{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T15:21:07Z","timestamp":1791213667252,"version":"4.1.0"},"reference-count":93,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2026,1,20]],"date-time":"2026-01-20T00:00:00Z","timestamp":1768867200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Palliat Med"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Informal caregivers are vital in providing end-of-life care to their loved ones. However, there is a lack of systematic understanding of their coping strategies during the caregiving process.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim:<\/jats:title>\n                    <jats:p>To synthesize qualitative data about coping strategies of informal caregivers of people with non-dementia terminal illnesses with a prognosis of less than 12\u2009months.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>Systematic review and thematic synthesis of qualitative studies and qualitative components of mixed-methods studies, appraised using the Mixed Methods Appraisal Tool.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Data sources:<\/jats:title>\n                    <jats:p>Seven electronic databases (Airiti Library, CINAHL Plus, PsycINFO, PubMed, Scopus, Wanfang, and Web of Science) were searched from inception to August 2025.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Analysis of 44 studies involving 691 caregivers generated five themes revealing that caregivers employ both adaptive and avoidance strategies. Caregivers managed distress by avoiding acknowledgment of death and decline, mobilizing professional and social support networks, cognitively reframing their situations through positive reappraisal and acceptance, deriving meaning through fulfilling relational obligations and spiritual beliefs, and maintaining normalcy by continuing personal routines and shared activities with care recipients. Coping emerged as a complex, fluid process wherein caregivers shifted between strategies to manage dual stressors: caregiving responsibilities and pre-death grief encompassing losses of identity, time, and anticipation of death.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Caregivers dynamically navigate simultaneous stressors of caregiving demands and pre-death grief through multiple strategies. Palliative care services should integrate routine caregiver grief assessment throughout the illness trajectory and implement early interventions addressing both caregiving stress and pre-death grief, rather than only addressing caregiving burden and bereavement.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/02692163251411767","type":"journal-article","created":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T06:43:32Z","timestamp":1768977812000},"page":"344-357","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Coping of informal caregivers for people with terminal illnesses: A systematic review and metasynthesis"],"prefix":"10.1177","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8019-982X","authenticated-orcid":false,"given":"Ming Shin","family":"Leung","sequence":"first","affiliation":[{"name":"Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0330-0143","authenticated-orcid":false,"given":"Yong Hao","family":"Ng","sequence":"additional","affiliation":[{"name":"Department of Social Work, Faculty of Arts and Social Sciences, National University of Singapore, Singapore"},{"name":"University of Western Australia and Perron Institute for Neurological and Translational Science, Nedlands, WA, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,1,20]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1136\/esmoopen-2020-000862"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.38125\/OAJBS.000191"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.5430\/cns.v6n3p57"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1177\/02692163211029514"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1080\/09699260.2019.1611988"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.3390\/cancers14174146"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cpr.2016.01.002"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1080\/07481187.2024.2329755"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.1177\/10497323251382832"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1017\/S1478951519000622"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1177\/02692163211042999"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2017.0134"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.29"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.1031205"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2407-14-541"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.4103\/IJPC.IJPC_154_19"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1177\/0269216318793286"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.4103\/2347-5625.308678"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1089\/jpm.2019.0026"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1002\/pon.4416"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1177\/00302228221142675"},{"key":"e_1_3_3_23_2","volume-title":"Stress, appraisal, and coping","author":"Lazarus RS","year":"1984","unstructured":"Lazarus RS, Folkman S. Stress, appraisal, and coping. Springer, 1984."