Introduction
With the rising incidence of new cancer cases in recent years, the number of individuals playing cancer patient caregiving roles is significantly increasing. One phenomenon experienced by caregivers of patients with cancer is anticipatory grief, which is a state of grief before the patient dies. This period is associated with initiating mourning and experiencing a wide range of grief responses. Anticipatory grief can lead to confusion and feelings of loss, disruption of attachment, recurrent thoughts related to losing the loved one, and the emergence of complicated grief after death. These issues can impair caregivers’ ability to identify patients’ care needs, degrade the quality of palliative care, adversely affect caregivers’ well-being, and predispose them to negative emotions such as anger, fear, guilt, and self-blame. Hence, exploring this phenomenon is crucial for understanding and designing effective interventions. In palliative care programs, assessing and treating anticipatory grief should be prioritized. For researchers, identifying anticipatory grief presents an opportunity to develop preventive interventions that minimize the adverse effects of sorrow. This not only facilitates successful therapeutic outcomes but also prevents subsequent risks and complications that may arise during the critical illness process. Based on these evaluations, effective and targeted programs should be developed for preventing psychological harm to them. Moreover, supportive interventions can be implemented to alleviate grief and facilitate family transition through this difficult process. These efforts can improve caregivers’ quality of life and help them manage negative emotions. The present study aimed to assess the prevalence and characteristics of anticipatory grief in caregivers of hospitalized patients with cancer.

Methods
This descriptive-cross-sectional study was conducted in 2024 on 160 caregivers of patients with cancer admitted to the oncology ward of Shahid Sadoughi Hospital in Yazd, Iran. They were selected via convenience sampling based on the inclusion and exclusion criteria. Sampling was done from May 2024 to April 2025. The inclusion criteria were informed consent, literacy, caring for a patient with a diagnosed cancer, and being the patient’s primary caregiver (based on the self-report of caregivers and patients), no life-threatening illness in the caregiver, not caring for multiple patients (for patients other than the one with cancer hospitalized in the ward), the onset of the cancer in patient within the past month, and no confirmed or treated mental disorder based on the caregiver’s self-report. 
The data were collected using a demographic form and the 13-item Anticipatory Grief Scale (AGS) developed by Holm et al. (2019). In the present study, content validity (CVR=0.85, CVI=0.90) and reliability (Cronbach’s alpha=0.87) of the Persian AGS were confirmed. The collected data were entered into SPSS  software, version 21 and analyzed using descriptive statistics (frequency, mean, and standard deviation) and inferential statistics (t-test and ANOVA).

Results
The mean age of the caregivers was 39.96±10.54 years. Moreover, 59 caregivers (36.9%) had lower than high school education, 62 (38.8%) were the patient’s child, and 114 (71.3%) were providing care for less than one year. The mean AGS score was 44.82±11.52. The independent-samples t-test results indicated that the mean AGS score among caregivers differed significantly by gender (P=0.007). The mean score was 45.93±10.85 for women and 39.41±13.33 for men. The one-way ANOVA results showed no significant difference by age (P=0.625). The highest mean score (46.50±13.34) was in the 40-49 age group. Furthermore, there was no significant difference based on the caregiver’s relationship with the patient (P=0.119). The highest score was observed in patients’ spouses (49.44±11.72). Moreover, the mean score did not differ significantly by economic status (P=0.415). Caregivers with poor economic status had a higher score (46.32±12.79). Regarding education level, the comparison did not reveal a significant difference, either (P=0.576). The mean score showed a significant difference based on the duration of caregiving (P=0.006). The caregivers who were providing care to their patients with cancer for more than 3 years had higher scores (54.55±7.58). Based on the pairwise comparison of means, this significant difference was between <1 year and >3 year groups (P=0.002) and between >1 year and >3 years groups (P=0.014).

Conclusion
The findings indicated that caregivers of patients with cancer in Iran experience a relatively high level of anticipatory grief. Thus, it is essential for healthcare providers to pay attention to these caregivers in parallel with patient care. The factors, including female gender, middle age, being the spouse of the patient, caring for over 4 years, and a poor economic status, can increase the intensity of anticipatory grief. To prevent the adverse effects of this grief on caregivers’ mental health and quality of life, psycho-emotional support programs should be developed and implemented. Such programs can help minimize the impact of anticipatory grief on the adaptation to the illness of patients and the associated conditions.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of Shahid Sadoughi University of Medical Sciences, Yazd, Iran (Code: IR.SSU.REC.1403.026). All participants received a full explanation of the study objectives and procedures and signed a written informed consent form.

Funding
This is part of a research project (code: 17901), funded by Shahid Sadoughi University of Medical Sciences, Yazd, Iran.

Authors' contributions
The authors contributed equally to the preparation of this manuscript.

Conflict of interest
The authors declare no conflict of interest.

Acknowledgments
The authors would like to thank all caregivers of patients with cancer who participated in this study for their cooperation.


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