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Clarke JJ, Halkett GKB, McDougall E, Dhillon HM, Lobb E, Phillips JL, Hudson P, Nowak AK. What do carers of people with high-grade glioma perceive could improve their preparedness to care, and what additional support do they require? Neurooncol Pract 2024; 11:296-306. [PMID: 38737602 PMCID: PMC11085844 DOI: 10.1093/nop/npae015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2024] Open
Abstract
Background Concerning levels of stress, strain, and poorer mental health are observed in family carers of patients diagnosed with high-grade glioma (HGG). Understanding the reported unmet needs of these carers will enable future interventions to address such needs to improve their preparedness for care and well-being. In this secondary analysis, we aimed to explore: (i) what carers of people with HGG perceive could improve their preparedness to care; and (ii) what needs carers reported they required additional support with. Methods Responses from 188 carers of patients with HGG participating in a randomized controlled trial of the Care-IS intervention were analyzed to identify reported unmet needs. Of this larger sample, 92 participants answered a qualitative question seeking to identify perceived unmet needs in carer preparedness over 12 months. These responses comprised the data for the current secondary analysis. Content analysis was used to analyze the qualitative data and observe trends across participant responses. Results Five overarching themes were identified: carer needs, providing emotional and practical care, coping with uncertainty, coping with the consequences of illness progression, and processing and supporting end-of-life care. Notably, the content analysis identified differences in response numbers between groups in the Care-IS trial, particularly with the control group having more needs regarding illness progression and end-of-life care. Conclusions Future interventions aimed at improving the well-being and preparedness of carers of people with HGG should consider providing better support centered on carer needs, their changed circumstances, living with uncertainty, and care transition.
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Affiliation(s)
- James J Clarke
- Faculty of Health Sciences, Curtin School of Nursing/Curtin Health Innovation Research Institute, Curtin University, Bentley, Western Australia, Australia
- Faculty of Health Sciences, Curtin School of Population Health/Curtin EnAble Institute, Curtin University, Bentley, Western Australia, Australia
| | - Georgia K B Halkett
- Faculty of Health Sciences, Curtin School of Nursing/Curtin Health Innovation Research Institute, Curtin University, Bentley, Western Australia, Australia
| | - Emma McDougall
- Faculty of Health Sciences, Curtin School of Nursing/Curtin Health Innovation Research Institute, Curtin University, Bentley, Western Australia, Australia
| | - Haryana M Dhillon
- Faculty of Science, Psycho-Oncology Cooperative Research Group, School of Psychology, University of Sydney, Sydney, Australia
- Centre for Medical Psychology & Evidence-based Decision-making, Sydney, Australia
| | - Elizabeth Lobb
- Faculty of Health, ImPACCT, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Jane L Phillips
- Faculty of Health, ImPACCT, University of Technology Sydney, Ultimo, New South Wales, Australia
- Faculty of Health, School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Peter Hudson
- Centre for Palliative Care, St Vincent’s Hospital Melbourne, Melbourne, Victoria, Australia
- Department of Nursing, University of Melbourne, Melbourne, Victoria, Australia
- End of LIfe Research Department, Vrije University Brussels, Brussels, Belgium
| | - Anna K Nowak
- University of Western Australia, Crawley, Western Australia, Australia
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Pedraza EC, Vokinger AK, Cleves D, Michel G, Wrigley J, Baker JN, Garcia-Quintero X, McNeil MJ. Grief and Bereavement Support for Parents in Low- or Middle-Income Countries: A Systematic Review. J Pain Symptom Manage 2024; 67:e453-e471. [PMID: 38244706 DOI: 10.1016/j.jpainsymman.2024.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/09/2024] [Accepted: 01/12/2024] [Indexed: 01/22/2024]
Abstract
INTRODUCTION The death of a child may be the most traumatic event a family can experience. Bereavement care for parents is essential for their physical and mental well-being and is a psychosocial standard of care. Childhood mortality is higher in low- or middle-income countries (LMICs); however, little is known regarding bereavement support or interventions for parents in LMICs. AIM To identify programs, services, initiatives, or interventions offered to bereaved parents in LMICs in hospital settings. METHODS A systematic search was executed following the Preferred Reported Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Articles from LMICs describing interventions, programs, or resources provided to parents after the death of a child (0-18 years old) from any cause were included. Extracted data was categorized by demographics, study design, outcomes, and quality assessment using the McGill Mixed Methods Appraisal Tool (MMAT). RESULTS We retrieved 4428 papers and screened their titles and abstracts, 36 articles were selected for full-text assessment, resulting in nine articles included in the final analysis. Most interventions described support for parents whose child died during the prenatal or neonatal period. The primary interventions included psychological counseling, creating mementos (such as photographs or footprints), and bereavement workshops. Only one paper described a fully established bereavement program for parents. Eight of the papers met high-quality criteria. DISCUSSION Although bereavement care is crucial for parents whose child has died, only a few studies have documented bereavement interventions in LMICs. More research may help with bereavement program implementation and improved care for bereaved parents in LMICs.
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Affiliation(s)
- Eddy Carolina Pedraza
- Faculty of Health Sciences and Medicine (P.E.C., V.A.K., M.G.), University of Lucerne, Lucerne, Switzerland.
| | - Anna Katharina Vokinger
- Faculty of Health Sciences and Medicine (P.E.C., V.A.K., M.G.), University of Lucerne, Lucerne, Switzerland
| | - Daniela Cleves
- Department of Global Pediatric Medicine (C.D., B.J.N., G.-Q.X., M.M.J.), St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Gisela Michel
- Faculty of Health Sciences and Medicine (P.E.C., V.A.K., M.G.), University of Lucerne, Lucerne, Switzerland
| | - Jordan Wrigley
- Biomedical Library (W.J.), St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Justin N Baker
- Department of Global Pediatric Medicine (C.D., B.J.N., G.-Q.X., M.M.J.), St. Jude Children's Research Hospital, Memphis, Tennessee, USA; Division of Quality of Life and Pediatric Palliative Care (B.J.N.), Stanford Medicine Children's Health, Palo Alto, California, USA
| | - Ximena Garcia-Quintero
- Department of Global Pediatric Medicine (C.D., B.J.N., G.-Q.X., M.M.J.), St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Michael J McNeil
- Department of Global Pediatric Medicine (C.D., B.J.N., G.-Q.X., M.M.J.), St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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Boven C, Dillen L, Van Humbeeck L, Van Den Block L, Piers R, Van Den Noortgate N. Relatives' needs in terms of bereavement care throughout euthanasia processes: A qualitative study. J Clin Nurs 2024. [PMID: 38661114 DOI: 10.1111/jocn.17185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 03/27/2024] [Accepted: 04/09/2024] [Indexed: 04/26/2024]
Abstract
AIM To explore relatives' needs in terms of bereavement care during euthanasia processes, how healthcare providers respond to these needs, and the degree of commonality between relatives' and healthcare providers' reports. DESIGN A phenomenological design was employed, utilising reflexive thematic analysis to examine interviews conducted with relatives (N = 19) and healthcare providers (N = 47). RESULTS Relatives' needs throughout euthanasia processes are presented in five main themes and several subthemes, with similar findings between both sets of participants. Although relatives infrequently communicated their needs explicitly to healthcare providers, they appreciated it when staff proactively met their needs. Healthcare providers aimed to assist with the relatives' grief process by tending to their specific needs. However, aftercare was not consistently offered, but relatives did not have high expectations for professional follow-up care. CONCLUSION Our research offers important directions for healthcare professionals, empowering them to provide needs-based bereavement care during euthanasia processes. Moreover, it emphasises the importance of recognising the unique needs of relatives and proactively addressing them in the period before the loss to positively contribute to relatives' grief process. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Insights into relatives' needs in the context of euthanasia. Good practices on how healthcare providers can attend to relatives' needs before, during and after the loss IMPACT: Current literature and guidelines on needs-based bereavement care in the context of euthanasia and, more generally, assisted dying, are limited. These findings provide concrete directions for practice in supporting (nearly) bereaved relatives in the context of euthanasia, potentially mitigating adverse health outcomes. REPORTING METHOD Standards for Reporting Qualitative Research (SRQR checklist). PATIENT OR PUBLIC CONTRIBUTION Relatives of deceased cancer patients were involved in the conduct of the study.
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Affiliation(s)
- Charlotte Boven
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
| | - Let Dillen
- Department of Geriatric Medicine and Palliative Care Unit, Ghent University Hospital, Ghent, Belgium
| | | | - Lieve Van Den Block
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB), Brussels Health Campus, Brussels, Belgium
- End-of-Life Care Research Group, Ghent University, Campus Ghent University Hospital, Ghent, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Ruth Piers
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
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Riguzzi M, Thaqi Q, Lorch A, Blum D, Peng-Keller S, Naef R. Contextual determinants of guideline-based family support during end-of-life cancer care and subsequent bereavement care: A cross-sectional survey of registered nurses. Eur J Oncol Nurs 2024; 70:102555. [PMID: 38626610 DOI: 10.1016/j.ejon.2024.102555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/09/2024] [Indexed: 04/18/2024]
Abstract
PURPOSE In end-of-life cancer care, 10-20% of bereaved family members experience adverse mental health effects, including prolonged grief disorder. Despite great efforts, evidence-based recommendations to support their grieving process and well-being are often not successfully adopted into routine clinical care. This study identified facilitators and barriers using implementation science methodology. METHODS 81 registered nurses working in cancer care from four hospitals and three home care services in Switzerland assessed their current family support practices in end-of-life care and bereavement care. They then assessed organisational attributes of their institution and their own individual characteristics and skills regarding literature-based factors of potential relevance. Facilitators and barriers to guideline-based family support were determined using fractional logistic regression. RESULTS Service specialisation in palliative care, a culture that supports change, the availability of family support guidelines, billing/reimbursement of bereavement support services, and individual knowledge of family support and skill were systematically associated with higher adoption of guideline-based family support practices. Lack of privacy with families and insufficient training acted as significant barriers. CONCLUSIONS While several potentially relevant factors have emerged in the literature, certain organisational and individual determinants actually empirically predict guideline-based family support according to nurses in end-of-life cancer care, with some determinants having much stronger implications than others. This provides crucial guidance for focussing quality improvement and implementation efforts through tailored strategies, especially with scarce resources. Furthermore, adoption is lower in bereavement care than in end-of-life care, suggesting a particular need for supportive organisational cultures including specific training and billing/reimbursement options.
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Affiliation(s)
- Marco Riguzzi
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Universitaetstrasse 84, 8006 Zurich, Switzerland; Centre of Clinical Nursing Science, University Hospital Zurich, Sonnentalstrasse 25, 8600 Dübendorf, Switzerland.
| | - Qëndresa Thaqi
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Universitaetstrasse 84, 8006 Zurich, Switzerland; Centre of Clinical Nursing Science, University Hospital Zurich, Sonnentalstrasse 25, 8600 Dübendorf, Switzerland
| | - Anja Lorch
- Department of Medical Oncology and Haematology Clinic, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - David Blum
- Competence Centre for Palliative Care, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; Centre for Palliative Care, City Hospital Zurich, Tièchestrasse 99, 8037 Zurich, Switzerland
| | - Simon Peng-Keller
- Spiritual Care, Faculty of Theology, University of Zurich, Kirchgasse 9, 8001 Zurich, Switzerland
| | - Rahel Naef
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Universitaetstrasse 84, 8006 Zurich, Switzerland; Centre of Clinical Nursing Science, University Hospital Zurich, Sonnentalstrasse 25, 8600 Dübendorf, Switzerland
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5
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Peng Y, Wu H, Zhang M, Huang P. Family members' experiences of bereavement in the emergency department: A meta-synthesis of qualitative studies. DEATH STUDIES 2024:1-12. [PMID: 38459868 DOI: 10.1080/07481187.2024.2324907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/11/2024]
Abstract
The emergency department (ED) is one of the places where patient deaths frequently occur. Understanding family members' experiences of bereavement would help provide individualized bereavement care. We conducted a meta-synthesis to synthesize family members' experiences of bereavement in the ED and assess the impact of bereavement on their lives. We searched seven international electronic databases. Five studies were selected and critically appraised. Thematic analysis was employed. Five themes (with 13 subthemes) were derived: suffering sudden changes and are severely impacted, multiple feelings and needs of waiting, final farewell, personal and family difficulties after leaving the ED, and journey through grief. Family members endured agonizing waits to see and learn more about their family members' condition. Family members reported the need for effective follow-up resources. Findings revealed that it would be helpful if the EDs could provide sensitive and respectful care to family members.