},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.1177\/1049909109350176"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1177\/1049909119836932"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1177\/02692163221074540"},{"key":"e_1_3_3_27_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjspcare-2020-002778"},{"key":"e_1_3_3_28_2","first-page":"583","article-title":"Acute organ failure and risk of admission to intensive medical care in cancer patients: a single center prospective cohort study","volume":"33","author":"Coelho S","year":"2021","unstructured":"Coelho S, Ribeiro T, Pereira I, et al. Acute organ failure and risk of admission to intensive medical care in cancer patients: a single center prospective cohort study. Rev Bras Ter Intensiva 2021; 33: 583\u2013591.","journal-title":"Rev Bras Ter Intensiva"},{"key":"e_1_3_3_29_2","doi-asserted-by":"publisher","DOI":"10.1177\/08919887211060016"},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12877-016-0280-8"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1080\/09638280802051721"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1177\/2055102918810659"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.1111\/jan.15942"},{"key":"e_1_3_3_34_2","doi-asserted-by":"publisher","DOI":"10.1590\/2237-6089-2017-0065"},{"key":"e_1_3_3_35_2","doi-asserted-by":"publisher","DOI":"10.1037\/men0000049"},{"key":"e_1_3_3_36_2","doi-asserted-by":"publisher","DOI":"10.1177\/0269216316673548"},{"key":"e_1_3_3_37_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2288-8-45"},{"key":"e_1_3_3_38_2","volume-title":"Mixed Methods Appraisal Tool (MMAT)","author":"Hong QN","year":"2018","unstructured":"Hong QN, Pluye P, F\u00e0bregues S, et al. (eds). Mixed Methods Appraisal Tool (MMAT). Version 2018 ed. Department of Family Medicine, McGill University, 2018."},{"key":"e_1_3_3_39_2","doi-asserted-by":"publisher","DOI":"10.1177\/0825859719827591"},{"key":"e_1_3_3_40_2","doi-asserted-by":"publisher","DOI":"10.4103\/IJPC.IJPC_63_18"},{"key":"e_1_3_3_41_2","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.19.00013"},{"key":"e_1_3_3_42_2","doi-asserted-by":"publisher","DOI":"10.15253\/2175-6783.2013000300002"},{"key":"e_1_3_3_43_2","first-page":"109","article-title":"How to face death for the significant caregivers of dead ill cancer patients?","volume":"7","author":"Chang SC","year":"2002","unstructured":"Chang SC, Lin SL. How to face death for the significant caregivers of dead ill cancer patients? Taiwan J Hospice Palliat Care 2002; 7: 109\u2013127.","journal-title":"Taiwan J Hospice Palliat Care"},{"key":"e_1_3_3_44_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2019.06.022"},{"key":"e_1_3_3_45_2","first-page":"1","article-title":"Pre-loss grief experiences of adults when someone important to them is at end-of-life: a qualitative systematic review","volume":"47","author":"Fee A","year":"2021","unstructured":"Fee A, Hanna J, Hasson F. Pre-loss grief experiences of adults when someone important to them is at end-of-life: a qualitative systematic review. Death Stud 2021; 47: 1\u201315.","journal-title":"Death Stud"},{"key":"e_1_3_3_46_2","doi-asserted-by":"publisher","DOI":"10.1177\/10499091221096351"},{"key":"e_1_3_3_47_2","first-page":"26","article-title":"Caregivers of cancer patients in Hospice : a qualitative study","volume":"37","author":"Chen Y","year":"2020","unstructured":"Chen Y, Du R, Lu H, et al. Caregivers of cancer patients in Hospice : a qualitative study. Mil Nurs Mil Nurs 2020; 37: 26\u201329.","journal-title":"Mil Nurs Mil Nurs"},{"key":"e_1_3_3_48_2","doi-asserted-by":"publisher","DOI":"10.3390\/bs7020033"},{"key":"e_1_3_3_49_2","article-title":"Dying of mesothelioma: a qualitative exploration of caregiver experiences","volume":"31","author":"Lee JT","year":"2022","unstructured":"Lee JT, Mittal DL, Warby A, et al. Dying of mesothelioma: a qualitative exploration of caregiver experiences. Eur J Cancer Care 2022; 31: e13627.","journal-title":"Eur J Cancer Care"},{"key":"e_1_3_3_50_2","doi-asserted-by":"publisher","DOI":"10.1177\/02692163241280016"},{"key":"e_1_3_3_51_2","doi-asserted-by":"publisher","DOI":"10.1186\/1472-684X-8-6"},{"key":"e_1_3_3_52_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2702.2007.01943.x"},{"key":"e_1_3_3_53_2","doi-asserted-by":"publisher","DOI":"10.1016\/S1364-9825(97)80072-7"},{"key":"e_1_3_3_54_2","doi-asserted-by":"publisher","DOI":"10.1177\/0269216311416036"},{"key":"e_1_3_3_55_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12904-022-01093-1"},{"key":"e_1_3_3_56_2","first-page":"1179","article-title":"Coping strategies of family caregivers in hospice homecare","volume":"19","author":"Hull MM","year":"1992","unstructured":"Hull MM. Coping strategies of family caregivers in hospice homecare. Oncol Nurs Forum 1992; 19: 1179\u20131187.","journal-title":"Oncol Nurs