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Sudden vs Anticipated Death and Grief — SCE Palliative Medicine MCQ

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ModerateBereavementSudden vs Anticipated Death and GriefSCE Palliative Medicine

A 72-year-old woman is reviewed after her husband, who had advanced COPD, died suddenly from an acute myocardial infarction. Although she understood that his COPD was life-limiting, she experienced the timing of his death as wholly unexpected. Which statement best reflects current evidence about the effect of unexpectedness on bereavement outcomes?

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Correct answer: B — Perceived unexpectedness is associated with increased risk of prolonged grief symptoms, but does not by itself determine the outcome.

Explanation lettering: D = shown as B · E = shown as C · C = shown as D · B = shown as E

D is correct. Unexpected death is a recognised risk factor for prolonged grief symptoms, although the pooled association is modest and most unexpectedly bereaved people do not develop prolonged grief disorder. Subjective unexpectedness remains relevant even when other loss-related variables are considered. Violence is a separate risk factor, so the association is not confined to violent deaths (A). Anticipated death may involve anticipatory grief or caregiver burden, but it is not generally associated with worse outcomes than unexpected death (B). Unexpectedness is associated with later as well as acute symptoms, making C incorrect. Relationship to the deceased is important, but adjusted evidence does not support dismissing unexpectedness as irrelevant (E). Bereavement risk assessment should remain individualised.

Reference: Buur C et al. Risk factors for prolonged grief symptoms: A systematic review and meta-analysis. Clinical Psychology Review. 2024;107:102375. https://pubmed.ncbi.nlm.nih.gov/38181586/