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Affiliation(s)
- Yingxin Peng
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Haoming Wu
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Min Zhang
- Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Ping Huang
- Nanjing Drum Tower Hospital Clinical College of Nanjing University of Chinese Medicine, Nanjing, China
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Gillespie K, McConnell T, Roulston A, Potvin N, Ghiglieri C, Gadde I, Anderson M, Kirkwood J, Thomas D, Roche L, O 'Sullivan M, McCullagh A, Graham-Wisener L. Music therapy for supporting informal carers of adults with life-threatening illness pre- and post-bereavement; a mixed-methods systematic review. BMC Palliat Care 2024; 23:55. [PMID: 38408966 PMCID: PMC10898157 DOI: 10.1186/s12904-024-01364-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 01/19/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Music therapy interventions with informal carers of individuals with life-threatening illness at pre- and post-bereavement is an increasingly important clinical area. This systematic review is the first to synthesise and critically evaluate the international evidence associated with music therapy with adult informal carers pre- and post-bereavement. Specifically, the objectives were: i) to describe the characteristics and effectiveness of music therapy interventions which aim to improve health-related outcomes for adult informal carers of adults with life-threatening illness (pre- and post-bereavement), and ii) to describe the experience of music therapy for adult informal carers of adults with life-threatening illness (pre- and post-bereavement). METHODS Eligibility: adult informal carers of adults at end of life or bereaved; music therapy interventions for improving health-related outcomes; qualitative; mixed-method; and quantitative studies including comparators of any other intervention; published in English from 1998 onwards. Six databases were searched up to July 2022. A JBI mixed-methods systematic review approach was followed throughout, including quality appraisal, data extraction and a convergent segregated approach to synthesis and integration. RESULTS A total of 34 studies were included, published between 2003 and 2022. Most were conducted in North America (n = 13), Australia (n = 10), or Europe (n = 8). No studies were conducted in low- and middle-income countries or in the UK. The majority were qualitative (n = 17), followed by quasi-experimental (n = 8), mixed-methods (n = 7) and two RCTs. The majority focused on carers of individuals with dementia (n = 21) or advanced cancer (n = 7). Seventeen studies were purely quantitative or included a quantitative component. During meta-synthesis, findings were aligned to core outcomes for evaluating bereavement interventions in palliative care and previously identified risk factors for complicated grief. Commonly targeted outcomes in quantitative studies included quality of life and mental wellbeing, showing equivocal effectiveness of music therapy with significant and non-significant results. Twenty-two studies either purely qualitative or with a qualitative component underwent meta synthesis and suggested a diverse range of improved pre- and post-bereavement outcomes for informal carers across all core outcomes, and across all risk and protective factors, including psychological, spiritual, emotional, and social outcomes. CONCLUSIONS Qualitative studies provide moderate to strong evidence for improved health-related outcomes for adult informal carers of adults with life-threatening illness pre-bereavement. Limited studies including those bereaved negates conclusions for the bereavement phase. Comparisons and explanations for effectiveness across quantitative and qualitative studies are equivocal, with a high risk of bias and small samples in the limited number of quantitative studies, demonstrating a need for high-quality RCTs. SYSTEMATIC REVIEW PRE-REGISTRATION PROSPERO [CRD42021244859].
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Affiliation(s)
- K Gillespie
- Centre for Improving Health-Related Quality of Life, School of Psychology, Queen's University Belfast, Belfast, UK
| | - T McConnell
- School of Nursing & Midwifery, Queen's University Belfast, Belfast, UK.
- Marie Curie Northern Ireland, Belfast, UK.
| | - A Roulston
- School of Social Sciences, Education & Social Work, Queen's University Belfast, Belfast, UK
| | - N Potvin
- Mary Pappert School of Music and School of Nursing, Music Therapy, Duquesne University, Pittsburgh, USA
| | - C Ghiglieri
- Centre for Improving Health-Related Quality of Life, School of Psychology, Queen's University Belfast, Belfast, UK
| | - I Gadde
- Centre for Improving Health-Related Quality of Life, School of Psychology, Queen's University Belfast, Belfast, UK
| | - M Anderson
- Cochrane Developmental, Psychosocial and Learning Problems, Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - J Kirkwood
- Independent Researcher, Belfast, Northern Ireland, UK
| | - D Thomas
- CHROMA Therapies, Overross House, Ross Park, Ross On Wye, Herefordshire, UK
| | - L Roche
- MusiCARER Project Carer Advisory Group, Belfast, UK
- AIIHPC Voices4Care, Dublin, Ireland
| | - M O 'Sullivan
- MusiCARER Project Carer Advisory Group, Belfast, UK
- AIIHPC Voices4Care, Dublin, Ireland
| | - A McCullagh
- MusiCARER Project Carer Advisory Group, Belfast, UK
- Marie Curie Research Voices, Southampton, UK
| | - L Graham-Wisener
- Centre for Improving Health-Related Quality of Life, School of Psychology, Queen's University Belfast, Belfast, UK
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Gettis MA, Basu R, Welling S, Wall E, Dutreuil V, Calamaro CJ. Pediatric Death and Family Organ Donation: Bereavement Support Services in One Pediatric Health System. J Patient Exp 2024; 11:23743735241226987. [PMID: 38361833 PMCID: PMC10868482 DOI: 10.1177/23743735241226987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
Health care providers need to support families and provide resources when facing their child's death and potential organ donation. Aims of this retrospective chart review in a tertiary health care system were: (1) describe characteristics of pediatric organ donors compared to those who were not; (2) determine differences between services utilized by families who selected organ donation versus those who did not. From 2017 to 2023 of 288 pediatric deaths, 76 were organ donors and 212 did not donate. Organ donors' mean age at admission was 6.3 ± 5.8 years. Thirty-four (44.7%) participated in Honor Walks. Significant differences existed between organ donors and non-organ donors in patients who were diagnosed with SIDS (3.9% vs 13.2%; P = .025). This study provides additional data to help further our understanding of bereavement support services for families making difficult decisions regarding organ donation.
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Affiliation(s)
| | - Rajit Basu
- Division Critical Care Medicine, Ann & Robert Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Eryn Wall
- Children's Healthcare of Atlanta, Atlanta, GA, USA
| | - Valerie Dutreuil
- Emory University Pediatric Biostatistics Core, Emory School of Medicine, Atlanta, GA, USA
| | - Christina J Calamaro
- Children's Healthcare of Atlanta, Atlanta, GA, USA
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
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Thaqi Q, Riguzzi M, Blum D, Peng-Keller S, Lorch A, Naef R. End-of-life and bereavement support to families in cancer care: a cross-sectional survey with bereaved family members. BMC Health Serv Res 2024; 24:155. [PMID: 38303007 PMCID: PMC10832212 DOI: 10.1186/s12913-024-10575-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 01/08/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND Losing a close other to cancer is an incisive experience that occurs after a long course of illness and intense family caregiving. Despite an evident need for family engagement and support and guidance on this, patients and family members may not receive the attention and support they need when a family unit is experiencing a disruption by death. A clear understanding of the quality of care that is currently provided and its ability to address family needs is necessary to improve end-of-life and bereavement support to families affected by cancer. The purpose of this study is to investigate the quality of support of end-of-life and bereavement care to families, their (un)met needs, grief experiences, and self-perceived health outcomes. METHODS A multi-center, cross-sectional observational survey study with family members (n = 35) whose close other died of cancer in a health institution or their own home in German-speaking Switzerland. RESULTS Bereaved family members were mostly satisfied with end-of-life care. Information on the grief process and services, and acknowledgment of their grief was experienced as helpful. Most coped with their grief drawing on family resources and exhibited resilience, but they reported unmet needs in relation to family togetherness and caregiving. CONCLUSION This study with a small number of family members indicates that support provided to families across settings and illness trajectories is perceived as helpful, with specific needs related to family support. The findings suggest that improvements should focus on ensuring care that addresses the family as a unit and enables togetherness, mutual reflection, meaningful relationships, preparedness for death, resilience, and benefit-finding. PROTOCOL REGISTRATION https://osf.io/j4kfh .
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Affiliation(s)
- Qëndresa Thaqi
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Universitaetstrasse 84, 8006, Zurich, Switzerland
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
| | - Marco Riguzzi
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Universitaetstrasse 84, 8006, Zurich, Switzerland
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
| | - David Blum
- Competence Centre for Palliative Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Centre for Palliative Care, City Hospital Zurich, Zurich, Switzerland
| | - Simon Peng-Keller
- Spiritual Care, Faculty of Theology, University of Zurich, Zurich, Switzerland
| | - Anja Lorch
- Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Rahel Naef
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Universitaetstrasse 84, 8006, Zurich, Switzerland.
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland.
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9
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Riguzzi M, Thaqi Q, Peng-Keller S, Lorch A, Blum D, Naef R. Adoption of evidence-based end-of-life and bereavement support to families in cancer care: A contextual analysis study with health professionals. J Clin Nurs 2024. [PMID: 38291546 DOI: 10.1111/jocn.17033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 12/19/2023] [Accepted: 01/07/2024] [Indexed: 02/01/2024]
Abstract
AIMS To investigate the level of adoption of evidence-based family engagement and support during end-of-life cancer care and subsequent bereavement and its contextual facilitators and barriers from health professionals' perspectives, and to explore differences between professional groups. DESIGN Contextual analysis using an online cross-sectional survey. METHODS This study was conducted in four Swiss hospitals and three home care oncology and palliative care services. Non-parametric testing was used to investigate the level of adoption and differences between nurses, physicians, occupational- and physiotherapists and psychosocial professionals (chaplains, onco-psychologists and social workers). The STROBE checklist for cross-sectional studies was followed. RESULTS The majority of the 111 participating health professionals were nurses. Adoption was statistically significantly higher during end-of-life care than bereavement, with nurses and physicians reporting higher levels than the other professional groups. Guidance on end-of-life family care was available in about half of the cases, in contrast to a quarter for bereavement care. Self-perceived knowledge, skills and attitudes were moderate to high, with nurses and physicians reporting higher levels than others, except for general skills in working with families. Organisational structures were experienced as rather supportive, with the psychosocial group appraising the organisational context as significantly less conducive to fully implementing end-of-life and bereavement care than others, particularly during the end-of-life phase. CONCLUSION Evidence-based family engagement and support were better adopted during end-of-life care than bereavement. Overall, nurses and physicians felt better enabled to care for families compared to other professional groups. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution. PROTOCOL REGISTRATION https://osf.io/j4kfh. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Implementation and quality improvement efforts should focus particularly on the bereavement phase and be tailored to professional groups. IMPACT The findings show that evidence-based family engagement and support practices during end-of-life were rather well adopted in contrast to subsequent bereavement care, with nurses and physicians better enabled than other professionals to provide care. A better understanding of health professionals' contributions and roles in family care is important to build interprofessional capacity for evidence-based end-of-life and bereavement support. REPORTING METHOD The STROBE checklist for reports of cross-sectional studies was followed (von Elm et al., 2007).
