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Cengiz H, Cacciatore J. Status Consumption as Coping With Fear of Death: The Mediating Role of Death Avoidance and the Moderating Role of Materialism. Psychol Rep 2024:332941241251458. [PMID: 38684445 DOI: 10.1177/00332941241251458] [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: 05/02/2024]
Abstract
Individuals employ various coping mechanisms to deal with the fear of death. While materialism and status consumption are commonly recognized in the literature as such strategies, no study has yet empirically tested this premise. Accordingly, this study examined the mediating role of death avoidance in the link between the fear of death and death-related status consumption (DRSC). Data obtained from 346 participants were analyzed using structural equation modeling. The results showed that fear of death significantly and positively influences DRSC and that death avoidance partially and positively mediates this relationship. Results also revealed that materialism strengthens the relationship between fear of death and DRSC, while it does not significantly moderate the relationship between death avoidance and DRSC. These results support the conclusion that death-related status consumption may play a critical role as an avoidance mechanism in coping with the fear of death. This study, being among the few that investigate death-related consumer behaviors, enriches both terror management theory and the literature on consumer behavior in crises.
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Affiliation(s)
- Hakan Cengiz
- School of Social Work, Arizona State University, Phoenix, AZ, USA
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2
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Levesque DA, Lunardini MM, Adams SN, Payne EL, Neumann BG. Grief Coach: Feasibility and acceptability of a text message program for bereavement support among grievers in the United Kingdom. DEATH STUDIES 2024:1-12. [PMID: 38573792 DOI: 10.1080/07481187.2024.2334080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
To address gaps in bereavement services in the UK, a national charity offered free access to Grief Coach, a 12-month text message-based grief support program. To assess the feasibility and acceptability of the approach, this study examined program reach, retention, and user satisfaction. Over 4000 grievers enrolled in the program over 13.5 months; 6- and 12-month retention rates were 87.8% and 83.2%. Among individuals responding to a satisfaction survey (response rate = 55.9%), 94.8% rated the program as moderately or very helpful and 95.4% said it contributed to their sense of being supported in their grief. Common themes emerging from a qualitative analysis of the written comments were how the program helped with coping with the pain of grief and user appreciation of the program. Grief Coach may be a promising component of high-quality grief support to meet the needs of grieving people in the UK.
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Cullen I, Bailes M, Shropshire P, Perry S, Karlekar M. Connecting Families to Bereavement Resources: A Hospital-Based, Bereavement Follow-Up Pilot During First-Wave COVID-19. J Palliat Med 2024; 27:532-536. [PMID: 38346311 DOI: 10.1089/jpm.2023.0375] [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] [Indexed: 04/06/2024] Open
Abstract
Background: Hospitals often lack bereavement programs. Bereaved families often navigate grief support on their own. This problem was complicated by the early COVID-19 pandemic. Objective: Describe a cost neutral pilot to support next of kin (NOK) of deceased patients from our communicable disease response unit (CDRU) and palliative care unit (PCU). Design: Ad hoc pilot leveraging chaplains and a social worker (SW) to call NOK for grief support using a templated guide, referring interested NOK to bereavement support agencies. Setting/Subjects: NOK of patients who died in the CDRU and PCU at a metropolitan, quaternary care, hospital over five months. Results: One hundred eighty-six patients died. Eighty-one NOK were called, 51 calls were considered complete. Fourteen NOK accepted a referral for bereavement support. Conclusions: This cost neutral pilot successfully connected 81 NOK with either a pilot chaplain or SW for bereavement support. Fourteen NOK accepted referral for a community bereavement resource.
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Affiliation(s)
- Ian Cullen
- Vanderbilt University Medical Center, Department of Spiritual and Pastoral Care, Nashville, Tennessee, USA
| | - Melinda Bailes
- Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Patricia Shropshire
- Vanderbilt University Medical Center, Department of Spiritual and Pastoral Care, Nashville, Tennessee, USA
| | - Sherry Perry
- Vanderbilt University Medical Center, Department of Spiritual and Pastoral Care, Nashville, Tennessee, USA
| | - Mohana Karlekar
- Vanderbilt University Medical Center, Division of Internal Medicine and Public Health, Nashville, Tennessee, USA
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4
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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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Iten R, O'Connor M, Gill FJ. Palliative care for infants with life-limiting conditions: integrative review. BMJ Support Palliat Care 2023:spcare-2023-004435. [PMID: 38123923 DOI: 10.1136/spcare-2023-004435] [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: 06/15/2023] [Accepted: 11/22/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Infants with life-limiting conditions are a heterogeneous population. Palliative care for infants is delivered in a diverse range of healthcare settings and by interdisciplinary primary healthcare teams, which may not involve specialist palliative care service consultation. OBJECTIVE To synthesise the literature for how palliative care is delivered for infants aged less than 12 months with life-limiting conditions. METHODS An integrative review design. MEDLINE, CINAHL, ProQuest, Cochrane, Joanna Briggs Institute and EMBASE were searched for research published in English language, from 2010 to 2022, and peer reviewed. Critical appraisal was completed for 26 patient case series, 9 qualitative, 5 cross-sectional and 1 quality improvement study. Data analysis involved deductive content analysis and narrative approach to summarise the synthesised results. RESULTS 37 articles met the eligibility for inclusion. Two models of palliative care delivery were examined, demonstrating differences in care received and experiences of families and health professionals. Health professionals reported lack of palliative care education, challenges for delivering palliative care in intensive care settings and barriers to advance care planning including prognostic uncertainty and transitioning to end-of-life care. Families reported positive experiences with specialist palliative care services and challenges engaging in advance care planning discussions. CONCLUSION There are complex issues surrounding the provision of palliative care for infants. Optimal palliative care should encompass a collaborative and coordinated approach between the primary healthcare teams and specialist palliative care services and prioritisation of palliative care education for nurses and physicians involved in providing palliative care to infants.
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Affiliation(s)
- Rebecca Iten
- Curtin University, Perth, Western Australia, Australia
- Perth Children's Hospital, Nedlands, Western Australia, Australia
| | | | - Fenella J Gill
- Curtin University, Perth, Western Australia, Australia
- Perth Children's Hospital, Nedlands, Western Australia, Australia
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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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7
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Scheinfeld E, Tenzek KE, Cherry J. Survivors' perspectives on saying goodbye: Implications for end-of-life engagement across the lifespan and grieving process. DEATH STUDIES 2023; 48:571-583. [PMID: 37632691 DOI: 10.1080/07481187.2023.2250999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/28/2023]
Abstract
Family members are often unaware of their loved ones' final wishes and underestimate the need to talk about them before parents reach end-of-life (EOL). The benefits of engaging in EOL conversations alleviate needless suffering and can allow an opportunity to say goodbye in a meaningful way. We examined final conversations 13 adults recalled having with their aging parents through the lens of the opportunity model for presence (OMP) during the EOL process, a communication process model based on engagement in the dying process from diagnosis through bereavement, to understand the process from the survivor's perspective, looking at content of conversations and where they occurred in the dying process. Findings illustrate final conversations that align with the socio-cultural space of the OMP before the knowledge that a parent was dying, and when entering imminent death engaging in the critical moments, have implications for the grief and bereavement.
