.3–3.7)	1.6 (0.8–2.9)
Les than entirely true	39/135 (25.5)	1.1 (0.8–1.5)	0.9 (0.7–1.3)
Entirely true	51/189 (27.0)	1.0	1.0
Satisfied with the care given
Not at all true	2/11 (18.2)	0.7 (0.2–2.4)	0.6 (0.2–2.0)
Les than entirely true	31/79 (39.2)	1.5 (1.0–2.1)	1.3 (0.9–1.8)
Entirely true	64/238 (26.9)	1.0	1.0

*Adjusted for age of the widow (as a continuous variable), widow's education (categorized as in Table II), and widow's self-reported depression (yes/no).

Table V.  Unadjusted and adjusted relative risks for feeling of guilt among bereaved widows in relation to the health care provided during the husbands last 3 months of life.

		Relative Risk
Variable	Feeling of Guilt No./ Total no.(%)	Unadjusted (95% CI)	Adjusted* (95% CI)
Health care reacted quickly in response to our needs
Not at all true	9/21 (42.9)	1.6 (0.9–2.8)	1.6 (0.9–2.7)
Les than entirely true	53/176 (30.1)	1.1 (0.8–1.6)	1.0 (0.7–1.4)
Entirely true	37/138 (26.8)	1.0	1.0
Good access to doctors
Not at all true	13/27 (48.1)	1.9 (1.2–3.0)	1.6 (1.0–2.7)
Les than entirely true	47/160 (29.4)	1.1 (0.8–1.6)	1.0 (0.7–1.4)
Entirely true	39/152 (25.7)	1.0	1.0
Good access to nurses
Not at all true	5/13 (38.5)	1.4 (0.7–2.9)	1.5 (0.7–3.1)
Les than entirely true	40/140 (28.6)	1.0 (0.7–1.5)	0.9 (0.7–1.3)
Entirely true	50/182 (27.5)	1.0	1.0
Access to care at hospital if needed
Not at all true	9/19 (47.4)	1.7 (1.0–2.8)	1.3 (0.8–2.2)
Les than entirely true	20/74 (27.0)	1.0 (0.6–1.5)	0.9 (0.6–1.4)
Entirely true	70/248 (28.2)	1.0	1.0
Sure to get immediate help at the hospital if needed
Not at all true	11/22 (50.0)	1.8 (1.1–3.0)	1.5 (0.9–2.4)
Les than entirely true	35/121 (28.9)	1.1 (0.7–1.5)	1.0 (0.7–1.4)
Entirely true	52/191 (27.2)	1.0	1.0
Sure to get immediate help at the home if needed
Not at all true	22/56 (39.3)	1.4 (0.9–2.1)	1.3 (0.8–2.0)
Les than entirely true	38/140 (27.1)	1.0 (0.7–1.4)	0.9 (0.6–1.3)
Entirely true	35/124 (28.2)	1.0	1.0
Opportunity to discuss the disease with the care givers
Not at all true	85/269 (31.6)	2.1 (0.8–5.4)	2.0 (0.8–4.9)
Les than entirely true	13/41 (31.7)	2.1 (0.8–5.9)	1.8 (0.7–5.0)
Entirely true	4/27 (14.8)	1.0	1.0
Supportive talks offered by the care givers
Not at all true	85/270 (31.5)	0.9 (0.5–1.7)	1.0 (0.6–1.6)
Les than entirely true	6/38 (15.8)	0.5 (0.2–1.2)	0.5 (0.2–1.2)
Entirely true	9/27 (33.3)	1.0	1.0
Feeling that sometimes things went wrong in the care
Not at all true	56/199 (28.1)	1.0	1.0
Les than entirely true	30/103 (29.1)	1.0 (0.7–1.5)	1.0 (0.7–1.4)
Entirely true	11/21 (52.4)	1.9 (1.2–3.0)	1.5 (0.9–2.6)
Exposure to less satisfactory care or treatment
Not at all true	63/244 (25.8)	1.0	1.0
Les than entirely true	24/73 (32.9)	1.3 (0.9–1.9)	1.1 (0.7–1.6)
Entirely true	9/15 (60.0)	2.3 (1.5–3.7)	1.9 (1.2–3.1)

*Adjusted for age of the widow (as a continuous variable), widow's education (categorized as in Table II), and widow's self-reported depression (yes/no).