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Affiliation(s)
- Marco Riguzzi
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
| | - Qëndresa Thaqi
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Simon Peng-Keller
- Spiritual Care, Faculty of Theology, University of Zurich, Zurich, Switzerland
| | - Anja Lorch
- Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - David Blum
- Competence Centre for Palliative Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Centre for Palliative Care, City Hospital Zurich, Zurich, Switzerland
| | - Rahel Naef
- Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
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10
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Wu Y, Zhang X. Examining Conversation Analysis in Palliative Care: A Systematic Review. HEALTH COMMUNICATION 2024:1-12. [PMID: 38166606 DOI: 10.1080/10410236.2023.2301202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Communication is an integral component in palliative care. A number of studies have used conversation analysis (CA) to examine communication between healthcare professionals (HCPs) and patients/companions in palliative care. To the best of our knowledge, however, no work has been done to synthesize these studies. Thus, the review aimed to synthesize these conversation analytic studies in the setting of palliative care. The review included peer-reviewed studies that focused on communication between HCPs and patients/companions and that were published in English before September 10 2022. The database and manual search produced 16 eligible studies. The thematic analysis generated five themes: (1) promoting patient agency and autonomy; (2) practices for gathering pain-related information and navigating pain concerns (practices for gathering pain-related information and practices for navigating patients' pain concerns); (3) initiating and managing end-of-life discussions; (4) facilitating shared decision making in palliative care; and (5) navigating sensitive topics and uncertainty in prognostic talk. The review highlighted the potential of CA for research in palliative care and had implications for communication practice.
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Affiliation(s)
- Yijin Wu
- Center for Geriatric Healthcare Services and Health Education, Qufu Normal University
| | - Xin Zhang
- Center for Geriatric Healthcare Services and Health Education, Qufu Normal University
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Peng Y, Wu H, Tao J, Wang Y, Zhang M, Huang P. The Current Status of Bereavement Care in Chinese Emergency Departments: A Multicenter Cross-Sectional Study. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231224550. [PMID: 38152874 DOI: 10.1177/00302228231224550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
Understanding the current status and challenges of bereavement care will help facilitate the development of bereavement care in the emergency department. However, little is known about the status of bereavement care in Chinese emergency departments and nurses' perceptions of bereavement care. We used a self-made questionnaire to survey 124 head nurses and 870 emergency nurses in 21 hospitals in Jiangsu Province in September 2023. Among 124 emergency departments, 78 (62.90%) emergency departments provided bereavement care strategies, and the most frequent strategy was a waiting room, relevant information on funeral arrangements and the establishment of a relatively secluded environment conducive to the solace of the patient's family, or the provision of a dedicated farewell chamber. Emergency nurses believed that bereavement care is important but difficult to implement, with support resources, environment and human resources being the main challenges. In the future, further attention should be paid to the development of bereavement care in the emergency department, and the implementation of bereavement care should be supported in terms of policies, funds, resources and personnel.
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Affiliation(s)
- Yingxin Peng
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Haoming Wu
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Junjie Tao
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Yuchuan Wang
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Min Zhang
- Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Ping Huang
- Nanjing Drum Tower Hospital, Clinical College of Nanjing University of Chinese Medicine, Nanjing, China
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12
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Boven C, Dillen L, Dierickx S, Van den Block L, Piers R, Van Den Noortgate N, Van Humbeeck L. Relatives' Experiences of Being Involved in Assisted Dying: A Qualitative Study. QUALITATIVE HEALTH RESEARCH 2023; 33:1154-1164. [PMID: 37791685 PMCID: PMC10626978 DOI: 10.1177/10497323231196827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Abstract
Recent literature demonstrates an interdependence between relatives and healthcare providers throughout euthanasia processes. Yet, current guidelines and literature scarcely specify the interactions between healthcare providers and bereaved relatives. The aim of this work consisted of providing an insight into bereaved relatives' experiences (1) of being involved in euthanasia processes and (2) of their interactions with healthcare providers before, during, and after the euthanasia. The research process was guided by the principles of constructivist grounded theory. Nineteen Dutch-speaking bereaved relatives of oncological patients, who received euthanasia at home or in a hospital less than 24 months ago, participated via semi-structured interviews. These interviews were conducted between May 2021 and June 2022. Due to the intensity of euthanasia processes, relatives wanted to be involved as early as possible, in order to receive time, space, and access to professionals' support whilst preparing themselves for the upcoming loss of a family member with cancer. Being at peace with the euthanasia request facilitated taking a supportive attitude, subsequently aiding in achieving a serene atmosphere. A serene atmosphere facilitated relatives' grief process because it helped them in creating and preserving good memories. Relatives appreciated support from healthcare providers, as long as overinvolvement on their part was not occurring. This study advocates for a relational approach in the context of euthanasia and provides useful complements to the existing euthanasia guidelines.
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Affiliation(s)
- Charlotte Boven
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
| | - Let Dillen
- Department of Geriatric Medicine and Palliative Care Unit, Ghent University Hospital, Ghent, Belgium
| | - Sigrid Dierickx
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Ghent, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Lieve Van den Block
- End-of-Life Care Research Group, Vrije Universiteit Brussel (VUB) & Ghent University, Ghent, Belgium
- Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Ruth Piers
- Department of Geriatric Medicine, Ghent University Hospital, Ghent, Belgium
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13
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Staniland L, Too C, Butshiire L, Skinner S, Breen LJ. Best Practice in Telephone Bereavement Support: A Thematic Analysis of Bereavement Support Providers' Perspectives. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231199876. [PMID: 37694375 DOI: 10.1177/00302228231199876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
Telephone bereavement support is recommended in bereavement care policy and practice; however, little is known about what constitutes best practice. To explore how best practice in telephone bereavement support is conceptualized by those who provide the service, 26 healthcare professionals working in Australian hospitals, hospices, and other palliative care settings were interviewed. Thematic analysis was used to construct seven themes: A Valuable Service with Limited Resources, The First Call, The Dance of Rapport, A Space to Share, Identifying and Responding to Risk, Maintaining Contact, and Training and Development Needs. Participants viewed telephone bereavement support as an effective and accessible tool in supporting individuals' processing of and adaptation to loss; however, concerns remain regarding the quality and consistency of care provided. Greater resourcing of bereavement care is required, and telephone bereavement care providers' perspectives offer a foundation to ensure the service is evidence-based, pragmatic, and supported by quality training.
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Affiliation(s)
- Lexy Staniland
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Charmaine Too
- Curtin School of Population Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Laura Butshiire
- Curtin School of Population Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
- Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Shelly Skinner
- Lionheart Camp for Kids, Perth, WA, Australia
- Perth Children's Hospital, Perth, WA, Australia
| | - Lauren J Breen
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
- Curtin School of Population Health, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
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14
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Hoffstädt HE, Boogaard JA, Tam MC, van Bodegom-Vos L, Stoppelenburg A, Hartog ID, van der Linden YM, van der Steen JT. Practice of Supporting Family Caregivers of Patients with Life-Threatening Diseases: A Two-phase Study Among Healthcare Professionals. Am J Hosp Palliat Care 2023; 40:633-643. [PMID: 36436831 PMCID: PMC10240656 DOI: 10.1177/10499091221123006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Abstract
Background: Although support for family caregivers is an essential component of palliative care, routine provision of such support is often lacking. To improve support for family caregivers, we assessed current practice and influencing factors as perceived by healthcare professionals. Methods: A two-phase study was conducted including a survey exploring healthcare professionals' practice of supporting family caregivers in Western urbanized Netherlands in 2017, and focus groups exploring facilitators and barriers to supporting family caregivers in 2018. Focus group data were thematically analyzed with deductive coding based on the COM-B system. Results: Of the 379 survey respondents (response 11%), 374 were eligible (physicians, 28%; nurses, 64%; nurse assistants, 9%). The respondents practiced in academic hospitals (52%), general hospitals (31%), nursing homes (11%) and hospices (5%). They reported to always (38%), most of the time (37%), sometimes (21%) or never (5%) provide support to family caregivers during the illness trajectory. Respondents reported to always (28%), sometimes (39%), or never (33%) provide support after death. Four focus group discussions with 22 healthcare professionals elicited motivational facilitators and barriers to supporting family caregivers (e.g., relationship with family caregivers, deriving satisfaction from supporting them), and factors related to capability (e.g., (lacking) conversational skills, knowledge) and opportunity (e.g., (un)availability of protocols and time). Conclusions: Support for family caregivers, especially after the patient's death, is not systematically integrated in working procedures of healthcare professionals. The barriers and facilitators identified in this study can inform the development of an intervention aiming to enhance support for family caregivers.
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Affiliation(s)
- Hinke E. Hoffstädt
- Center of Expertise of Palliative Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Jannie A. Boogaard
- Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Marcella C. Tam
- Center of Expertise of Palliative Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Leti van Bodegom-Vos
- Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands
| | - Arianne Stoppelenburg
- Center of Expertise of Palliative Care, Leiden University Medical Center, Leiden, The Netherlands
- Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - Iris D. Hartog
- Center of Expertise of Palliative Care, Leiden University Medical Center, Leiden, The Netherlands
- Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - Yvette M. van der Linden
- Center of Expertise of Palliative Care, Leiden University Medical Center, Leiden, The Netherlands
- Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands
| | - Jenny T. van der Steen
- Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- Primary and Community Care, Radboud university medical center, Nijmegen, The Netherlands
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15
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Lenzo V, Quattropani MC. Psychological factors and prosociality as determinants in grief reactions: Proposals for an integrative perspective in palliative care. Front Psychol 2023; 14:1136301. [PMID: 37057170 PMCID: PMC10086117 DOI: 10.3389/fpsyg.2023.1136301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Accepted: 03/08/2023] [Indexed: 03/30/2023] Open
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Levesque DA, Lunardini MM, Payne EL, Callison-Burch V. Grief Coach, a Text-Based Grief Support Intervention: Acceptability Among Hospice Family Members. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231159450. [PMID: 36867525 DOI: 10.1177/00302228231159450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
U.S. Medicare-certified hospices must provide bereavement care to family members for 13 months following a patient's death. This manuscript describes Grief Coach, a text message program that delivers expert grief support and can assist hospices in meeting the bereavement care mandate. It also describes the first 350 Grief Coach subscribers from hospice and the results of a survey of active subscribers (n = 154) to learn whether and how they found the program helpful. The 13-month program retention rate was 86%. Among survey respondents (n = 100, response rate = 65%), 73% rated the program as very helpful, and 74% rated it as contributing to their sense of being supported in their grief. Grievers aged 65+ and males gave the highest ratings. Respondents' comments identify key intervention content that they found helpful. These findings suggest that Grief Coach may be a promising component of hospice grief support programming to meet the needs of grieving family members.
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Sardella A, Musetti A, Caponnetto P, Quattropani MC, Lenzo V. Prolonged Grief Disorder and Symptoms of Anxiety and Depression among Bereaved Family Caregivers in the Context of Palliative Home Care. Eur J Investig Health Psychol Educ 2023; 13:490-500. [PMID: 36826221 PMCID: PMC9955476 DOI: 10.3390/ejihpe13020037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 02/10/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
Background: This study aimed to investigate the prevalence and the psychological comorbidity of PGD among bereaved family caregivers of palliative care cancer patients. We also examined the discriminant validity of two simple and reliable tools in correctly categorized individuals with PGD. Methods: A cross-sectional study was conducted with 157 bereaved participants (77.1% females, mean age = 43.50 ± 14.04 years, mean time since the loss = 3.59 years) recruited from three palliative home care services. These participants completed the Prolonged Grief Scale (PG-13) and the Hospital Anxiety and Depression Scale (HADS). Results: The prevalence of PGD within the sample was 4.46% (i.e., = 7/157). Participants scored higher than the cut-off on the PG-13 and the HADS-D. Symptoms of PGD were positively correlated with depression levels. The ROC curve analysis showed that the HADS-D was outstanding in categorizing individuals with prolonged grief disorder from those without PGD. A HADS-D score of ≥7.5 was able to categorize participants with a sensitivity of 0.90 and a specificity of 0.73. Conclusions: Overall, these results highlight the relationship between grief and depression symptoms and their exceptional discriminant validity among correctly identified individuals with PGD.