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Affiliation(s)
- Emily Scheinfeld
- School of Communication and Media, Kennesaw State University, Kennesaw, Georgia, USA
| | - Kelly E Tenzek
- Department of Communication, University at Buffalo, Buffalo, New York, USA
| | - Jessica Cherry
- Department of Communication Studies, Ohio University, Athens, Ohio, USA
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Häger Tibell L, Årestedt K, Holm M, Wallin V, Steineck G, Hudson P, Kreicbergs U, Alvariza A. Preparedness for caregiving and preparedness for death: Associations and modifiable thereafter factors among family caregivers of patients with advanced cancer in specialized home care. DEATH STUDIES 2023; 48:407-416. [PMID: 37441803 DOI: 10.1080/07481187.2023.2231388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/15/2023]
Abstract
The purpose of this study was to (1) explore associations between preparedness for caregiving and preparedness for death among family caregivers of patients with advanced cancer and (2) explore modifiable preparedness factors, such as communication and support. Data was derived from a baseline questionnaire collected in specialized home care. The questionnaire included socio-demographics, the Preparedness for Caregiving Scale, and single items addressing preparedness for death, received support and communication about incurable illness. Data was analyzed using descriptive statistics and Spearman correlations. Altogether 39 family caregivers participated. A significant association was found between preparedness for caregiving and preparedness for death. Received support and communication about the illness was associated with higher levels of preparedness for caregiving and death. This study contributes to evidence on the association between preparedness for caregiving and death, but also that communication and support employed by healthcare professionals could improve family caregiver preparedness and wellbeing.
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Affiliation(s)
- Louise Häger Tibell
- The Department of Health Care Science/Palliative Research Centre, Marie Cederschiöld University, Stockholm, Sweden
- Tema Cancer, BES: Breast-Endocrine Tumours and Sarcoma, Karolinska University Hospital, Stockholm, Sweden
| | - Kristofer Årestedt
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
- Department of Research, Region Kalmar County, Kalmar, Sweden
| | - Maja Holm
- The Department of Health Care Science/Palliative Research Centre, Marie Cederschiöld University, Stockholm, Sweden
- Department of Nursing Science, Sophiahemmet University, Stockholm, Sweden
| | - Viktoria Wallin
- The Department of Health Care Science/Palliative Research Centre, Marie Cederschiöld University, Stockholm, Sweden
| | - Gunnar Steineck
- Department of Clinical Cancer Epidemiology, Karolinska Institutet, Stockholm, Sweden
- Division of Clinical Cancer Epidemiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Peter Hudson
- Centre for Palliative Care, St Vincent´s Hospital and The University of Melbourne, Melbourne, Australia
- Vrije University Brussels, Brussels, Belgium
| | - Ulrika Kreicbergs
- The Department of Health Care Science/Palliative Research Centre, Marie Cederschiöld University, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Anette Alvariza
- Research and Development-Unit/Palliative Care, Stockholms Sjukhem, Stockholm, Sweden
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Russell L, Howard R, Street M, Johnson CE, Berry D, Flemming-Judge E, Brean S, William L, Considine J. Cancer Decedents' Hospital End-of-Life Care Documentation: A Retrospective Review of Patient Records. J Palliat Care 2023:8258597231170836. [PMID: 37113101 DOI: 10.1177/08258597231170836] [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: 04/29/2023]
Abstract
Objective: International standards of end-of-life care (EOLC) intend to guide the delivery of safe and high-quality EOLC. Adequately documented care is conducive to higher quality of care, but the extent to which EOLC standards are documented in hospital medical records is unknown. Assessing which EOLC standards are documented in patients' medical records can help identify areas that are performed well and areas where improvements are needed. This study assessed cancer decedents' EOLC documentation in hospital settings. Methods: Medical records of 240 cancer decedents were retrospectively evaluated. Data were collected across six Australian hospitals between 1/01/2019 and 31/12/2019. EOLC documentation related to Advance Care Planning (ACP), resuscitation planning, care of the dying person, and grief and bereavement care was reviewed. Chi-square tests assessed associations between EOLC documentation and patient characteristics, and hospital settings (specialist palliative care unit, sub-acute/rehabilitation care settings, acute care wards, and intensive care units). Results: Decedents' mean age was 75.3 years (SD 11.8), 52.0% (n = 125) were female, and 73.7% lived with other adults or carers. All patients (n = 240; 100%) had documentation for resuscitation planning, 97.6% (n = 235) for Care for the Dying Person, 40.0% for grief and bereavement care (n = 96), and 30.4% (n = 73) for ACP. Patients living with other adults or carers were less likely to have a documented ACP than those living alone or with dependents (OR 0.48; 95% CI 0.26-0.89). EOLC documentation was significantly greater in specialist palliative care settings than that in other hospital settings (P < .001). Conclusion: The process of dying is well documented among inpatients diagnosed with cancer. ACP and grief and bereavement support are not documented enough. Organizational endorsement of a clear practice framework and increased training could improve documentation of these aspects of EOLC.
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Affiliation(s)
- L Russell
- Deakin University, School of Nursing and Midwifery, Geelong, Australia
- Deakin University, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Geelong, Victoria, Australia
- Centre for Quality and Patient Safety Research - Eastern Health Partnership, Box Hill, Victoria, Australia
| | - R Howard
- Centre for Quality and Patient Safety Research - Eastern Health Partnership, Box Hill, Victoria, Australia
| | - M Street
- Deakin University, School of Nursing and Midwifery, Geelong, Australia
- Deakin University, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Geelong, Victoria, Australia
- Centre for Quality and Patient Safety Research - Eastern Health Partnership, Box Hill, Victoria, Australia
| | - C E Johnson
- Palliative Aged Care Outcomes Program, Australian Health Services Research Institute, University of Wollongong, Wollongong, NSW, Australia
| | - D Berry
- Deakin University, School of Nursing and Midwifery, Geelong, Australia
- Deakin University, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Geelong, Victoria, Australia
- Centre for Quality and Patient Safety Research - Eastern Health Partnership, Box Hill, Victoria, Australia
| | - E Flemming-Judge
- Consumer Representative, Australian Resuscitation Council, Eastern Health, East Melbourne, VIC, Australia
- Consumer Representative, Safer Care Victoria, Melbourne VIC, Australia
- Consumer Representative, Eastern Health, Box Hill, VIC, Australia
- Consumer Representative, Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia
| | - S Brean
- Advance Care Planning, Eastern Health, Melbourne, VIC, Australia
| | - L William
- Supportive and Palliative Care Service, Eastern Health, Melbourne, VIC, Australia
- Faculty of Medicine, Nursing and Health Sciences, Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
- Public Health Palliative Care Unit, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - J Considine
- Deakin University, School of Nursing and Midwifery, Geelong, Australia
- Deakin University, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Geelong, Victoria, Australia
- Centre for Quality and Patient Safety Research - Eastern Health Partnership, Box Hill, Victoria, Australia
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10
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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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11
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Carlsson N, Alvariza A, Axelsson L, Bremer A, Årestedt K. Grief reactions in relation to professional and social support among family members of persons who died from sudden cardiac arrest: A longitudinal survey study. Resusc Plus 2022; 12:100318. [PMID: 36299826 PMCID: PMC9589205 DOI: 10.1016/j.resplu.2022.100318] [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: 06/29/2022] [Revised: 09/23/2022] [Accepted: 10/02/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The loss of a close person from sudden cardiac arrest (CA) leaves family members at risk of developing grief reactions such as symptoms of prolonged grief, anxiety, depression, and posttraumatic stress. The aim was to describe longitudinal variations in grief reactions and its association with professional and social support among bereaved family members after a close person's death from sudden CA. METHODS This longitudinal multimethod survey included 69 bereaved family members who completed a questionnaire 6 and 12-months after the CA, including the Prolonged Grief Disorder-13, Hospital Anxiety and Depression Scale, PTSD Checklist for DSM-5, and Multidimensional Scale of Perceived Social Support. Qualitative data were collected by open-ended questions. Quantitative data was analyzed using Wilcoxon signed-rank test and linear regression analysis while written comments were analyzed using qualitative content analysis. RESULTS The median age was 62 years, 67 % were women, and 38 % had been present during the resuscitation attempts. Using the cut-off scores at the 6- and 12-month assessments respectively, 14 % and 17 % reported symptoms of prolonged grief, 32 % and 26 % symptoms of anxiety, 14 % and 9 % depression, and 4 % and 1 % posttraumatic stress. Professional and social support at the 6-month assessment were significantly associated with symptoms of prolonged grief, anxiety, depression, and/or posttraumatic stress at the 12-month assessments but could not predict any changes in the grief reactions. CONCLUSIONS Family members' grief reactions point to the importance of proactive and available support over time to meet family members' needs.
