Layers of Loss: A Scoping Review and Taxonomy of HD Caregivers' Spiritual Suffering, Grief/Loss and Coping Strategies

Context. Huntington's disease (HD), an incurable, multi-generational, autosomal dominant disorder, creating unique chal-lenges and a myriad of spiritually-related stressors in those affected and their familial caregivers. Spiritual suffering, experiences of grief/loss, and coping strategies have not been systematically studied in HD caregivers.Objectives. To comprehensively define spiritual suffering, grief/loss, and coping strategies used by HD caregivers. Methods. A PRISMA-ScR scoping literature review was conducted. Data from included research articles were organized the-matically using induction and open coding. A grounded, deductive approach was used to delineate a demarcated taxonomy of themes, which encompasses all three over-arching domains. Four reviewers, employing a modified Delphi approach, ascer-tained which themes were demonstrated by research participants in each study.Results. 36 of 583 articles met the review criteria; none were published in the palliative care literature. Investigations primar-ily focused on intrapersonal (self-image) distress and existential angst; only rarely looking deeper into divine/transpersonal suf-fering, disrupted religious relationships, or meaning distress. HD caregivers experience profound grief/loss, expressed as disenfranchised grief that is associated with the ambiguous loss of their loved one, loss of family structure, social connectedness, and personal losses. Half of the studies reported maladaptive HD caregiver coping strategies-characterized by dysfunctional escape schemes; in contrast, transcendent/creative strategies were often unexplored.Conclusion. HD caregivers experience prolonged grief and other forms of spiritual suffering as they progressively lose their loved ones and disruption to their own lives. With an improved assessment tool, teams with spiritual and palliative care experts will better be able to support HD family caregivers. J Pain Symptom Manage 2023;65:e29-e50. (c) 2022 American Academy of Hos-pice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

Automated summary

This article examines the spiritual suffering, grief/loss, and coping strategies of Huntington's disease caregivers. The findings indicate that HD caregivers experience profound grief and other forms of spiritual suffering, emphasizing the need for improved assessment tools and support from spiritual and palliative care experts.