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Affiliation(s)
- Alberto Sardella
- Department of Clinical and Experimental Medicine, University of Messina, 98124 Messina, Italy
- Correspondence:
| | - Alessandro Musetti
- Department of Humanities, Social Sciences and Cultural Industries, University of Parma, 43121 Parma, Italy
| | - Pasquale Caponnetto
- Department of Educational Sciences, University of Catania, 95124 Catania, Italy
- Center of Excellence for the Acceleration of Harm Reduction (CoEHAR), University of Catania, 95123 Catania, Italy
| | | | - Vittorio Lenzo
- Department of Educational Sciences, University of Catania, 95124 Catania, Italy
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18
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Boven C, Van Humbeeck L, Van den Block L, Piers R, Van Den Noortgate N, Dillen L. Bereavement care and the interaction with relatives in the context of euthanasia: A qualitative study with healthcare providers. Int J Nurs Stud 2023; 140:104450. [PMID: 36796117 DOI: 10.1016/j.ijnurstu.2023.104450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 02/01/2023]
Abstract
BACKGROUND A recent review shows an interdependence between healthcare providers and relatives in the context of euthanasia. Belgian guidelines do focus on the role of certain healthcare providers (physicians, nurses, and psychologists), yet they hardly specify bereavement care services before, during and after the euthanasia. PURPOSE A conceptual model showing underlying mechanisms of healthcare providers' experiences regarding the interaction with and the provision of bereavement care to relatives of cancer patients throughout a euthanasia process. METHODS 47 semi-structured interviews with Flemish physicians, nurses and psychologists working in hospitals and/or homecare, conducted from September 2020 to April 2022. Transcripts were analyzed using the Constructivist Grounded Theory Approach. RESULTS Participants experienced the interaction with relatives as very diverse, which can be visualized as a continuum ranging from negative to positive, depending on each unique case. The achieved degree of serenity was the main contributor in determining their position on the aforementioned continuum. To create this serene atmosphere, healthcare providers undertook actions underpinned by two attitudes (wariness and meticulousness), which are guided by different considerations. These considerations can be categorized into three groups: 1) ideas about a good death and its importance, 2) having the situation well under control and 3) self-reassurance. CONCLUSIONS If relatives were not at peace, most participants said that they deny a request or formulate additional requirements. Moreover, they wanted to ensure relatives can cope with the loss, which was often experienced as intense and time-consuming. Our insights shape needs-based care from healthcare providers' perspective in the context of euthanasia. Future research should explore the relatives' perspective regarding this interaction and the provision of bereavement care. TWEETABLE ABSTRACT Professionals strive for a serene atmosphere throughout a euthanasia process to ensure relatives can cope with the loss, and the way in which the patient died.
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Affiliation(s)
- Charlotte Boven
- Department of Geriatric Medicine, Ghent University Hospital, Corneel Heymanslaan 10, Ghent, Belgium.
| | - Liesbeth Van Humbeeck
- Department of Geriatric Medicine, Ghent University Hospital, Corneel Heymanslaan 10, Ghent, Belgium
| | - Lieve Van den Block
- End-of-life Care Research Group, Vrije Universiteit Brussel (VUB), Brussels Health Campus, Laarbeeklaan 103, 1090 Brussels, Belgium; Department of Family Medicine and Chronic Care, Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Ruth Piers
- Department of Geriatric Medicine, Ghent University Hospital, Corneel Heymanslaan 10, Ghent, Belgium
| | - Nele Van Den Noortgate
- Department of Geriatric Medicine, Ghent University Hospital, Corneel Heymanslaan 10, Ghent, Belgium
| | - Let Dillen
- Department of Geriatric Medicine and Palliative Care Unit, Ghent University Hospital, Ghent, Belgium
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MacArthur ND, Kirby E, Mowll J. Bereavement affinities: A qualitative study of lived experiences of grief and loss. DEATH STUDIES 2023; 47:836-846. [PMID: 36327234 DOI: 10.1080/07481187.2022.2135044] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Attending to bereaved peoples' lived experiences offers considerable potential for better understanding how to improve support following loss. In-depth interviews (n = 36) and solicited diaries (n = 23) were conducted with bereaved adults following a death in palliative or residential aged care. A constructivist grounded theory approach guided data analysis, through which three themes were derived: making sense of the lived experience of bereavement; relationships in bereavement; and bereavement over time. The results reveal the nuances within everyday experiences of bereavement, in particular the multiplicity of affinities, present or lacking, in social support and recognition.
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Affiliation(s)
- Nathan D MacArthur
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - Emma Kirby
- Centre for Social Research in Health, University of New South Wales, Sydney, Australia
| | - Jane Mowll
- School of Social Sciences, University of New South Wales, Sydney, Australia
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20
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Alenezi E, Zeilani RS, Othman EH. Attitude and Associated Factors Toward end of Life Care among Nurses Working in Kuwait Hospitals: A Cross-sectional Study. Indian J Palliat Care 2022; 28:280-286. [PMID: 36072242 PMCID: PMC9443116 DOI: 10.25259/ijpc_93_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 03/10/2022] [Indexed: 11/21/2022] Open
Abstract
Objective: The current study assessed the attitude toward end of life (EOL) care among nurses working in Kuwait hospitals. Material and Methods: A descriptive, cross-sectional design was used to recruit 900 nurses from nine public, private and military hospitals in Kuwait. Data were collected using a self-administered questionnaire of the Frommelt Attitude Toward the Care of Dying questionnaire. Results: The results showed that nurses in Kuwait had a favourable and supportive attitude towards EOL care, mainly toward the families’ need for emotional support, care for the dying patients, involving the family in care, and accepting death. Further, attitude scores differed significantly based on nurses’ age, year of experience, education level, nationality, type of hospital, and place of work. Conclusion: Nurses working in Kuwait have a favourable attitude toward care for dying patients but an unfavourable perception toward making conversation with patients about death. Hence, providing appropriate awareness to nurses about death and dying in Kuwait might be a promising intervention to improve their attitude and sensitise the concept of death among them.
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Affiliation(s)
- Ebtesam Alenezi
- Department of Nursing, Palliative Care Center, Al-Sabahiyah, Kuwait,
| | | | - Elham H. Othman
- Faculty of Nursing, Applied Science Private University, Amman, Jordan,
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21
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Bereavement care provision and its associated factors among nurses in cancer care settings: a cross-sectional study. Support Care Cancer 2022; 30:7625-7633. [PMID: 35676344 DOI: 10.1007/s00520-022-07180-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 05/25/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The goals of this study were to (1) investigate bereavement care provision in practical settings, (2) examine the difference in care by nurses' affiliation (general hospital, hospice, or homecare setting), and (3) identify institutional and personal barriers associated with bereavement care provision. METHODS A cross-sectional survey was conducted using an online questionnaire. Nurses (n = 309) who had an experience of cancer patient care before death at least once in a previous year were included in the analysis. Kruskal-Wallis test and Mann-Whitney test were conducted to compare bereavement care provision by nurses' affiliation, and hierarchical logistic regression analysis was conducted to investigate the correlation between bereavement care provision and its associated factors. RESULTS Less than 30% of nurses reported providing bereavement care in structured settings such as home visits, counseling at a hospital, or phone calls. The differences in bereavement care provision by nurses' affiliation were significant, and the nurses working in a hospital were less likely to provide bereavement care than those working in a hospice or homecare setting. Working in a palliative care setting (OR = 2.35, 95%CI 1.09-5.07, p < 0.05) and greater confidence (OR = 2.18, 95%CI 1.07-4.42, p < 0.05) and knowledge regarding bereavement care (OR = 12.46, 95%CI 5.69-27.29, p < 0.001) were significantly associated factors of bereavement care provision. CONCLUSION This study indicated a lack of bereavement care provision, especially in general hospitals. Improving nurses' confidence and knowledge may encourage them to provide bereavement care provision.
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Walker W, Efstathiou N, Jones J, Collins P, Jennens H. Family experiences of in-hospital end-of-life care for adults: A systematic review of qualitative evidence. J Clin Nurs 2022; 32:2252-2269. [PMID: 35332593 DOI: 10.1111/jocn.16268] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/29/2021] [Accepted: 02/14/2022] [Indexed: 11/29/2022]
Abstract
AIM To systematically identify, appraise, aggregate and synthesise qualitative evidence on family members' experiences of end-of-life care (EoLC) in acute hospitals. METHODS A systematic review and qualitative evidence synthesis based on the Joanna Briggs Institute methodology. Primary research, published 2014 onwards was identified using a sequential strategy of electronic and hand searches. Six databases (CINAHL, Medline, Embase, EMCare, PsycINFO, BNI) were systematically searched. Studies that met pre-determined inclusion/exclusion criteria were uniformly appraised using the Critical Appraisal Skills Programme checklist for qualitative research, and synthesised using a meta-aggregative approach. The ENTREQ statement was used as a checklist for reporting the review. RESULTS Sixteen studies of European, Australasian and North American origin formed the review. The quality of each study was considered very good in view of a 'yes' response to most screening questions. Extracted findings were assembled into 12 categories, and five synthesised findings: Understanding of approaching end of life; essential care at the end of life; interpersonal interactions; environment of care; patient and family care after death. CONCLUSION Enabling and improving peoples' experience of EoLC must remain part of the vision and mission of hospital organisations. Consideration must be given to the fulfilment of family needs and apparent hallmarks of quality care that appear to influence experiential outcomes. RELEVANCE TO CLINICAL PRACTICE This review of qualitative research represents the first-stage development of a family-reported experience measure for adult EoLC in the hospital setting. The synthesised findings provide a Western perspective of care practices and environmental factors that are perceived to impact the quality of the care experience. Collectively, the review findings serve as a guide for evidence-informed practice, quality improvement, service evaluation and future research. A developed understanding of the families' subjective reflections creates reciprocal opportunity to transform experiential insights into practical strategies for professional growth and practice development.
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Affiliation(s)
- Wendy Walker
- The Royal Wolverhampton NHS Trust, Wolverhampton, UK.,School of Nursing, University of Birmingham, Birmingham, UK
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23
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Boven C, Dillen L, Van den Block L, Piers R, Van Den Noortgate N, Van Humbeeck L. In-Hospital Bereavement Services as an Act of Care and a Challenge: An Integrative Review. J Pain Symptom Manage 2022; 63:e295-e316. [PMID: 34695567 DOI: 10.1016/j.jpainsymman.2021.10.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/13/2021] [Accepted: 10/15/2021] [Indexed: 10/20/2022]
Abstract
CONTEXT Globally, people most often die within hospitals. As such, healthcare providers in hospitals are frequently confronted with dying persons and their bereaved relatives. OBJECTIVES To provide an overview of the current role hospitals take in providing bereavement care. Furthermore, we want to present an operational definition of bereavement care, the way it is currently implemented, relatives' satisfaction of receiving these services, and finally barriers and facilitators regarding the provision of bereavement care. METHODS An integrative review was conducted by searching four electronic databases, from January 2011 to December 2020, resulting in 47 studies. Different study designs were included and results were reported in accordance with the theoretical framework of Whittemore and Knafl (2005). RESULTS Only four articles defined bereavement care: two as services offered solely post loss and the other two as services offered pre and post loss. Although different bereavement services were delivered the time surrounding the death, the follow-up of bereaved relatives was less routinely offered. Relatives appreciated all bereavement services, which were rather informally and ad-hoc provided to them. Healthcare providers perceived bereavement care as important, but the provision was challenged by numerous factors (such as insufficient education and time). CONCLUSION Current in-hospital bereavement care can be seen as an act of care that is provided ad-hoc, resulting from the good-will of individual staff members. A tiered or stepped approach based on needs is preferred, as it allocates funds towards individuals-at-risk. Effective partnerships between hospitals and the community can be a useful, sustainable and cost-effective strategy.