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Affiliation(s)
- Nina Carlsson
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar/Växjö, Sweden,Corresponding author at: Faculty of Health and Life Sciences, Linnaeus University, SE-39182 Kalmar, Sweden.
| | - Anette Alvariza
- Department of Health Care Sciences/Palliative Research Centre, Marie Cederschiöld University, Stockholm, Sweden,Capio, Palliative Care, Dalen Hospital, Stockholm, Sweden
| | | | - Anders Bremer
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar/Växjö, Sweden,Department of Ambulance Service, Region Kalmar County, Kalmar, Sweden
| | - Kristofer Årestedt
- Faculty of Health and Life Sciences, Linnaeus University, Kalmar/Växjö, Sweden,Department of Research, Region Kalmar County, Kalmar, Sweden
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12
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LaTourette L, Williams K, Wong M, Thomas J, Pennarola A, Liantonio J. Evaluation of Bereavement Assessment Within Inpatient Palliative Care Consultation. Am J Hosp Palliat Care 2022:10499091221128256. [PMID: 36154714 DOI: 10.1177/10499091221128256] [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] [Indexed: 11/16/2022] Open
Abstract
It is crucial for palliative care teams to evaluate practices in assessing the risk of developing complicated grief among family members and caregivers of patients. A retrospective chart review of 99 patients seen by an inpatient palliative care team at an academic medical center was conducted to assess for documentation and prevalence of complicated grief risk factors. Factors included patients whose family are their primary caregiver, involvement of young children, mental health or substance use diagnoses in patients or their family members, a history of multiple losses, traumatic or sudden death. 64% of charts did not formally document bereavement assessment while 45% of families exhibited at least one risk factor for prolonged grief. This work suggests the need for increased education for PC providers on grief risk factors as well as the implementation of a formal screening assessment in order to best utilize limited psychosocial support resources to address needs.
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Affiliation(s)
- Lauren LaTourette
- Division of Geriatric Medicine and Palliative Care, Department of Family and Community Medicine, 23217Thomas Jefferson University Hospital (TJUH), Philadelphia, PA, USA
| | - Kaitlyn Williams
- Division of Geriatric Medicine and Palliative Care, Department of Family and Community Medicine, 23217Thomas Jefferson University Hospital (TJUH), Philadelphia, PA, USA
| | - Michael Wong
- Sidney Kimmel Medical College, 12313Thomas Jefferson University, Philadelphia, PA, USA
| | - Jillian Thomas
- Division of Geriatric Medicine and Palliative Care, Department of Family and Community Medicine, 23217Thomas Jefferson University Hospital (TJUH), Philadelphia, PA, USA
| | - Adam Pennarola
- Division of Geriatric Medicine and Palliative Care, Department of Family and Community Medicine, 23217Thomas Jefferson University Hospital (TJUH), Philadelphia, PA, USA
| | - John Liantonio
- Division of Geriatric Medicine and Palliative Care, Department of Family and Community Medicine, 23217Thomas Jefferson University Hospital (TJUH), Philadelphia, PA, USA
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13
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Diggle MFJ, Schutz S, Butcher D. Bereaved Caregivers' Experiences of End of Life Care For People With Advanced Heart Failure: A Narrative Synthesis. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221124636. [PMID: 36113134 DOI: 10.1177/00302228221124636] [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: 12/22/2023]
Abstract
BACKGROUND Heart Failure is a life-limiting condition with a poor and uniquely unpredictable prognosis. The aim of this review is to present and synthesise the current evidence around bereaved caregivers' experiences of end of life care for people with Heart Failure. METHODS A systematic review of the literature was conducted using four electronic databases (CINHAL, Medline, BND, PsycINFO). Data was analysed and presented using a narrative synthesis approach. RESULTS Eight articles were included within this review. Themes included: Limited and inadequate communication around the condition (including prognosis, preparations for death and the aim of palliative care), the burden of caregiving, and the limited provision of services and formal support. CONCLUSION Bereaved caregivers experience unique and significant challenges when caring for someone dying from Heart Failure. However, further research is required to greater understand the experiences of bereaved caregivers of people with Heart Failure.
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Affiliation(s)
- Melanie F J Diggle
- Oxford School of Nursing and Midwifery, Faculty of Health and Life Sciences, Oxford Brookes University, UK
| | - Sue Schutz
- Oxford School of Nursing and Midwifery, Faculty of Health and Life Sciences, Oxford Brookes University, UK
| | - Dan Butcher
- Oxford School of Nursing and Midwifery, Faculty of Health and Life Sciences, Oxford Brookes University, UK
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14
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Sealey M, Breen LJ, Aoun SM, O'Connor M. Development and initial test of the self-report grief and bereavement assessment. DEATH STUDIES 2022; 47:421-429. [PMID: 35666691 DOI: 10.1080/07481187.2022.2081998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Implementing evidence-based and cost-effective bereavement care is a challenge. A self-report measure could assist to identify caregivers at-risk of prolonged grief. We developed a new measure via five steps: identification of risk and protective factors for prolonged grief, item generation, consultation with an expert panel (n = 8), review by the academic team and expert panel, and a pilot test with family caregivers (n = 19) from three palliative care services. The Grief and Bereavement Assessment is a brief self-report measure that is theoretically and empirically grounded, acceptable to caregivers, feasible for use in palliative care, and requires psychometric validation.
