Bereavement and bereavement care in health and social care: provision and practice in Scotland

An educational bereavement program to decrease clinical staff's barriers and improve self-efficacy of providing bereavement care

PURPOSE

Clinicians face personal barriers that impede the provision of bereavement care and require education in hospice care. This study aims to investigate the effects of an educational bereavement program on emotional and cognitive barriers, self-efficacy, and professional quality of life among clinicians in hospice care.

METHODS

A pretest-posttest design was implemented. A total of 194 clinicians with working experience in hospice care were recruited. The participants underwent a 12-h workshop. The content included lectures, role-play, and group discussion. Emotional and cognitive barriers, self-efficacy, and professional quality of life were measured before and after the program and at 3-month follow-up.

RESULTS

After the educational program, negative emotional barriers (F (2, 386) = 17.07, p < 0.001), lack of ability (F (2, 386) = 20.11, p < 0.001), belief in avoidance (F (2, 386) = 7.10, p = 0.001), outcome expectancy (F (2, 386) = 11.32, p < 0.001), and burnout (F (2, 386) = 5.59, p = 0.005) decreased significantly. Self-efficacy (F (2, 386) = 5.37, p = 0.006) and compassion satisfaction (F (2, 386) = 127.99, p < 0.001) increased significantly.

CONCLUSION

The educational program addressed personal barriers to bereavement care. Role-play and group discussion about emotional and cognitive barriers can reduce barriers and improve self-efficacy in clinicians in hospice care.

Phone follow up to families of COVID-19 patients who died at the hospital: families' grief reactions and clinical psychologists' roles

A proportion of persons affected by coronavirus disease‐19 (COVID‐19) die and do so in extraordinary circumstances. This can make grief management extremely challenging for families. The Clinical Psychology unit of an Italian hospital offered a bereavement follow‐up call to such families. This study aimed to explore the families' experiences and needs collected during these calls, and the role that the psychologists played through the call. A total of 246 families were called over 3 months. Multiple qualitative methods included: (i) written reports of the calls with relatives of patients who died at the hospital for COVID‐19; (ii) qualitative semi‐structured interviews with psychologists involved in the calls; (iii) observation of psychologists' peer group discussions. A thematic analysis was conducted. Six themes emerged: without death rituals, solitary, unexpected, unfair, unsafe, coexisting with other stressors. Families' reactions were perceived by psychologists as close to a traumatic grief. Families' needs ranged from finding alternative rituals to giving meaning and expressing different emotions. The psychologists played both a social‐institutional and a psychological‐human role through the calls (e.g., they cured disrupted communication or validated feelings and choices). This study highlighted the potential of traumatic grief of families of COVID‐19 victims, and provided indications for supporting them within the space of a short phone call.

Community-based counseling reaches and helps bereaved people living in low-income households

OBJECTIVE

Poverty is related to increased grief-related mental health problems, leading some to suggest bereavement counseling should be tailored to income. However, information about accessibility and effectiveness of such counseling programs serving low-income households is scarce. This longitudinal study therefore investigated the association between poverty and complicated grief (CG), and the effectiveness of a community-based bereavement counseling program in serving low-income households.

METHODS

Two hundred eighty-eight participants (75% female) were enrolled. Loss-related and demographic variables were assessed at baseline. Regression analyses were used to investigate household income as a predictor of CG, and examine bereavement counseling effectiveness by comparing CG symptom change across three household income categories across three time-points: baseline (T1), T1 + 12 months (T2), and T1 + 18 months (T3).

RESULTS

Of all participants, 35.8% reported below poverty-threshold income, twice the general population's rate. Multiple regression analysis indicated poverty-threshold income was a predictor of CG symptoms over and above demographic and loss-related characteristics. Three-way interaction analysis detected a significant treatment effect for study condition across time, but no differences in treatment effects across income.

CONCLUSION

Lower household income was associated with higher CG symptoms. Since income did not predict differential treatment response, community-based bereavement counseling appeared no less efficacious for members of low-income households. Clinical or methodological significance of this article: While previous research has indicated low income may be a risk factor for mental health problems after bereavement, and it has therefore been suggested bereavement counseling should be tailored to income, no study to date has investigated the need for such tailoring. This controlled, longitudinal treatment study fills this gap in knowledge. Main findings are that low income is a key predictor of complicated grief symptoms. The study also shows that the effectiveness of one-to-one bereavement counseling does not appear to differ according to income level.

Effectiveness of bereavement counselling through a community-based organization: A naturalistic, controlled trial

This controlled, longitudinal investigation tested the effectiveness of a bereavement counselling model for adults on reducing complicated grief (CG) symptoms. Participants (N = 344; 79% female; mean age: 49.3 years) were adult residents of Scotland who were bereaved of a close relation or partner, experiencing elevated levels of CG, and/or risks of developing CG. It was hypothesized that participants who received intervention would experience a greater decline in CG levels immediately following the intervention compared to the control participants, but the difference would diminish at follow‐up (due to relapse). Data were collected via postal questionnaire at 3 time points: baseline (T), post‐intervention (T + 12 months), and follow‐up (T + 18 months). CG, post‐traumatic stress, and general psychological distress were assessed at all time points. Multilevel analyses controlling for relevant covariates were conducted to examine group differences in symptom levels over time. A stepwise, serial gatekeeping procedure was used to correct for multiple hypothesis testing. A main finding was that, contrary to expectations, counselling intervention and control group participants experienced a similar reduction in CG symptoms at postmeasure. However, intervention participants demonstrated a greater reduction in symptom levels at follow‐up (M = 53.64; d = .33) compared to the control group (M = 62.00). Results suggest community‐based bereavement counselling may have long‐term beneficial effects. Further longitudinal treatment effect investigations with extensive study intervals are needed.