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Affiliation(s)
- Charlotte Boven
- Department of Geriatric Medicine (C.B., R.P., N.V.D.N., L.V.H.), Ghent University Hospital, Ghent, Belgium.
| | - Let Dillen
- Department of Geriatric Medicine and Palliative Care Unit (L.D.), Ghent University Hospital, Ghent, Belgium
| | - Lieve Van den Block
- End-of-life Care Research Group (L.V.D.B.), Vrije Universiteit Brussel (VUB) & Ghent University, Brussels Health Campus (Building C), Laarbeeklaan 103, 1090 Brussels, Belgium & Campus Ghent University Hospital (Entrance 42 K3), Ghent, Belgium; Department of Family Medicine and Chronic Care (L.V.D.B.), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Ruth Piers
- Department of Geriatric Medicine (C.B., R.P., N.V.D.N., L.V.H.), Ghent University Hospital, Ghent, Belgium
| | - Nele Van Den Noortgate
- Department of Geriatric Medicine (C.B., R.P., N.V.D.N., L.V.H.), Ghent University Hospital, Ghent, Belgium
| | - Liesbeth Van Humbeeck
- Department of Geriatric Medicine (C.B., R.P., N.V.D.N., L.V.H.), Ghent University Hospital, Ghent, Belgium
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Crooms RC, Johnson MO, Leeper H, Mehta A, McWhirter M, Sharma A. Easing the Journey-an Updated Review of Palliative Care for the Patient with High-Grade Glioma. Curr Oncol Rep 2022; 24:501-515. [PMID: 35192120 DOI: 10.1007/s11912-022-01210-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/20/2022] [Indexed: 12/26/2022]
Abstract
PURPOSE OF REVIEW High-grade gliomas (HGG) are rare brain tumors that cause disproportionate suffering and mortality. Palliative care, whose aim is to relieve the symptoms and stressors of serious illness, may benefit patients with HGG and their families. In this review, we summarize the extant literature and provide recommendations for addressing the symptom management and communication needs of brain tumor patients and their caregivers at key points in the illness trajectory: initial diagnosis; during upfront treatment; disease recurrence; end-of-life period; and after death during bereavement. RECENT FINDINGS Patients with HGG experience highly intrusive symptoms, cognitive and functional decline, and emotional and existential distress throughout the disease course. The caregiver burden is also substantial during the patient's illness and after death. There is limited evidence to guide the palliative management of these issues. Palliative care is likely to benefit patients with HGG, yet further research is needed to optimize the delivery of palliative care in neuro-oncology.
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Affiliation(s)
- Rita C Crooms
- Department of Neurology, Icahn School of Medicine at Mount Sinai, 1468 Madison Ave, 1052, NY, 10029, New York, USA.,Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Margaret O Johnson
- Department of Neurosurgery, Duke University Medical Center, Trent Drive 047 Baker House, Durham, NC, 27710, USA.,The Preston Robert Tirsch Brain Tumor Center, Duke University Medical Center, Trent Drive 047 Baker House, NC, 27710, Durham, USA
| | - Heather Leeper
- Neuro-Oncology Branch, National Institutes of Health, National Cancer Institute, 9030 Old Georgetown Rd, Bloch Bldg 82, Bethesda, MD, 20892, USA
| | - Ambereen Mehta
- Palliative Care Program, Division of Medicine, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, 21224, MD, USA.,Division of Medicine, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, 21224, MD, USA
| | - Michelle McWhirter
- Palliative Care Program, Division of Medicine, Johns Hopkins School of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, 21224, MD, USA.,Department of Social Work, Johns Hopkins Bayview Medical Center, Baltimore, 21224, MD, USA
| | - Akanksha Sharma
- Department of Translational Neurosciences, Pacific Neuroscience Institute/Saint John's Cancer Institute, 2200 Santa Monica Blvd, Santa Monica, CA, 90404, USA.
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Brennan F, Gardiner MD, Narasimhan M. The neuropalliative multidisciplinary team-Members and their roles. HANDBOOK OF CLINICAL NEUROLOGY 2022; 190:33-59. [PMID: 36055719 DOI: 10.1016/b978-0-323-85029-2.00010-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Neurodegenerative conditions are prominent contributors to both morbidity and mortality worldwide. They pose a significant challenge to health professionals, health systems, and the often unpaid, untrained family members and carers. The many and varied challenges encountered are best managed by a multidisciplinary neuropalliative team, as it is impossible for a single clinician to possess and deliver the wide range of skills and services required to optimally care for these patients. This chapter discusses the assembly, maintenance, and care of such a team, as well as potential difficulties and solutions in domains such as funding, training, geographical remoteness, as well as the potential lack of awareness and acceptance by colleagues. A comprehensive description of the role of all possible team members is discussed. The chapter outlines the concept, content, and potential benefits of a multidisciplinary team in neuropalliative care. Its thesis is twofold: that multidisciplinary care is vital and, second, that the sum of the whole of a team can be greater than the individual parts with respect to organization, planning, experience, and creativity of approach. With all these factors considered, and implemented wherever possible, we may all move closer to optimizing the comfort and care of our shared neuropalliative patients.
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Affiliation(s)
- Frank Brennan
- Departments of Palliative and Rehabilitation Medicine, Calvary and St George Hospitals, Sydney, NSW, Australia; The Faculty of Medicine, St George Clinical School, The University of New South Wales, Sydney, NSW, Australia.
| | - Matthew D Gardiner
- Departments of Palliative and Rehabilitation Medicine, Calvary and St George Hospitals, Sydney, NSW, Australia; The Faculty of Medicine, St George Clinical School, The University of New South Wales, Sydney, NSW, Australia
| | - Manisha Narasimhan
- School of Psychology and Brain and Mind Centre, The University of Sydney, Sydney, NSW, Australia; Department of Neurology, Sutherland Hospital, Sydney, NSW, Australia
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Keegan O, Murphy I, Benkel I, Limonero JT, Relf M, Guldin MB. Using the Delphi technique to achieve consensus on bereavement care in palliative care in Europe: An EAPC White Paper. Palliat Med 2021; 35:1908-1922. [PMID: 34488504 DOI: 10.1177/02692163211043000] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The WHO definition of palliative care includes bereavement support as integral to palliative care, yet a previous survey of bereavement support in palliative care in Europe has shown a range of service responses to loss. A rigorous approach to agreeing and implementing a palliative care bereavement framework was required. AIM The aim of this study was to develop consensus on best-practice recommendations for bereavement care principles, structures, processes and delivery based on current practice and evidence. DESIGN In accordance with Guidance on Conducting and Reporting Delphi Studies, a consensus-building five-round Delphi technique was performed. A scoping review of research literature informed drafting of 54 statements by the EAPC Bereavement Task Force. Evaluation of the statements was performed by an expert panel using a 5-point Likert scale. ⩾80% agreement were defined as essential items and 75%-79% agreement were defined as desirable items. Items with a consensus rating <75% were revised during the process. SETTING/PARTICIPANTS The Delphi study was carried out by an expert panel among membership organisations of the European Association for Palliative Care. RESULTS In total, 376 email requests to complete Delphi questionnaire were distributed with a response rate of 23% (n = 87) and a follow-up response-rate of 79% (n = 69). Of the initial 54 statements in six dimensions, 52 statements were endorsed with 26 essential statements and 26 desirable statements. CONCLUSIONS The six dimensions and 52 statements agreed through this Delphi study clarify a coherent direction for development of bereavement services in palliative care in Europe.
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Affiliation(s)
- Orla Keegan
- Head of Education & Bereavement, Irish Hospice Foundation, Dublin, Ireland
| | - Irene Murphy
- Maymount University Hospital and Hospice, Cork, Ireland
| | | | - Joaquim T Limonero
- Facultat de Psicologia, Universitat Autonoma de Barcelona, Barcelona, Spain
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Roberts KE, Lichtenthal WG, Ferrell BR. Being a Bereavement-Conscious Hospice and Palliative Care Clinician. J Hosp Palliat Nurs 2021; 23:293-295. [PMID: 34185724 DOI: 10.1097/njh.0000000000000775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lichtenthal WG, Roberts KE, Ferrell BR. Bereavement Care: Walking the Walk. J Palliat Med 2021; 24:805-806. [PMID: 34061671 DOI: 10.1089/jpm.2021.0195] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Wendy G Lichtenthal
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Kailey E Roberts
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York, USA
| | - Betty R Ferrell
- Division of Nursing Research and Education, Beckman Research Institute, City of Hope National Medical Center, Duarte, California, USA
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Applebaum AJ, Kent EE, Lichtenthal WG. Documentation of Caregivers as a Standard of Care. J Clin Oncol 2021; 39:1955-1958. [PMID: 33945287 PMCID: PMC8260920 DOI: 10.1200/jco.21.00402] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/22/2021] [Accepted: 04/14/2021] [Indexed: 11/20/2022] Open
Affiliation(s)
- Allison J. Applebaum
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Psychology in Psychiatry, Weill Cornell Medicine, New York, NY
| | - Erin E. Kent
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Wendy G. Lichtenthal
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY
- Department of Psychology in Psychiatry, Weill Cornell Medicine, New York, NY
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Bindley K, Lewis J, Travaglia J, DiGiacomo M. Social welfare needs of bereaved Australian carers: Implications of insights from palliative care and welfare workers. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:631-642. [PMID: 33704840 DOI: 10.1111/hsc.13339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 11/09/2020] [Accepted: 02/11/2021] [Indexed: 06/12/2023]
Abstract
An individual and psychological emphasis has influenced practice and research on bereavement following informal care provision in the context of life-limiting illness. Consideration of the potential for bereavement to be shaped by intersecting social and structural inequities is needed; and should include an understanding of interactions with government institutions and social policy. This qualitative study employed interpretive description to explore the way in which palliative care workers and welfare sector workers perceive and approach experiences and needs of bereaved carers receiving government income support or housing assistance in Western Sydney, an area associated with recognised socioeconomic disadvantage. A total of 21 palliative care workers within a public health service and welfare workers from two government social welfare services participated in in-depth interviews. Data were analysed using framework analysis. Participants highlighted social welfare policy and related interactions that may impact bereavement, potentially related to financial, housing and employment precariousness. Personal, interpersonal and structural factors perceived to shape the navigation of welfare needs were explored, alongside needed professional and structural changes envisioned by workers. With limited forms of capital, vulnerably positioned carers may encounter difficulties that heighten their precariousness in bereavement. Transactional organisational cultures alongside health and welfare agencies that function in a siloed manner appear to contribute to structural burden for carers, following death due to life-limiting illness. Palliative care and welfare workers also associated elements of their work with bereaved carers with their own experiences of helplessness, frustration and distress. Findings point to a need for the development of interagency strategies in addition to policy underpinned by more nuanced understandings of vulnerability in bereavement, post-caring.