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Affiliation(s)
- Margaret Sealey
- Discipline of Counselling, College of Science, Health, Engineering and Education, Murdoch University, Perth, Australia
| | - Lauren J Breen
- Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
- School of Population Health, Curtin University, Perth, Australia
| | - Samar M Aoun
- Medical School, University of Western Australia, Perth, Australia
- Perron Institute for Neurological and Translational Science, Perth, Australia
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Moira O'Connor
- School of Population Health, Curtin University, Perth, Australia
- Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, Perth, Australia
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Components for providing person-centred palliative healthcare: An umbrella review. Int J Nurs Stud 2021; 125:104111. [PMID: 34773736 DOI: 10.1016/j.ijnurstu.2021.104111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 09/24/2021] [Accepted: 10/11/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Person-centred palliative healthcare is an important approach to maintaining and improving patients' quality of life living with a chronic non-communicable disease and their partners. Such an approach can reduce unnecessary hospitalisation, holistically address the patient and their partners' needs, and help develop an advance care plan. OBJECTIVES Assess, analyse, and synthesise the currently existing international guidelines for providing person-centred palliative care and identify the key components for providing a high-quality approach. METHODS An umbrella review methodology of systematic reviews with the method of examination, analysis and synthesis of literature and the compilation method. Relevant systematic reviews of guidelines for providing person-centred palliative care in English, German and/or Slovenian language in PubMed, CINAHL, Web of Science and Cochrane Library databases, until November 2020. RESULTS Out of 3,910 records, we included seven reviews for thematic synthesis. We identified four key elements of flourishing in person-centred palliative healthcare: (i) Healthcare staff prerequisites and traits; (ii) Palliative healthcare environment; (iii) Palliative healthcare processes; and (iv) Palliative healthcare outcomes. CONCLUSIONS We concluded that person-centred palliative healthcare plays an important role in the comprehensive treatment of patients living with a non-communicable disease accompanied by disturbing symptoms. Therefore, it is necessary to raise awareness amongst healthcare professionals and especially general practitioners about the possibilities of including patients with a non-communicable disease in early person-centred palliative healthcare. Tweetable Abstract: #UmbrellaReview of components for providing #personcentredpalliative #healthcare. Components provide healthcare professionals and interdisciplinary #palliative teams with the steps on how to give #personcentredpalliative #healthcare to #patient and #support to #carepartners.
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Supporting bereavement and complicated grief in primary care: a realist review. BJGP Open 2021; 5:BJGPO.2021.0008. [PMID: 33653707 PMCID: PMC8278512 DOI: 10.3399/bjgpo.2021.0008] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 02/18/2021] [Indexed: 12/03/2022] Open
Abstract
Background Bereavement can have significant impacts on physical and mental health, and a minority of people experience complicated and prolonged grief responses. Primary care is ideally situated to offer bereavement care, yet UK provision remains variable and practitioners feel uncertain how best to support bereaved patients. Aim To identify what works, how, and for whom, in the management of complicated grief (CG) in primary care. Design & setting A review of evidence on the management of CG and bereavement in UK primary care settings. Method A realist approach was taken that aims to provide causal explanations through the generation and articulation of contexts, mechanisms, and outcomes. Results Forty-two articles were included. Evidence on the primary care management of complicated or prolonged grief was limited. GPs and nurses view bereavement support as part of their role, yet experience uncertainty over the appropriate extent of their involvement. Patients and clinicians often have differing views on the role of primary care in bereavement. Training in bereavement, local systems for reporting deaths, practitioner time, and resources can assist or hinder bereavement care provision. Practitioners find bereavement care can be emotionally challenging. Understanding patients’ needs can encourage a proactive response and help identify appropriate support. Conclusion Bereavement care in primary care remains variable and practitioners feel unprepared to provide appropriate bereavement care. Patients at higher risk of complicated or prolonged grief may fail to receive the support they need from primary care. Further research is required to address the potential unmet needs of bereaved patients.
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Lee SA, Neimeyer RA, Breen LJ. The Utility of the Pandemic Grief Scale in Identifying Functional Impairment from COVID-19 Bereavement. J Palliat Med 2021; 24:1783-1788. [PMID: 33926228 DOI: 10.1089/jpm.2021.0103] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: Meeting the needs of people bereaved by COVID-19 poses a substantial challenge to palliative care. The Pandemic Grief Scale (PGS) is a 5-item mental health screener to identify probable cases of dysfunctional grief during the pandemic. Objective: The PGS has strong psychometric and diagnostic features. The objective was to examine the incremental validity of the PGS in identifying mourners at risk of harmful outcomes. Design: A cross-sectional survey design involving sociodemographic questions and self-report measures of pandemic grief, generalized anxiety, depression, post-traumatic stress, separation distress, functional impairment, meaning-making difficulties, and substance use coping. Setting/Subjects: A sample of people bereaved through COVID-19 (N = 1065) in the United States. Results: Fully 56.6% of participants scored above the cut score of ≥7 on the PGS for clinically dysfunctional pandemic grief and 69.7% coped with their loss using drugs or alcohol for at least several days in past two weeks. PGS scores were not associated with time since loss. Hierarchical multiple regression models demonstrated that the PGS uniquely explained variance in functional impairment, meaning-making difficulties, and substance use coping, over relevant background factors, bereavement-related psychopathology, and separation distress. In the final model, the standardized regression coefficients for the PGS were 2-15 times larger than for the other competing measures in explaining each of the three outcomes. Conclusions: The findings underscore the clinical utility of this short and easy-to-use measure in identifying risk of deleterious outcomes across a range of functional and behavioral domains.
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Affiliation(s)
- Sherman A Lee
- Department of Psychology, Christopher Newport University, Newport News, Virginia, USA
| | - Robert A Neimeyer
- Department of Psychology, University of Memphis, Memphis, Tennessee, USA.,Portland Institute for Loss and Transition, Portland, Oregon, USA
| | - Lauren J Breen
- School of Psychology, Curtin University, Perth, Western Australia, Australia
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Breen LJ, Lee SA, Neimeyer RA. Psychological Risk Factors of Functional Impairment After COVID-19 Deaths. J Pain Symptom Manage 2021; 61:e1-e4. [PMID: 33476753 DOI: 10.1016/j.jpainsymman.2021.01.006] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 01/09/2021] [Accepted: 01/12/2021] [Indexed: 01/08/2023]
Abstract
CONTEXT People bereaved from COVID-19 report higher levels of grief than people bereaved from natural causes. The full impact of this onslaught of grief will not be known for some time. Ensuring high-quality bereavement care in the context of COVID-19 presents unprecedented challenges to end-of-life care. OBJECTIVES We aimed to determine how psychological symptoms explain functional impairment. METHODS A sample of people bereaved through COVID-19 (N = 307) in the United States completed demographic questions and self-report measures of neuroticism; symptoms of depression, generalized anxiety, posttraumatic stress, separation distress, and dysfunctional grief; and functional impairment due to a COVID-19 loss. RESULTS Most participants' scores were in the clinical ranges for generalized anxiety, depression, dysfunctional grief, and functional impairment. Functional impairment scores were not associated with age, gender, and time since loss but were associated with being diagnosed with COVID-19, having received professional help with the loss, and a close relationship to the deceased. A logistic regression model showed that, after controlling for covariates, the odds of functional impairment significantly increased by 27% for higher scores in separation distress, 25% for higher scores in dysfunctional grief, and 13% for higher scores in posttraumatic stress. CONCLUSION People bereaved because of COVID-19 are at risk of functional impairment, especially if they have symptoms of separation distress, dysfunctional grief, and/or posttraumatic stress. Attention to identifying and treating functional impairment may be important in facilitating grieving persons' full participation in social and economic life during and after the pandemic.