Forum"},{"key":"e_1_3_3_57_2","doi-asserted-by":"publisher","DOI":"10.1002\/pon.774"},{"key":"e_1_3_3_58_2","doi-asserted-by":"publisher","DOI":"10.1097\/JNN.0000000000000348"},{"key":"e_1_3_3_59_2","doi-asserted-by":"publisher","DOI":"10.7748\/ns.11.30.39.s43"},{"key":"e_1_3_3_60_2","doi-asserted-by":"publisher","DOI":"10.1177\/082585970301900206"},{"key":"e_1_3_3_61_2","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afw047"},{"key":"e_1_3_3_62_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejon.2025.102880"},{"key":"e_1_3_3_63_2","doi-asserted-by":"publisher","DOI":"10.1017\/S1478951518001025"},{"key":"e_1_3_3_64_2","doi-asserted-by":"publisher","DOI":"10.1080\/15524256.2011.623460"},{"key":"e_1_3_3_65_2","doi-asserted-by":"publisher","DOI":"10.1097\/NJH.0000000000000191"},{"key":"e_1_3_3_66_2","doi-asserted-by":"publisher","DOI":"10.1097\/NJH.0000000000000463"},{"key":"e_1_3_3_67_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2011.04.017"},{"key":"e_1_3_3_68_2","doi-asserted-by":"publisher","DOI":"10.1097\/01.NCC.0000305686.36637.b5"},{"key":"e_1_3_3_69_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.hkjot.2013.06.002"},{"key":"e_1_3_3_70_2","doi-asserted-by":"publisher","DOI":"10.1177\/00302228221108288"},{"key":"e_1_3_3_71_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpainsymman.2018.02.018"},{"key":"e_1_3_3_72_2","first-page":"277","article-title":"\u201cThe communication I had with him back then is still stuck in my mind.\u201d Bereaved families of cancer patients\u2019 experiences for end-of-life communication","volume":"31","author":"Jeon H","year":"2023","unstructured":"Jeon H, Kim S, Lee I. \u201cThe communication I had with him back then is still stuck in my mind.\u201d Bereaved families of cancer patients\u2019 experiences for end-of-life communication. Support Care Cancer 2023; 31: 277.","journal-title":"Support Care Cancer"},{"key":"e_1_3_3_73_2","doi-asserted-by":"publisher","DOI":"10.1017\/S1478951514000017"},{"key":"e_1_3_3_74_2","doi-asserted-by":"publisher","DOI":"10.1177\/02692163251316677"},{"key":"e_1_3_3_75_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0328993"},{"key":"e_1_3_3_76_2","doi-asserted-by":"publisher","DOI":"10.1017\/S1478951523001670"},{"key":"e_1_3_3_77_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-011-1252-3"},{"key":"e_1_3_3_78_2","doi-asserted-by":"publisher","DOI":"10.1177\/104990919901600207"},{"key":"e_1_3_3_79_2","first-page":"12","article-title":"The positive experience of family caregivers for terminal cancer patients receiving home-based hospice care: a qualitative study","volume":"36","author":"Chen L","year":"2019","unstructured":"Chen L, Yang Z, Li R, et al. The positive experience of family caregivers for terminal cancer patients receiving home-based hospice care: a qualitative study. Nurs J Chin People\u2019s Liber Army 2019; 36: 12\u201324.","journal-title":"Nurs J Chin People\u2019s Liber Army"},{"key":"e_1_3_3_80_2","doi-asserted-by":"publisher","DOI":"10.1080\/07481187.2022.2051095"},{"key":"e_1_3_3_81_2","doi-asserted-by":"publisher","DOI":"10.4061\/2011\/105985"},{"key":"e_1_3_3_82_2","doi-asserted-by":"publisher","DOI":"10.12968\/ijpn.2001.7.5.15893"},{"key":"e_1_3_3_83_2","article-title":"Health workers coping with having a relative in palliative care for cancer","volume":"37","author":"Schiavon AB","year":"2016","unstructured":"Schiavon AB, Muniz RM, Azevedo NA, et al. Health workers coping with having a relative in palliative care for cancer. Revista Ga\u00facha de Enfermagem 2016; 37: e55080.","journal-title":"Revista Ga\u00facha de Enfermagem"},{"key":"e_1_3_3_84_2","doi-asserted-by":"publisher","DOI":"10.9788\/TP2017.3-17En"},{"key":"e_1_3_3_85_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1471-6712.2003.00220.x"},{"key":"e_1_3_3_86_2","doi-asserted-by":"publisher","DOI":"10.1177\/1049732308320110"},{"key":"e_1_3_3_87_2","doi-asserted-by":"publisher","DOI":"10.1111\/jocn.16954"},{"key":"e_1_3_3_88_2","doi-asserted-by":"publisher","DOI":"10.2147\/PRBM.S164946"},{"key":"e_1_3_3_89_2","first-page":"837","volume":"399","author":"Sallnow L","year":"2022","unstructured":"Sallnow L, Smith R, Ahmedzai SH, et al. Report of the Lancet Commission on the value of death: Bringing death back into life. Lancet 2022; 399: 837\u2013884.","journal-title":"Report of the Lancet Commission on the value of death: Bringing death back into life"},{"key":"e_1_3_3_90_2","doi-asserted-by":"publisher","DOI":"10.1024\/1662-9647\/a000340"},{"key":"e_1_3_3_91_2","doi-asserted-by":"publisher","DOI":"10.1111\/hsc.13126"},{"key":"e_1_3_3_92_2","doi-asserted-by":"publisher","DOI":"10.1037\/1089-2680.1.2.115"},{"key":"e_1_3_3_93_2","doi-asserted-by":"publisher","DOI":"10.1080\/07481187.2024.2433109"},{"key":"e_1_3_3_94_2","doi-asserted-by":"publisher","DOI":"10.1080\/13607863.2022.2032599"}],"container-title":["Palliative Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/02692163251411767","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/02692163251411767","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/02692163251411767","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T18:38:22Z","timestamp":1777660702000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/02692163251411767"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,20]]},"references-count":93,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2026,3]]}},"alternative-id":["10.1177\/02692163251411767"],"URL":"https:\/\/doi.org\/10.1177\/02692163251411767","relation":{},"ISSN":["0269-2163","1477-030X"],"issn-type":[{"value":"0269-2163","type":"print"},{"value":"1477-030X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,20]]}}}