The suffering in silence of older parents whose child died of cancer: A qualitative study

As life expectancy grows, the death of an adult child becomes a highly prevalent problem for older adults. The present study is based on nine interviews and explores the experience of parents (≥70 years) outliving an adult child. The bereaved parents described some silencing processes constraining their expression of grief. When an adult dies, the social support system nearly automatically directs its care towards the bereaved nuclear family. Parental grief at old age is therefore often not recognized and/or acknowledged. Health care providers should be sensitive to the silent grief of older parents both in geriatric and oncology care settings.

Initial Validation of a Comprehensive Assessment Instrument for Bereavement-Related Grief Symptoms and Risk of Complications: The Indicator of Bereavement Adaptation-Cruse Scotland (IBACS)

Objective

This study assessed the validity of the Indicator of Bereavement Adaptation Cruse Scotland (IBACS). Designed for use in clinical and non-clinical settings, the IBACS measures severity of grief symptoms and risk of developing complications.

Method

N = 196 (44 male, 152 female) help-seeking, bereaved Scottish adults participated at two timepoints: T1 (baseline) and T2 (after 18 months). Four validated assessment instruments were administered: CORE-R, ICG-R, IES-R, SCL-90-R. Discriminative ability was assessed using ROC curve analysis. Concurrent validity was tested through correlation analysis at T1. Predictive validity was assessed using correlation analyses and ROC curve analysis. Optimal IBACS cutoff values were obtained by calculating a maximal Youden index J in ROC curve analysis. Clinical implications were compared across instruments.

Results

ROC curve analysis results (AUC = .84, p < .01, 95% CI between .77 and .90) indicated the IBACS is a good diagnostic instrument for assessing complicated grief. Positive correlations (p < .01, 2-tailed) with all four instruments at T1 demonstrated the IBACS' concurrent validity, strongest with complicated grief measures (r = .82). Predictive validity was shown to be fair in T2 ROC curve analysis results (n = 67, AUC = .78, 95% CI between .65 and .92; p < .01). Predictive validity was also supported by stable positive correlations between IBACS and other instruments at T2. Clinical indications were found not to differ across instruments.

Conclusions

The IBACS offers effective grief symptom and risk assessment for use by non-clinicians. Indications are sufficient to support intake assessment for a stepped model of bereavement intervention.

Primary care providers' bereavement care practices: recommendations for research directions

OBJECTIVE

Bereaved patients are often seen in primary care settings. Although most do not require formal support, physicians may be called upon to provide support to some bereaved, particularly those with bereavement-related mental health disorders like complicated grief and bereavement-related depression. Research evidence on physician bereavement care is scant. We make recommendations for future research in this area.

DESIGN

Literature review focuses on studies conducted between 1996 and 2013 in the United States. Searches of Medline and PsychInfo, along with hand searches of reference sections, were conducted.

RESULTS

The limited existing research indicates substantial gaps in the research literature, especially in the areas of primary care physician skill and capacity, patient-level outcomes, and the quality of research methodology. No US studies have focused specifically on care for bereavement-related mental health disorders. We provide recommendations about how to improve research about primary care bereavement care.

CONCLUSIONS

The primary care sector offers ample opportunities for research on bereavement care. With greater research efforts, there may be improvements to quality of bereavement care in primary care, in general, and also to the accurate detection and appropriate referral for bereavement-related mental health conditions.

Relationships among actions, antecedents, and outcomes of grief care for bereaved caregivers: surveying visiting nurses throughout Japan

AIM

This research identified and analyzed relationships of grief care by visiting nurses using antecedent factors and grief care outcomes.

METHODS

A mailed, original, researcher-developed, self-administered questionnaire for visiting nurses employed at home-visit nursing care stations throughout Japan provided data which was then analyzed using multiple regression analyses. Grief care provided by nurses is divided into three scales: (i) grief care from beginning of home care to the terminal period (GCBT); (ii) grief care at deathbed (GCDB); and (iii) grief care after the patient's death (GCAD).

RESULTS

Valid responses were provided by 332 (90.7%) administrators and 1442 (76.1%) staff nurses. The data revealed that it was "years of experience as a visiting nurse" and "experience of learning grief care after the patient's death" that were significant to GCBT. Also, nurses' outcomes "learning opportunity" and "confidence in visiting nursing" were significant to GCBT and GCAD.

CONCLUSION

Simply being told how to provide care to the patient during the terminal phase is inadequate. The care during this period seemed to require years of experience as a visiting nurse. Nurses should consider more effective educational methods to nurture this skill rather than wait for it to be acquired through experience. Implementation of grief care is an opportunity for receiving feedback on the care nurses provided. Grief care provides motivation for nursing and maintains mental health.

A qualitative evaluation of the provision of bereavement care accessed by service users living in a Health and Social Care Trust area in Northern Ireland

Within the health and social care sector in the United Kingdom, the management of death and bereavement has become increasingly challenging. This service evaluation sought to explore the bereavement care offered to individuals living in one Health and Social Care Trust catchment area of Northern Ireland. Qualitative interviews were conducted with key government and voluntary agency staff. The findings indicated that much of the bereavement provision is based on the interest and initiative of individual staff members, with few processes to assess the level of bereavement care needed and those best skilled to provide it. Recommendations are made for a bereavement care strategy that outlines a bereavement needs assessment process, identifying the scope of interventions and protocols for practice.