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Affiliation(s)
- Lauren J Breen
- School of Psychology, Curtin University, Perth, Western Australia, Australia.
| | - Sherman A Lee
- Department of Psychology, Christopher Newport University, Newport News, Virginia, USA
| | - Robert A Neimeyer
- Department of Psychology, University of Memphis, Memphis, Tennessee, USA; Portland Institute for Loss and Transition, Portland, Oregon, USA
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Aoyama M, Sakaguchi Y, Igarashi N, Morita T, Shima Y, Miyashita M. Effects of financial status on major depressive disorder and complicated grief among bereaved family members of patients with cancer. Psychooncology 2021; 30:844-852. [PMID: 33507560 DOI: 10.1002/pon.5642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/20/2021] [Accepted: 01/25/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To examine current financial status, changes before and after bereavement, and their effects on possible major depressive disorder (MDD) and complicated grief (CG) among bereaved family members of patients with cancer. METHODS We conducted a nationwide cross-sectional questionnaire survey on 787 bereaved family members of patients with cancer in 71 palliative care institutions in Japan from May to July 2016. The survey assessed perceived level of concern regarding current financial status and whether it changed after bereavement. We also collected information on demographic factors and assessed the possible MDD and CG using the Patient Health Questionnaire-9 and Brief Grief Questionnaire, respectively. We then conducted bivariate analysis to examine the relationship between these factors and financial status. RESULTS A total of 491 (62%) questionnaires were returned. The majority of the participants (n = 382, 78%) reported having no or mild concerns about their livelihood, whereas 19% (n = 95) had moderate to severe concerns. Regarding the change in financial status after bereavement, 7% (n = 35) reported improvement, 28% (n = 131) reported worsening, and 65% (n = 308) reported no change. The prevalences of possible MDD and CG were 22% (n = 108) and 9% (n = 41), respectively, and were significantly lower among participants with less concern regarding their livelihood and whose financial status had not changed after bereavement (both p < 0.05). CONCLUSIONS About one-fifth of the bereaved family members reported financial difficulties to some extent; these were significantly associated with MDD and CG. These findings provide evidence of the need for psychosocial support including financial consultation for bereaved family members.
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Affiliation(s)
- Maho Aoyama
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yukihiro Sakaguchi
- School of Human Welfare Studies, Kwansei Gakuin University, Nishinomiya, Hyogo, Japan
| | - Naoko Igarashi
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Yasuo Shima
- Department of Palliative Medicine, Home Care Service, Tsukuba Medical Center Hospital, Ibaraki, Tsukuba, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Aoyama M, Miyashita M, Masukawa K, Morita T, Kizawa Y, Tsuneto S, Shima Y, Akechi T. Predicting models of depression or complicated grief among bereaved family members of patients with cancer. Psychooncology 2021; 30:1151-1159. [PMID: 33462913 DOI: 10.1002/pon.5630] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 01/11/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To derive and validate a risk scoring system for predicting major depressive disorder (MDD) and complicated grief (CG) among bereaved family members of patients with cancer that is feasible for clinical use. METHODS We conducted a secondary analysis of two cross-sectional nationwide bereavement surveys in Japan. From a total of 17,312 bereaved family members of patients with cancer, 8618 and 8619 were randomly assigned to a derivation and a validation group. The Patient Health Questionnaire 9 (PHQ-9) and the Brief Grief Questionnaire (BGQ) were used to assess MDD (PHQ-9 score ≥ 10) and CG (BGQ score ≥ 8), respectively. We compared five models with potential predictive variables that could be easily obtained in daily practice and were included in the bereavement survey (i.e., sociodemographic data). RESULTS The model which included variables such as the families' physical/mental health status and preparedness toward bereavement, in addition to their sociodemographic data, was considered modest for predicting the risk of both MDD and CG. The areas around the curve for MDD and CG were 0.74 (95% CI: 0.73-0.76) and 0.74 (95% CI: 0.72-0.75) and 0.78 (95% CI: 0.76-0.79) and 0.77 (95% CI: 0.76-0.79) in the derivation and validation groups, respectively. CONCLUSIONS We developed a clinical risk score for predicting MDD and CG among bereaved family members of patients with cancer. However, further research is needed for external validation and assessment regarding its implementation in actual practice.
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Affiliation(s)
- Maho Aoyama
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Mitsunori Miyashita
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Kento Masukawa
- Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan
| | - Yoshiyuki Kizawa
- Department of Palliative Medicine, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Saikyo-ku, Kyoto, Japan
| | - Yasuo Shima
- Department of Palliative Medicine, Tsukuba Medical Center Foundation, Director, Home Care Service, Tsukuba Medical Center Hospital, Tsukuba, Japan
| | - Tatsuo Akechi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Center for Psycho-oncology and Palliative Care, Nagoya City University Hospital, Nagoya, Japan
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21
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Lopes FG, Lima MJV, Arrais RH, Amaral NDD. A dor que não pode calar: reflexões sobre o luto em tempos de Covid-19. PSICOLOGIA USP 2021. [DOI: 10.1590/0103-6564e210112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo A Covid-19 provocou número elevado de perdas e mudanças nos processos de cuidado e despedida, fatores que podem dificultar a elaboração do luto. Objetivamos, assim, compreender as particularidades do luto no âmbito da Covid-19, ressaltando a importância da adaptação e da criação de estratégias voltadas ao cuidado da saúde mental nos processos de luto. O ensaio realiza um panorama teórico, indicando elementos presentes na pandemia com potencial para interferir no luto, e apresenta um levantamento de iniciativas adaptadas a tal contexto. A pandemia trouxe mudanças na forma de experienciar o morrer. Evidenciam-se iniciativas na tentativa de mitigar os efeitos emocionais, cognitivos e comportamentais. O momento convoca a repensar conceitos e (re)criar compreensões acerca da morte e do luto, ressaltando-se a importância da Rede de Saúde Mental, com o fortalecimento de ações de base sociocomunitária, reconhecimento de diferentes níveis de complexidade das demandas e acesso organizado à atenção especializada.
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22
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Paul S, Vaswani N. The prevalence of childhood bereavement in Scotland and its relationship with disadvantage: the significance of a public health approach to death, dying and bereavement. Palliat Care Soc Pract 2020; 14:2632352420975043. [PMID: 33313505 PMCID: PMC7716073 DOI: 10.1177/2632352420975043] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 10/29/2020] [Indexed: 11/15/2022] Open
Abstract
Background and Method There is an absence of research on the prevalence of bereavement during early childhood and the relationship between childhood bereavement and socioeconomic status (SES) and this poses a challenge in both understanding and supporting children's bereavement experiences. Using longitudinal data from the Growing Up in Scotland study, which tracks the lives of three nationally representative cohorts of children, this paper aimed to address these gaps in research. It specifically drew on data from Birth Cohort 1 to document the recorded bereavements of 2,815 children who completed all 8 sweeps of data collection, from age 10 months to 10 years. Findings The study found that 50.8% of all children are bereaved of a parent, sibling, grandparent or other close family member by age 8 and this rises to 62% by age 10. The most common death experienced was that of a grandparent or other close relative. The study also found that children born into the lowest income households are at greater risk of being bereaved of a parent or sibling than those born into the highest income households. Discussion and Conclusion Given the prevalence of childhood bereavement and its relationship with disadvantage, this paper argues that there is an important need to understand bereavement as a universal issue that is affected by the social conditions in which a child becomes bereaved, as well as an individual experience potentially requiring specialist support. This paper thus seeks to position childhood bereavement more firmly within the public health approach to palliative and bereavement care discourse and contends that doing so provides a unique and comprehensive opportunity to better understand and holistically respond to the experience of bereavement during childhood.