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Affiliation(s)
- Kristin Bindley
- Faculty of Health, The University of Technology Sydney, Ultimo, NSW, Australia
- Supportive and Palliative Care, Western Sydney Local Health District, Mt Druitt, NSW, Australia
| | - Joanne Lewis
- Faculty of Health, The University of Technology Sydney, Ultimo, NSW, Australia
| | - Joanne Travaglia
- Faculty of Health, The University of Technology Sydney, Ultimo, NSW, Australia
| | - Michelle DiGiacomo
- Faculty of Health, The University of Technology Sydney, Ultimo, NSW, Australia
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Schuelke T, Crawford C, Kentor R, Eppelheimer H, Chipriano C, Springmeyer K, Shukraft A, Hill M. Current Grief Support in Pediatric Palliative Care. CHILDREN (BASEL, SWITZERLAND) 2021; 8:278. [PMID: 33916583 PMCID: PMC8066285 DOI: 10.3390/children8040278] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 03/27/2021] [Accepted: 04/01/2021] [Indexed: 02/06/2023]
Abstract
Grief support changes as more is learned from current grief theory and research. The authors provide a comprehensive overview of current grief support as it relates to Pediatric Palliative Care (PPC). The following aspects of grief are addressed: (1) anticipatory grief: the nondeath losses that occur with a complex and chronic illness, as well as the time leading up to death; (2) grief around the time of death: the intense and sacred experience of companioning with a dying child; (3) grief after death: supporting bereavement and mourning through programing and other methods; (4) innovative approaches: the future of grief support. The contents of this article are meant to support and educate programs currently providing grief services and those aiming to begin the meaningful work of grief support.
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Affiliation(s)
- Taryn Schuelke
- Department of Pediatric Palliative Care, Texas Children’s Hospital, 6621 Fannin St., Houston, TX 77030, USA; (C.C.); (K.S.)
| | - Claire Crawford
- Department of Pediatric Palliative Care, Texas Children’s Hospital, 6621 Fannin St., Houston, TX 77030, USA; (C.C.); (K.S.)
| | - Rachel Kentor
- Department of Pediatrics, Baylor College of Medicine, Psychology Service, Texas Children’s Hospital, 6701 Fannin St., Houston, TX 77030, USA;
| | - Heather Eppelheimer
- Memorial Hermann Pediatric Hospice, 902 Frostwood Suite 288, Houston, TX 77024, USA;
| | | | - Kirstin Springmeyer
- Department of Pediatric Palliative Care, Texas Children’s Hospital, 6621 Fannin St., Houston, TX 77030, USA; (C.C.); (K.S.)
| | - Allison Shukraft
- Department of Pediatrics, Pediatric Advanced Care Team, Atrium Health’s Levine Children’s Hospital, MEB 415-F, 1000 Blythe Blvd, Charlotte, NC 28203, USA;
| | - Malinda Hill
- Justin Michael Ingerman Center for Palliative Care, Children’s Hospital of Philadelphia, 3401 Civic Center Blvd., Philadelphia, PA 19104, USA;
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Zuniga-Villanueva G, Ramirez-GarciaLuna JL, Villafranca-Andino RI. A Compassionate Communities Approach in a Grief and Bereavement Support Program: Bridging the Gap in Palliative Care. JOURNAL OF SOCIAL WORK IN END-OF-LIFE & PALLIATIVE CARE 2021; 17:9-18. [PMID: 33722177 DOI: 10.1080/15524256.2021.1894309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Grief and bereavement support is a fundamental component of palliative care, yet there is a gap in practice as not all palliative care services offer it. The compassionate communities (CC) approach aims to build community capacity to address grief as grief support is considered everyone's responsibility. This study describes the characteristics, development, growth and attendees of a grief support program that uses a CC approach to bridge the gap of grief support in palliative care.
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Affiliation(s)
- Gregorio Zuniga-Villanueva
- Division of Pediatric Palliative Medicine, McMaster University, Hamilton, Canada
- Department of Pediatrics, Tecnologico de Monterrey, Monterrey, Mexico
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Grant M, Hudson P, Forrest A, Collins A, Israel F. Developing a model of bereavement care in an adult tertiary hospital. AUST HEALTH REV 2020; 45:110-116. [PMID: 33353586 DOI: 10.1071/ah19270] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 02/15/2020] [Indexed: 11/23/2022]
Abstract
Objectives Hospitals are the most common place of death in Australia. Bereavement care is recognised by national standards as being central to providing high-quality care at the end of life, and has significant health implications on morbidity, mortality and health service usage. Despite this, bereavement care is not routinely or systematically provided in most Australian hospitals. This study aimed to develop a comprehensive, evidence-based model of bereavement care specific to the needs of an acute Australian adult tertiary hospital. Methods This study used a multiple-methods design, which included a scoping literature review, a survey of current institutional bereavement practices, interviews with bereaved family members and staff focus groups and the development of a model of bereavement care for the acute hospital service through advisory group and expert consensus. Results Staff and bereaved family members strongly supported a systematic approach to bereavement, perceiving the need for greater support, training, coordination and follow-up. In all, 10 core elements were developed to support a structured model of bereavement care provision and follow-up for the acute hospital organisation. Conclusions This evidence-generated model of care promotes the provision of quality and systematic bereavement care in the acute hospital setting. What is known about the topic? Acute hospitals are the most common place to die in Australia, yet there is a lack of understanding of how bereavement care is or should be provided in these environments. The bereavement period is associated with increased use of health services and worse morbidity and mortality, and thus has significant implications for public health. The provision of bereavement care in acute hospitals is often sporadic, often involving untrained staff who may not provide evidence-based care. What does this paper add? This paper describes the development of a comprehensive, evidence-based model of bereavement care specific to the needs of an Australian acute hospital. What are the implications for practitioners? Developing a consistent approach to bereavement for the acute care sector has the potential to support staff, minimise conflict at the end of life, facilitate recognition of those suffering from difficult bereavement and proactively engage services for these people. It is hoped that such a model of care can find relevance across acute hospitals in Australia, to improve the quality and consistency of bereavement care.
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Affiliation(s)
- Matthew Grant
- The Centre for Palliative Care, St Vincent's Hospital, Melbourne, Vic. 3065, Australia. ; ; and Department of Palliative Medicine, St Vincent's Hospital, Melbourne, Vic. 3065, Australia; and Palliative Nexus, Department of Medicine, The University of Melbourne, Melbourne, Vic. 3010, Australia. ; and Corresponding author.
| | - Peter Hudson
- The Centre for Palliative Care, St Vincent's Hospital, Melbourne, Vic. 3065, Australia. ; ; and Vrije Universiteit Brussel, Brussels, Belgium; and Department of Medicine, The University of Melbourne, Melbourne, Vic. 3010, Australia
| | - Annie Forrest
- Mission Directorate, St Vincent's Hospital, Melbourne, Vic. 3065, Australia.
| | - Anna Collins
- Palliative Nexus, Department of Medicine, The University of Melbourne, Melbourne, Vic. 3010, Australia.
| | - Fiona Israel
- The Centre for Palliative Care, St Vincent's Hospital, Melbourne, Vic. 3065, Australia. ;
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Harper A, Willis K. Hospital memorial service bereavement support. BMJ Support Palliat Care 2020:bmjspcare-2020-002834. [PMID: 33355174 DOI: 10.1136/bmjspcare-2020-002834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 12/02/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Pastoral care in an acute hospital setting necessarily includes some bereavement support for families of patients who die. Termed universal bereavement support, an important component of such support is provision of educational information to assist bereaved people struggling with grief. This project aimed to understand, from the perspective of those attending, the value of providing a memorial service for remembering a loved one and whether the education provided at the service successfully met the requirement of a universal bereavement support strategy. METHODS A qualitative study, comprising a semistructured telephone interview with memorial service attendees was undertaken. Data were audio recorded, transcribed and analysed thematically. RESULTS Twenty-nine attendees participated. Three themes provided insights into attendees' perceptions. The first theme encapsulated the value of remembering and celebrating the life of the deceased; the second theme focused on 'finding our way through the grief process' including the value of the educational materials ; and the third theme identified appreciation for the hospital in providing care to those bereaved. CONCLUSION The memorial service provides a valued universal bereavement support strategy and such support strategies are an important part in the process of grieving for many attendees.
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Affiliation(s)
- Andrew Harper
- Pastoral Care, Allied Health, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Karen Willis
- School of Allied Health, Human Services and Sport, Melbourne, Victoria, Australia
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Roberts KE, Jankauskaite G, Slivjak E, Rubin L, Schachter S, Stabler S, Wiener L, Prigerson HG, Lichtenthal WG. Bereavement risk screening: A pathway to psychosocial oncology care. Psychooncology 2020; 29:2041-2047. [PMID: 32840939 DOI: 10.1002/pon.5526] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/10/2020] [Accepted: 08/13/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This qualitative study sought to obtain feedback from stakeholder cancer caregivers and bereaved family members on the implementation of bereavement risk screening in oncology. METHODS Semi-structured interviews were conducted with 38 family members of patients with advanced cancer (n = 12) and bereaved family members (n = 26) on when and how to effectively implement bereavement risk screening. Data were analyzed using thematic analysis. RESULTS Many participants indicated that they would be open to completing a self-report screening measure before and after the patient's death. Several suggested screening at multiple timepoints and the importance of follow-up. Participants viewed screening as an opportunity to connect to psychosocial support. CONCLUSIONS The findings suggest that family members appear supportive of sensitively approached bereavement risk screening before and after a patient's death as an important component of quality psychosocial care. To optimize implementation, bereavement risk screening would involve screening at multiple timepoints and include follow-up. Findings suggest standardized risk screening using a brief, validated self-report tool would be a pragmatic approach to increasing access to bereavement care.
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Affiliation(s)
- Kailey E Roberts
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York, USA
| | - Greta Jankauskaite
- Department of Psychology, University of Maryland, College Park, Maryland, USA
| | - Elizabeth Slivjak
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
| | - Lisa Rubin
- Department of Clinical Psychology, The New School for Social Research, New York, New York, USA
| | | | - Stacy Stabler
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Lori Wiener
- National Cancer Institute, Pediatric Oncology Branch, Bethesda, Maryland, USA
| | - Holly G Prigerson
- Cornell Center for Research on End-of-life Care, Weill Cornell Medicine, New York, New York, USA
| | - Wendy G Lichtenthal
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Psychiatry, Weill Cornell Medicine, New York, New York, USA
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The Impact of Receiving a Family-Oriented Therapeutic Conversation Intervention Before and During Bereavement Among Family Cancer Caregivers: A Nonrandomized Trial. J Hosp Palliat Nurs 2020; 22:383-391. [PMID: 32826543 DOI: 10.1097/njh.0000000000000679] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Effective communication is the foundation of quality care in palliative nursing. As frontline palliative home care providers, nurses could foster more effective bereavement coping skills through therapeutic conversations. The purpose of this study was to evaluate the impact of a nursing intervention offered to bereaved family cancer caregivers. This was a quasi-experimental design, with a posttest-only comparison of the intervention and control groups receiving usual care. Bereaved caregivers (n = 51) receiving services from a specialized palliative home care unit participated and completed measures of depression, anxiety, stress, and grief reactions 3, 5, and 6 months after their close relative had died.There was a significant decrease in anxiety symptoms in the intervention group compared with the control group across all 3 time points. Anxiety and stress symptoms also decreased over time in the 2 groups combined, but this decrease was not observed for depression. When evaluating grief reactions, the intervention group had a lower mean of controlled grief responses, across the posttest period, than the control group.Results demonstrate that providing bereaved family caregivers the opportunity to participate in a therapeutic conversation intervention might reduce distressing symptoms in early bereavement.