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Affiliation(s)
- Sally Paul
- University of Strathclyde, Lord Hope Building, 141 St James Road, Glasgow G4 0LT, UK
| | - Nina Vaswani
- Children and Young People's Centre for Justice, University of Strathclyde, Glasgow, UK
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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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Bajwah S, Oluyase AO, Yi D, Gao W, Evans CJ, Grande G, Todd C, Costantini M, Murtagh FE, Higginson IJ. The effectiveness and cost-effectiveness of hospital-based specialist palliative care for adults with advanced illness and their caregivers. Cochrane Database Syst Rev 2020; 9:CD012780. [PMID: 32996586 PMCID: PMC8428758 DOI: 10.1002/14651858.cd012780.pub2] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Serious illness is often characterised by physical/psychological problems, family support needs, and high healthcare resource use. Hospital-based specialist palliative care (HSPC) has developed to assist in better meeting the needs of patients and their families and potentially reducing hospital care expenditure. There is a need for clarity on the effectiveness and optimal models of HSPC, given that most people still die in hospital and also to allocate scarce resources judiciously. OBJECTIVES To assess the effectiveness and cost-effectiveness of HSPC compared to usual care for adults with advanced illness (hereafter patients) and their unpaid caregivers/families. SEARCH METHODS We searched CENTRAL, CDSR, DARE and HTA database via the Cochrane Library; MEDLINE; Embase; CINAHL; PsycINFO; CareSearch; National Health Service Economic Evaluation Database (NHS EED) and two trial registers to August 2019, together with checking of reference lists and relevant systematic reviews, citation searching and contact with experts to identify additional studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) evaluating the impact of HSPC on outcomes for patients or their unpaid caregivers/families, or both. HSPC was defined as specialist palliative care delivered by a palliative care team that is based in a hospital providing holistic care, co-ordination by a multidisciplinary team, and collaboration between HSPC providers and generalists. HSPC was provided to patients while they were admitted as inpatients to acute care hospitals, outpatients or patients receiving care from hospital outreach teams at home. The comparator was usual care, defined as inpatient or outpatient hospital care without specialist palliative care input at the point of entry into the study, community care or hospice care provided outside of the hospital setting. DATA COLLECTION AND ANALYSIS We used standard methodological procedures expected by Cochrane. We assessed risk of bias and extracted data. To account for use of different scales across studies, we calculated standardised mean differences (SMDs) with 95% confidence intervals (CIs) for continuous data. We used an inverse variance random-effects model. For binary data, we calculated odds ratio (ORs) with 95% CIs. We assessed the evidence using GRADE and created a 'Summary of findings' table. Our primary outcomes were patient health-related quality of life (HRQoL) and symptom burden (a collection of two or more symptoms). Key secondary outcomes were pain, depression, satisfaction with care, achieving preferred place of death, mortality/survival, unpaid caregiver burden, and cost-effectiveness. Qualitative data was analysed where available. MAIN RESULTS We identified 42 RCTs involving 7779 participants (6678 patients and 1101 caregivers/family members). Twenty-one studies were with cancer populations, 14 were with non-cancer populations (of which six were with heart failure patients), and seven with mixed cancer and non-cancer populations (mixed diagnoses). HSPC was offered in different ways and included the following models: ward-based, inpatient consult, outpatient, hospital-at-home or hospital outreach, and service provision across multiple settings which included hospital. For our main analyses, we pooled data from studies reporting adjusted endpoint values. Forty studies had a high risk of bias in at least one domain. Compared with usual care, HSPC improved patient HRQoL with a small effect size of 0.26 SMD over usual care (95% CI 0.15 to 0.37; I2 = 3%, 10 studies, 1344 participants, low-quality evidence, higher scores indicate better patient HRQoL). HSPC also improved other person-centred outcomes. It reduced patient symptom burden with a small effect size of -0.26 SMD over usual care (95% CI -0.41 to -0.12; I2 = 0%, 6 studies, 761 participants, very low-quality evidence, lower scores indicate lower symptom burden). HSPC improved patient satisfaction with care with a small effect size of 0.36 SMD over usual care (95% CI 0.41 to 0.57; I2 = 0%, 2 studies, 337 participants, low-quality evidence, higher scores indicate better patient satisfaction with care). Using home death as a proxy measure for achieving patient's preferred place of death, patients were more likely to die at home with HSPC compared to usual care (OR 1.63, 95% CI 1.23 to 2.16; I2 = 0%, 7 studies, 861 participants, low-quality evidence). Data on pain (4 studies, 525 participants) showed no evidence of a difference between HSPC and usual care (SMD -0.16, 95% CI -0.33 to 0.01; I2 = 0%, very low-quality evidence). Eight studies (N = 1252 participants) reported on adverse events and very low-quality evidence did not demonstrate an effect of HSPC on serious harms. Two studies (170 participants) presented data on caregiver burden and both found no evidence of effect of HSPC (very low-quality evidence). We included 13 economic studies (2103 participants). Overall, the evidence on cost-effectiveness of HSPC compared to usual care was inconsistent among the four full economic studies. Other studies that used only partial economic analysis and those that presented more limited resource use and cost information also had inconsistent results (very low-quality evidence). Quality of the evidence The quality of the evidence assessed using GRADE was very low to low, downgraded due to a high risk of bias, inconsistency and imprecision. AUTHORS' CONCLUSIONS Very low- to low-quality evidence suggests that when compared to usual care, HSPC may offer small benefits for several person-centred outcomes including patient HRQoL, symptom burden and patient satisfaction with care, while also increasing the chances of patients dying in their preferred place (measured by home death). While we found no evidence that HSPC causes serious harms, the evidence was insufficient to draw strong conclusions. Although these are only small effect sizes, they may be clinically relevant at an advanced stage of disease with limited prognosis, and are person-centred outcomes important to many patients and families. More well conducted studies are needed to study populations with non-malignant diseases and mixed diagnoses, ward-based models of HSPC, 24 hours access (out-of-hours care) as part of HSPC, pain, achieving patient preferred place of care, patient satisfaction with care, caregiver outcomes (satisfaction with care, burden, depression, anxiety, grief, quality of life), and cost-effectiveness of HSPC. In addition, research is needed to provide validated person-centred outcomes to be used across studies and populations.
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Affiliation(s)
- Sabrina Bajwah
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Adejoke O Oluyase
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Deokhee Yi
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Wei Gao
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Catherine J Evans
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Gunn Grande
- School of Health Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | - Chris Todd
- School of Health Sciences, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
- Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Fliss E Murtagh
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Irene J Higginson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
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Wakefield D, Fleming E, Howorth K, Waterfield K, Kavanagh E, Billett HC, Kiltie R, Robinson L, Rowley G, Brown J, Woods E, Dewhurst F. Inequalities in awareness and availability of bereavement services in North-East England. BMJ Support Palliat Care 2020:bmjspcare-2020-002422. [PMID: 32967861 DOI: 10.1136/bmjspcare-2020-002422] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/09/2020] [Accepted: 08/27/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVES National guidance recommends equality in access to bereavement services; despite this, awareness and availability appears inconsistent. The aim of this study was to explore availability and accessibility of bereavement services across the North-East of England and to highlight issues potentially applicable across the UK, at a time of unprecedented need due to the impact of COVID-19. METHODS Phase 1: an eight item, web-based survey was produced. A survey link was cascaded to all GP practices (General Practitioners) in the region. Phase 2: an email was sent to all services identified in phase 1, requesting details such as referral criteria and waiting times. RESULTS All 392 GP practices in the region were invited to participate. The response rate was 22% (85/392). Twenty-one per cent (18/85) of respondents reported that they do not refer patients, comments included 'not aware of any services locally'. A total of 36 services were contacted with 72% responding with further information. Most bereavement specific support was reliant on charity-funded services including hospices, this sometimes required a pre-existing link with the hospice. Waiting times were up to 4 months. CONCLUSIONS Although multiple different, usually charity-funded services were identified, awareness and accessibility were variable. This survey was conducted prior to the COVID-19 pandemic, where complex situations surrounding death is likely to impact on the usual grieving process and increase the need for bereavement support. Meanwhile, charities providing this support are under severe financial strain. There is an urgent need to bridge the gap between need and access to bereavement services.
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Affiliation(s)
- Donna Wakefield
- Consultant in Palliative Medicine, North Tees and Hartlepool NHS Foundation Trust, Stockton-Upon-Tees, UK
| | - Elizabeth Fleming
- NEPRRA (North East Palliative Registrar Research Alliance), Health Education North East, Newcastle upon Tyne, UK
| | - Kate Howorth
- NEPRRA (North East Palliative Registrar Research Alliance), Health Education North East, Newcastle upon Tyne, UK
| | - Kerry Waterfield
- NEPRRA (North East Palliative Registrar Research Alliance), Health Education North East, Newcastle upon Tyne, UK
| | - Emily Kavanagh
- NEPRRA (North East Palliative Registrar Research Alliance), Health Education North East, Newcastle upon Tyne, UK
| | - Hannah C Billett
- NEPRRA (North East Palliative Registrar Research Alliance), Health Education North East, Newcastle upon Tyne, UK
| | - Rachel Kiltie
- NEPRRA (North East Palliative Registrar Research Alliance), Health Education North East, Newcastle upon Tyne, UK
| | - Lucy Robinson
- NEPRRA (North East Palliative Registrar Research Alliance), Health Education North East, Newcastle upon Tyne, UK
| | - Grace Rowley
- NEPRRA (North East Palliative Registrar Research Alliance), Health Education North East, Newcastle upon Tyne, UK
| | - Jolene Brown
- NEPRRA (North East Palliative Registrar Research Alliance), Health Education North East, Newcastle upon Tyne, UK
| | - Elizabeth Woods
- NEPRRA (North East Palliative Registrar Research Alliance), Health Education North East, Newcastle upon Tyne, UK
| | - Felicity Dewhurst
- NEPRRA (North East Palliative Registrar Research Alliance), Health Education North East, Newcastle upon Tyne, UK
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Tziraki C, Grimes C, Ventura F, O’Caoimh R, Santana S, Zavagli V, Varani S, Tramontano D, Apóstolo J, Geurden B, De Luca V, Tramontano G, Romano MR, Anastasaki M, Lionis C, Rodríguez-Acuña R, Capelas ML, dos Santos Afonso T, Molloy DW, Liotta G, Iaccarino G, Triassi M, Eklund P, Roller-Wirnsberger R, Illario M. Rethinking palliative care in a public health context: addressing the needs of persons with non-communicable chronic diseases. Prim Health Care Res Dev 2020; 21:e32. [PMID: 32928334 PMCID: PMC7503185 DOI: 10.1017/s1463423620000328] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 06/18/2020] [Accepted: 07/14/2020] [Indexed: 11/12/2022] Open
Abstract
Non-communicable chronic diseases (NCCDs) are the main cause of morbidity and mortality globally. Demographic aging has resulted in older populations with more complex healthcare needs. This necessitates a multilevel rethinking of healthcare policies, health education and community support systems with digitalization of technologies playing a central role. The European Innovation Partnership on Active and Healthy Aging (A3) working group focuses on well-being for older adults, with an emphasis on quality of life and healthy aging. A subgroup of A3, including multidisciplinary stakeholders in health care across Europe, focuses on the palliative care (PC) model as a paradigm to be modified to meet the needs of older persons with NCCDs. This development paper delineates the key parameters we identified as critical in creating a public health model of PC directed to the needs of persons with NCCDs. This paradigm shift should affect horizontal components of public health models. Furthermore, our model includes vertical components often neglected, such as nutrition, resilience, well-being and leisure activities. The main enablers identified are information and communication technologies, education and training programs, communities of compassion, twinning activities, promoting research and increasing awareness amongst policymakers. We also identified key 'bottlenecks': inequity of access, insufficient research, inadequate development of advance care planning and a lack of co-creation of relevant technologies and shared decision-making. Rethinking PC within a public health context must focus on developing policies, training and technologies to enhance person-centered quality life for those with NCCD, while ensuring that they and those important to them experience death with dignity.
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Affiliation(s)
- Chariklia Tziraki
- Israel Gerontological Data Center, Hebrew University of Jerusalem, Jerusalem, Israel
- MELABEV – Community Clubs for Elders, Jerusalem, Israel
| | | | - Filipa Ventura
- The Health Sciences Research Unit: Nursing, Nursing School of Coimbra, Coimbra, Portugal
| | - Rónán O’Caoimh
- Department of Medicine, Clinical Sciences Institute, National University of Ireland, Galway, Ireland
| | - Silvina Santana
- Department of Economics, Management, Industrial Engineering and Tourism, Institute of Electronics and Informatics Engineering of Aveiro, University of Aveiro, Aveiro, Portugal
| | | | | | - Donatella Tramontano
- Department of Molecular Medicine and Medical Biotechnology, Federico II University of Naples, Naples, Italy
| | - João Apóstolo
- Department of Nursing, Nursing School of Coimbra, Coimbra, Portugal
| | - Bart Geurden
- Nursing and Midwifery, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Vincenzo De Luca
- Research and Development Unit, Federico II University Hospital, Naples, Italy
| | - Giovanni Tramontano
- Hospital Care Division, General Directorate for Health, Campania Region, Naples, Italy
| | - Maria Rosaria Romano
- Hospital Care Division, General Directorate for Health, Campania Region, Naples, Italy
| | - Marilena Anastasaki
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Christos Lionis
- Department of Social Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece
| | | | - Manuel Luis Capelas
- Interdisciplinary Health Research Center (CIIS), Institute of Health Sciences, Portuguese Catholic University, Lisbon, Portugal
| | - Tânia dos Santos Afonso
- Faculty of Pharmacy, Center for Pharmaceutical Studies, University of Coimbra, Coimbra, Portugal
| | - David William Molloy
- Centre for Gerontology and Rehabilitation, School of Medicine, University College of Cork, Cork, Ireland
| | - Giuseppe Liotta
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Guido Iaccarino
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Maria Triassi
- Department of Public Health, Federico II University of Naples, Naples, Italy
| | - Patrik Eklund
- Department of Computing Science, Umeå University, Umeå, Sweden
| | | | - Maddalena Illario
- Department of Public Health, Federico II University of Naples, Naples, Italy
- Health Innovation Division, General Directorate for Health, Campania Region, Naples, Italy
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27
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Aoun SM, Cafarella PA, Rumbold B, Thomas G, Hogden A, Jiang L, Gregory S, Kissane DW. Who cares for the bereaved? A national survey of family caregivers of people with motor neurone disease. Amyotroph Lateral Scler Frontotemporal Degener 2020; 22:12-22. [PMID: 32909457 DOI: 10.1080/21678421.2020.1813780] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Although Motor Neurone Disease (MND) caregivers are most challenged physically and psychologically, there is a paucity of population-based research to investigate the impact of bereavement, unmet needs, range of supports, and their helpfulness as perceived by bereaved MND caregivers. Methods: An anonymous national population-based cross-sectional postal and online survey of bereavement experiences of family caregivers who lost a relative/friend to MND in 2016, 2017, and 2018. Recruitment was through all MND Associations in Australia. Results: 393 valid responses were received (31% response rate). Bereaved caregiver deterioration in physical (31%) and mental health (42%) were common. Approximately 40% did not feel their support needs were met. Perceived insufficiency of support was higher for caregivers at high bereavement risk (63%) and was associated with a significant worsening of their mental and physical health. The majority accessed support from family and friends followed by MND Associations, GPs, and funeral providers. Informal supports were reported to be the most helpful. Sources of professional help were the least used and they were perceived to be the least helpful. Conclusions: This study highlights the need for a new and enhanced approach to MND bereavement care involving a caregiver risk and needs assessment as a basis for a tailored "goodness of fit" support plan. This approach requires continuity of care, more resources, formal plans, and enhanced training for professionals, as well as optimizing community capacity. MND Associations are well-positioned to support affected families before and after bereavement but may require additional training and resources to fulfill this role.