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Lennaerts-Kats H, Ebenau A, Steppe M, van der Steen JT, Meinders MJ, Vissers K, Munneke M, Groot M, Bloem BR. "How Long Can I Carry On?" The Need for Palliative Care in Parkinson's Disease: A Qualitative Study from the Perspective of Bereaved Family Caregivers. JOURNAL OF PARKINSONS DISEASE 2020; 10:1631-1642. [PMID: 32651330 PMCID: PMC8764597 DOI: 10.3233/jpd-191884] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Background: Family caregivers provide the majority of care for people with Parkinson’s disease (PD) in the palliative care phase. For many this is a demanding experience, affecting their quality of life. Objective: We set out to map the experiences of bereaved family caregivers during the period of informal care in the palliative care phase as well as after the death of their loved one with PD. Methods: Ten bereaved family caregivers participated in this qualitative study. Semi-structured interviews were conducted and interpretative phenomenological analysis was used executed. Results: We identified four main themes. 1) Feeling like a professional caregiver: while caring for a person with PD, the family caregivers took over many roles and tasks of the person with PD. 2) Healthcare professionals do not always know what PD really means: most interviewees had negative experiences with knowledge and understanding of PD of, especially, (practice) nurses. 3) Being on your own: many respondents had felt highly responsible for their loved one’s care and lacked time and space for themselves. Grief and feelings of guilt were present during the caregiving period and after death. 4) Being behind the times: to provide palliative care in line with patients’ preferences and to feel prepared for the palliative care phase of PD, proactive palliative care planning was considered important. However, the interviewees told that this was most often not provided. Conclusion: These findings indicate that caring for a person with PD in the palliative care phase is a demanding experience for family caregivers. They experience psychological problems for many years before and after the death of the person with PD. Increasing healthcare professionals’ awareness of family and bereaved caregivers’ needs may mitigate these long-term detrimental effects.
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Affiliation(s)
- Herma Lennaerts-Kats
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands.,Radboud University Medical Center (Radboudumc), Department of Anesthesiology, Pain and Palliative Care, Nijmegen, The Netherlands
| | - Anne Ebenau
- Radboud University Medical Center (Radboudumc), Department of Anesthesiology, Pain and Palliative Care, Nijmegen, The Netherlands
| | - Maxime Steppe
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands
| | - Jenny T van der Steen
- Radboud University Medical Center (Radboudumc), Nijmegen, Department of Primary and Community Care, Nijmegen, The Netherlands; and Leiden University Medical Center, Department of Public Health and Primary Care, Leiden, The Netherlands
| | - Marjan J Meinders
- Radboud University Medical Center (Radboudumc), Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare, Nijmegen, the Netherlands
| | - Kris Vissers
- Radboud University Medical Center (Radboudumc), Department of Anesthesiology, Pain and Palliative Care, Nijmegen, The Netherlands
| | - Marten Munneke
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands
| | - Marieke Groot
- Radboud University Medical Center (Radboudumc), Department of Anesthesiology, Pain and Palliative Care, Nijmegen, The Netherlands
| | - Bastiaan R Bloem
- Radboud University Medical Center, Donders Institute for Brain, Cognition and Behaviour, Department of Neurology, Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands
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Harrop E, Morgan F, Longo M, Semedo L, Fitzgibbon J, Pickett S, Scott H, Seddon K, Sivell S, Nelson A, Byrne A. The impacts and effectiveness of support for people bereaved through advanced illness: A systematic review and thematic synthesis. Palliat Med 2020; 34:871-888. [PMID: 32419630 PMCID: PMC7341024 DOI: 10.1177/0269216320920533] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Bereavement support is a key component of palliative care, with different types of support recommended according to need. Previous reviews have typically focused on specialised interventions and have not considered more generic forms of support, drawing on different research methodologies. AIM To review the quantitative and qualitative evidence on the effectiveness and impact of interventions and services providing support for adults bereaved through advanced illness. DESIGN A mixed-methods systematic review was conducted, with narrative synthesis of quantitative results and thematic synthesis of qualitative results. The review protocol is published in PROSPERO ( www.crd.york.ac.uk/prospero , CRD42016043530). DATA SOURCES The databases MEDLINE, Embase, PsycINFO, CINAHL and Social Policy and Practice were searched from 1990 to March 2019. Studies were included which reported evaluation results of bereavement interventions, following screening by two independent researchers. Study quality was assessed using GATE checklists. RESULTS A total of 31 studies were included, reporting on bereavement support groups, psychological and counselling interventions and a mix of other forms of support. Improvements in study outcomes were commonly reported, but the quality of the quantitative evidence was generally poor or mixed. Three main impacts were identified in the qualitative evidence, which also varied in quality: 'loss and grief resolution', 'sense of mastery and moving ahead' and 'social support'. CONCLUSION Conclusions on effectiveness are limited by small sample sizes and heterogeneity in study populations, models of care and outcomes. The qualitative evidence suggests several cross-cutting benefits and helps explain the impact mechanisms and contextual factors that are integral to the support.
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Affiliation(s)
- Emily Harrop
- Marie Curie Research Centre, Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Fiona Morgan
- Marie Curie Research Centre and SURE, Cardiff University, Cardiff, UK
| | - Mirella Longo
- Marie Curie Research Centre, Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Lenira Semedo
- Marie Curie Research Centre, Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Jim Fitzgibbon
- Marie Curie Research Centre, Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Sara Pickett
- Swansea Centre for Health Economics, Swansea University, Swansea, UK
| | - Hannah Scott
- School of Dentistry, Cardiff University, University Hospital Wales, Cardiff, UK
| | - Kathy Seddon
- Marie Curie Research Centre, Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Stephanie Sivell
- Marie Curie Research Centre, Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Annmarie Nelson
- Marie Curie Research Centre, Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Anthony Byrne
- Marie Curie Research Centre, Division of Population Medicine, Cardiff University, Cardiff, UK
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Hudson P, Morrison RS, Schulz R, Brody AA, Dahlin C, Kelly K, Meier DE. Improving Support for Family Caregivers of People with a Serious Illness in the United States: Strategic Agenda and Call to Action. Palliat Med Rep 2020; 1:6-17. [PMID: 34223450 PMCID: PMC8241318 DOI: 10.1089/pmr.2020.0004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2020] [Indexed: 11/29/2022] Open
Abstract
Background: An estimated 30% of the adult American population are caregivers and many of the people they support live with serious illnesses. Caregivers provide an average of 20 hours of services per week and are heavily involved in assisting with activities of daily living. This input represents considerable economic value to the health care system and to the well-being of communities. However, the impact of the burden on caregivers is considerable with negative outcomes on their physical, psychological, social, and financial well-being. The current landscape of caregiver policy in the United States is not well coordinated and does not meet the needs of this population. Objective: To develop a strategy to enhance the future of family caregiver support of people with serious illness within the United States. Methods: (1) Creation of project steering and key stakeholder groups; (2) survey and in-depth interviews with key stakeholders; (3) review of key family caregiver reports, systematic reviews, policies, and financial initiatives. Results: A strategy to provide clear direction to enhance the future of family caregiver support of people with serious illness within the United States was developed focusing explicitly on policy, research, training, service delivery, and public engagement. Conclusions: The strategy is an initial step aimed at enhancing support for family caregivers of people living with serious illness. It outlines key recommendations and a "call to action." Subsequent work will be needed on prioritization of tasks, gaining buy-in at all levels of the policy-making apparatus, operationalization, and implementation.
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Affiliation(s)
- Peter Hudson
- Centre for Palliative Care, St Vincent's Hospital, Melbourne, Australia
- The University of Melbourne, Melbourne, Australia
- Vrije University Brussels, Belgium
| | - R. Sean Morrison
- National Palliative Care Research Center, Icahn School of Medicine of Mount Sinai, New York, New York, USA
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine of Mount Sinai, New York, New York, USA
- Lilian and Benjamin Hertzberg Palliative Care Institute, Mount Sinai Hospital, New York, New York, USA
| | - Richard Schulz
- Center for Social and Urban Research, Education, and Policy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Psychiatry, School of Medicine, Education, and Policy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Center for Caregiving Research, Education, and Policy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Abraham Aizer Brody
- Rory Meyers College of Nursing, New York University, New York, New York, USA
- Hartford Institute for Geriatric Nursing, New York University, New York, New York, USA
| | - Constance Dahlin
- Center to Advance Palliative Care, New York, New York, USA
- Hospice and Palliative Nurses Association, Pittsburgh, Pennsylvania, USA
- North Shore Medical Center, Salem, Massachusetts, USA
| | - Kathleen Kelly
- Family Caregiver Alliance, National Center on Caregiving, San Francisco, California, USA
| | - Diane E. Meier
- North Shore Medical Center, Salem, Massachusetts, USA
- Patty and Jay Baker National Palliative Care Center, Icahn School of Medicine of Mount Sinai, New York, New York, USA
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine of Mount Sinai, New York, New York, USA
- Medical Ethics, Icahn School of Medicine of Mount Sinai, New York, New York, USA
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40
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Breen LJ, Moullin JC. The value of implementation science in bridging the evidence gap in bereavement care. DEATH STUDIES 2020; 46:639-647. [PMID: 32250203 DOI: 10.1080/07481187.2020.1747572] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
There is a gap in the use of evidence in bereavement care. Implementation science is a field focused on moving evidence into practice and therefore may help close the gap. Implementation science advances the design, relevance, and dissemination of research and the adoption, implementation, and maintenance of evidence-based practices. We provide an overview of implementation science, describe five implementation frameworks (Knowledge to Action; Behavior Change Wheel; Exploration Preparation Implementation Sustainment; Interactive Systems Framework; and Reach, Adoption, Implementation, Maintenance), and illustrate their application in bereavement care. These advancements will promote high-quality bereavement care that improves the lives of bereaved people.
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Affiliation(s)
- Lauren J Breen
- School of Psychology, Curtin University, Perth, Australia
| | - Joanna C Moullin
- School of Pharmacy and Biomedical Sciences, Curtin University, Perth, Australia
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Harrop E, Scott H, Sivell S, Seddon K, Fitzgibbon J, Morgan F, Pickett S, Byrne A, Nelson A, Longo M. Coping and wellbeing in bereavement: two core outcomes for evaluating bereavement support in palliative care. BMC Palliat Care 2020; 19:29. [PMID: 32164642 PMCID: PMC7068975 DOI: 10.1186/s12904-020-0532-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 02/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bereavement support is a core part of palliative care. However, the evidence base is limited by a lack of consistency in the outcomes used to evaluate services and models of support, which makes it difficult to compare approaches. Core Outcome Sets (COS) represent the minimum that should be measured in research into specific conditions or services. The aim of this study was to use a stakeholders' perspective to develop a COS for evaluating bereavement support for adults in adult palliative care settings. METHODS A list of outcomes relevant to bereavement support was created following a systematic review of the quantitative and qualitative literature. At an expert workshop 21 stakeholders discussed their views on the most important outcomes and compared these to and critiqued the lists constructed from the review. These lists and discussions informed a two round international DELPHI survey (n = 240) designed to reach consensus on which outcomes/outcome dimensions should be included in the COS. To prioritise and validate the items emerging from the survey, participants at a subsequent consensus day ranked the relative importance of these items (n = 23). A final feedback exercise with these consensus day participants was conducted to confirm the selection of outcomes and dimensions. RESULTS 'Ability to cope with grief' and 'Quality of life and mental wellbeing' were selected as two core outcomes. Twenty-one different dimensions to explore when assessing these outcomes were also identified. The coping related dimensions have been categorised as: Negative and overwhelming grief; Communication and connectedness; Understanding, accepting and finding meaning in grief; Finding balance between grief and life going forwards; Accessing appropriate support. Those relating to quality of life and wellbeing have been categorised as; Participation in work and/or regular activities; Relationships and social functioning; Positive mental wellbeing and Negative mental and emotional state. CONCLUSION This COS outlines a more consistent way forward for bereavement researchers and practitioners, whilst also orientating towards public health and resilience-based approaches to bereavement care. Further work is planned to identify and develop measures which are specific to this core outcome set, and which will facilitate the future comparability of bereavement services and interventions.
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Affiliation(s)
- Emily Harrop
- Marie Curie Research Centre, Division of Population Medicine, Cardiff University, 8th Floor Neuadd Meirionydd, Heath Park Way, Cardiff, CF14 4YS UK
| | - Hannah Scott
- School of Dentistry, Cardiff University, University Hospital Wales, Heath Park, Cardiff, CF14 4XY UK
| | - Stephanie Sivell
- Marie Curie Research Centre, Division of Population Medicine, Cardiff University, 8th Floor Neuadd Meirionydd, Heath Park Way, Cardiff, CF14 4YS UK
| | - Kathy Seddon
- Marie Curie Research Centre, Division of Population Medicine, Cardiff University, 8th Floor Neuadd Meirionydd, Heath Park Way, Cardiff, CF14 4YS UK
| | - Jim Fitzgibbon
- Marie Curie Research Centre, Division of Population Medicine, Cardiff University, 8th Floor Neuadd Meirionydd, Heath Park Way, Cardiff, CF14 4YS UK
| | - Fiona Morgan
- Marie Curie Research Centre, Division of Population Medicine, Cardiff University, 8th Floor Neuadd Meirionydd, Heath Park Way, Cardiff, CF14 4YS UK
| | - Sara Pickett
- Swansea Centre for Health Economics, Swansea University, Singleton Park, Swansea, SA2 8PP UK
| | - Anthony Byrne
- Marie Curie Research Centre, Division of Population Medicine, Cardiff University, 8th Floor Neuadd Meirionydd, Heath Park Way, Cardiff, CF14 4YS UK
| | - Annmarie Nelson
- Marie Curie Research Centre, Division of Population Medicine, Cardiff University, 8th Floor Neuadd Meirionydd, Heath Park Way, Cardiff, CF14 4YS UK
| | - Mirella Longo
- Marie Curie Research Centre, Division of Population Medicine, Cardiff University, 8th Floor Neuadd Meirionydd, Heath Park Way, Cardiff, CF14 4YS UK
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42
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Breen LJ, Aoun SM, O'Connor M, Johnson AR, Howting D. Effect of caregiving at end of life on grief, quality of life and general health: A prospective, longitudinal, comparative study. Palliat Med 2020; 34:145-154. [PMID: 31659934 DOI: 10.1177/0269216319880766] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Determining the effect of caregiving and bereavement remains a challenge. To date, no study has employed a comparison group to investigate caregivers' grief, quality of life and general health in relation to non-caregivers. AIM We aimed to determine how caregivers' grief, quality of life and general health changed following death compared to non-caregivers and whether pre-death grief predicted these outcomes. DESIGN A prospective, longitudinal study of family caregivers and a comparison group matched for age, gender and postcode was conducted. All participants completed questionnaires at four points - once pre-death and three times post-death (3-4 months, 6-7 months and 9-10 months). SETTING/PARTICIPANTS Participants (N = 70) were family caregivers of persons receiving palliative care, mostly for cancer, recruited from three palliative care providers in Western Australia and matched comparisons recruited from advertisements. RESULTS There were significant differences between the caregivers' and comparisons' grief, general health and quality of life at pre-death, 3-4 months and 6-7 months post-death, but not at 9-10 months post-death. The rate of progression in these constructs following death was independent from the intensity of pre-death grief. However, caregiver prolonged grief score significantly predicted prolonged grief score at 6-7 and 9-10 months post-death. CONCLUSION It took 9-10 months for the caregivers' grief, general health and quality of life to correspond to the comparison group. These findings present an opportunity for palliative care research and practice to consider how best to support the majority of caregivers without grief complications so that their pre- and post-death support needs are realised.
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Affiliation(s)
- Lauren J Breen
- School of Psychology, Curtin University, Perth, WA, Australia
| | - Samar M Aoun
- Palliative Care Unit, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia.,The Perron Institute for Neurological and Translational Science, Perth, WA, Australia
| | - Moira O'Connor
- School of Psychology, Curtin University, Perth, WA, Australia
| | | | - Denise Howting
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, WA, Australia.,Centre for Medical Research, The University of Western Australia, Perth, WA, Australia.,Harry Perkins Institute of Medical Research, Perth, WA, Australia
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43
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Sekgobela G, Peu M, van der Wath A. "They brought my smile back": A phenomenological description of widows' experiences of psychosocial support. DEATH STUDIES 2019; 45:603-612. [PMID: 31584347 DOI: 10.1080/07481187.2019.1671542] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The consequences of widowhood can be overwhelming. Widows sometimes experience difficulties to obtain psychosocial support to overcome the challenges they face. In this phenomenological study, purposively selected widows were asked about their experiences of widowhood in terms of different sources of support. The analysis illuminated the meaning widows attach to different sources of psychosocial support. Participants experienced both positive and negative encounters with their sources of support. During negative encounters, widows experienced feelings of disappointment; and when their psychosocial support needs were met, they experienced a sense of happiness and a positive level of satisfaction.
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Affiliation(s)
- Gopolang Sekgobela
- Department of Nursing Science, University of Pretoria, Pretoria, South Africa
| | - Mmapheko Peu
- Department of Nursing Science, University of Pretoria, Pretoria, South Africa
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Kobel C, Morris D, Thompson C, Williams KE. Bereavement Support in Palliative Care: A National Survey of Australian Services. J Palliat Med 2019; 22:933-938. [DOI: 10.1089/jpm.2018.0502] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Conrad Kobel
- Centre for Health Service Development, Australian Health Services Research Institute (AHSRI), Faculty of Business, University of Wollongong, Wollongong, Australia
| | - Darcy Morris
- Centre for Health Service Development, Australian Health Services Research Institute (AHSRI), Faculty of Business, University of Wollongong, Wollongong, Australia
| | - Cristina Thompson
- Centre for Health Service Development, Australian Health Services Research Institute (AHSRI), Faculty of Business, University of Wollongong, Wollongong, Australia
| | - Kathryn E. Williams
- Centre for Health Service Development, Australian Health Services Research Institute (AHSRI), Faculty of Business, University of Wollongong, Wollongong, Australia
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45
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Hay A, Hall CW, Sealey M, Lobb EA, Breen LJ. Developing a practice-based research agenda for grief and bereavement care. DEATH STUDIES 2019; 45:331-341. [PMID: 31293223 DOI: 10.1080/07481187.2019.1636897] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
We aimed to identify practitioners' perspectives on current research priorities in grief and bereavement care. Grief and bereavement care providers were invited to participate in a three-phase Delphi study to create expert consensus on the top priorities for grief and bereavement research. A total of 140 participants completed Phase 1, 84 completed Phase 2, and 70 completed Phase 3. These top 10 research priorities form the basis of a practice-based research agenda for grief and bereavement care to enable researchers to respond to key issues in grief and bereavement care that will ultimately improve the lives of bereaved people.
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Affiliation(s)
- Ashton Hay
- School of Psychology, Curtin University, Perth, Australia
| | | | - Margaret Sealey
- College of Science, Health, Engineering and Education, Murdoch University, Perth, Australia
| | - Elizabeth A Lobb
- Calvary Health Care Kogarah, Kogarah, Australia
- Cunningham Centre for Palliative Care, Darlinghurst, Australia
- School of Medicine, University of Notre Dame Sydney, Darlinghurst, Australia
| | - Lauren J Breen
- School of Psychology, Curtin University, Perth, Australia
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46
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Vermorgen M, De Vleminck A, Leemans K, Van den Block L, Van Audenhove C, Deliens L, Cohen J. Family carer support in home and hospital: a cross-sectional survey of specialised palliative care. BMJ Support Palliat Care 2019; 10:e33. [PMID: 31243021 DOI: 10.1136/bmjspcare-2019-001795] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/03/2019] [Accepted: 04/23/2019] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate: (1) to what extent family carers of people supported by specialised palliative care services felt they had been provided with information, support and aftercare and (2) how this varied by type of palliative care service, length of enrolment and characteristics of deceased. METHODS A cross-sectional postal survey was conducted using a structured questionnaire with nine items on information, support and aftercare provided by specialised palliative care services to family carers. Flemish family carers of people who had made use of specialised palliative care services at home or in hospital were contacted. RESULTS Of all primary family carers (response rate of 53.5% resulting in n=1504), 77.7% indicated they were asked frequently by professionals how they were feeling. Around 75% indicated they had been informed about specific end-of-life topics and around 90% felt sufficiently supported before and immediately after the death. Family carers of people who had died in a palliative care unit, compared with other types of specialised palliative care services, indicated having received more information, support and aftercare. CONCLUSIONS Family carers evaluate the professional assistance provided more positively when death occurred in a palliative care unit. Policy changes might be needed to reach the same level of care across all specialised palliative care services.
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Affiliation(s)
- Maarten Vermorgen
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium
| | - Aline De Vleminck
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium
| | - Kathleen Leemans
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium.,Department of Radiotherapy, Brussels University Hospital, Brussels, Belgium
| | - Lieve Van den Block
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium
| | - Chantal Van Audenhove
- LUCAS Center for Care Research and Consultancy, University of Leuven, Leuven, Belgium
| | - Luc Deliens
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium.,Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Joachim Cohen
- End-of-Life Care Research Group, Vrije Universiteit Brussel & Ghent University, Brussels, Belgium
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Weaver MS, Lichtenthal WG, Larson K, Wiener L. How I approach expressing condolences and longitudinal remembering to a family after the death of a child. Pediatr Blood Cancer 2019; 66:e27489. [PMID: 30318860 PMCID: PMC6726425 DOI: 10.1002/pbc.27489] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 09/13/2018] [Accepted: 09/13/2018] [Indexed: 11/06/2022]
Abstract
Bereaved families fear their child being forgotten by those who knew their loved child, including their child's oncology team. Thoughtfully timed, family-centric condolences shared by pediatric oncology team members have the potential to extend our compassion and kindness toward a family during the darkness of grief. Well-intended medical teams sometimes feel "at a loss" in terms of what to say to a grieving family and how or when to say it. This paper provides a tangible overview of written or verbal condolence communication in a format that can be personalized to the provider and the patient's family.
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Affiliation(s)
- Meaghann S. Weaver
- Division of Palliative Care, Department of Pediatrics, Children's Hospital and Medical Center, Omaha, Nebraska
| | - Wendy G. Lichtenthal
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Kara Larson
- Division of Spiritual Ministry and Chaplaincy, Department of Pediatrics, Children's Hospital and Medical Center, Omaha, Nebraska
| | - Lori Wiener
- Pediatric Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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49
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Leonard R, Horsfall D, Rosenberg J, Noonan K. Carer experience of end-of-life service provision: a social network analysis. BMJ Support Palliat Care 2018; 10:e20. [PMID: 29440050 PMCID: PMC7286032 DOI: 10.1136/bmjspcare-2017-001344] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 12/07/2017] [Accepted: 01/17/2018] [Indexed: 12/02/2022]
Abstract
Objective To identify the position of formal service providers in the networks of those providing end-of-life care in the home from the perspective of the informal network. Methods Using third-generation social network analysis, this study examined the nature and strength of relationships of informal caring networks with formal service providers through individual carer interviews, focus groups of caring networks and outer network interviews. Results Service providers were usually highly valued for providing services, equipment, pain management and personalised care for the dying person plus support and advice to the principal carer about both caring tasks and negotiating the health system. However, formal service providers were positioned as marginal in the caring network. Analysis of the relative density of relationships within networks showed that whereas relationships among family and friends had similar density, relationships between service providers and family or friends were significantly lower. Conclusion The results supported the Circles of Care model and mirror the perspective of formal service providers identified in previous research. The research raises questions about how formal and informal networks might be better integrated to increase their effectiveness for supporting in-home care.
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Affiliation(s)
- Rosemary Leonard
- School of Social Science and Psychology, Western Sydney University, Sydney, New South Wales, Australia
| | - Debbie Horsfall
- School of Social Science and Psychology, Western Sydney University, Sydney, New South Wales, Australia
| | - John Rosenberg
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Kerrie Noonan
- School of Social Science and Psychology, Western Sydney University, Sydney, New South Wales, Australia.,School of Social Sciences & Psychology, Western Sydney University and Palliative Care, Liverpool Hospital, Sydney, New South Wales, Australia
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