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Affiliation(s)
- Samar M Aoun
- Public Health Palliative Care Unit, School of Psychology and Public Health, La Trobe University, Melbourne, Australia.,Perron Institute for Neurological and Translational Science, Perth, Australia
| | - Paul A Cafarella
- Department of Respiratory Medicine, Flinders Medical Centre, Adelaide, Australia.,School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Australia
| | - Bruce Rumbold
- Public Health Palliative Care Unit, Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Geoff Thomas
- Consumer Advocate Thomas MND Research Group, Adelaide, Australia
| | - Anne Hogden
- Australian Institute of Health Service Management, College of Business and Economics, University of Tasmania, Australia
| | - Leanne Jiang
- Public Health Palliative Care Unit, School of Psychology and Public Health, La Trobe University, Melbourne, Australia.,Perron Institute for Neurological and Translational Science, Perth, Australia
| | | | - David W Kissane
- Palliative Medicine Research, The University of Notre Dame Australia, Sydney, Australia.,The Cunningham Centre for Palliative Care Research, St Vincent's Hospital, Sydney, Australia and.,Cabrini Psycho-Oncology and Supportive Care Research Unit, Monash University, Melbourne, Australia
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28
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Aoun SM, Keegan O, Roberts A, Breen LJ. The impact of bereavement support on wellbeing: a comparative study between Australia and Ireland. Palliat Care Soc Pract 2020; 14:2632352420935132. [PMID: 32783026 PMCID: PMC7385836 DOI: 10.1177/2632352420935132] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 05/27/2020] [Indexed: 12/31/2022] Open
Abstract
Background: There is a dearth of national and international data on the impact of social support on physical, mental, and financial outcomes following bereavement. Methods: We draw from two large, population-based studies of bereaved people in Australia and Ireland to compare bereaved people’s experience of support. The Australian study used a postal survey targeting clients of six funeral providers and the Irish study used telephone interviews with a random sample of the population. Results: Across both studies, the vast majority of bereaved people reported relying on informal supporters, particularly family and friends. While sources of professional help were the least used, they had the highest proportions of perceived unhelpfulness. A substantial proportion, 20% to 30% of bereaved people, reported worsening of their physical and mental health and about 30% did not feel their needs were met. Those who did not receive enough support reported the highest deterioration in wellbeing. Discussion: The compassionate communities approach, which harnesses the informal resources inherent in communities, needs to be strengthened by identifying a range of useful practice models that will address the support gaps. Ireland has taken the lead in developing a policy framework providing guidance on level of service provision, associated staff competencies, and training needs.
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Affiliation(s)
- Samar M Aoun
- Public Health Palliative Care Unit, School of Psychology and Public Health, La Trobe University, Melbourne, VIC 3086, Australia
| | - Orla Keegan
- Irish Hospice Foundation, Dublin, Ireland; Royal College of Surgeons in Ireland, Dublin, Ireland
| | | | - Lauren J Breen
- School of Psychology, Curtin University, Perth, WA, Australia
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29
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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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30
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Müller H, Berthold D, Bongard S, Gramm J, Hauch H, Sibelius U. Komplizierte Trauer erfassen: Ein systematischer
Review. Psychother Psychosom Med Psychol 2020; 70:490-498. [DOI: 10.1055/a-1144-3705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Zusammenfassung
Ziel Überblick englisch- und deutschsprachiger Messinstrumente
zur Diagnostik von klinisch relevanten Trauerverläufen und Trauer in
ihrer Multidimensionalität.
Methodik Systematischer Literaturreview.
Ergebnisse Insgesamt konnten 22 Inventare extrahiert werden, die sich
unterteilen lassen in allgemeine und spezielle Verfahren zur Akutdiagnostik
sowie Verfahren zur Früherkennung. Alle Inventare weisen
überwiegend gute psychometrische Kennwerte auf.
Diskussion International existiert eine Vielzahl an Messverfahren.
Für den deutschen Sprachraum liegen 3 allgemeine und 3 spezielle
Inventare vor.
Schlussfolgerung Bislang fehlen deutschsprachige Verfahren zur
Früherkennung schwieriger Trauerverläufe.
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Affiliation(s)
| | - Daniel Berthold
- Medizinische Klinik V, Internistische Onkologie und Palliativmedizin,
Universitätsklinikum Gießen und Marburg, Standort
Gießen
- Institut für Palliativpsychologie, Friedberg
| | - Stephan Bongard
- Institut für Psychologie, Goethe-Universität Frankfurt
am Main
| | - Jan Gramm
- Institut für Palliativpsychologie, Friedberg
| | - Holger Hauch
- Palliative Care Team für Kinder und Jugendliche Mittelhessen,
Universitätsklinikum Gießen und Marburg, Standort
Gießen
| | - Ulf Sibelius
- Medizinische Klinik V, Internistische Onkologie und Palliativmedizin,
Universitätsklinikum Gießen und Marburg, Standort
Gießen
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31
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Breen LJ, Johnson AR, O'Connor M, Howting D, Aoun SM. Challenges in Palliative Care Research on Family Caregivers: Who Volunteers for Interviews? J Palliat Med 2020; 24:112-115. [PMID: 32255736 DOI: 10.1089/jpm.2019.0672] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Background: Interviews are a common method of data collection in palliative care research because they facilitate the gathering of rich, experiential data that are important for theory and practice. What is less clear is the extent to which those interviewed are representative of the larger group. Objective: The aim of this study was to determine if family caregivers who volunteer to be interviewed were similar or different to those who do not. Design: This study used data from the Caregiving and Bereavement study, a prospective, longitudinal mixed-methods study of family caregivers' general health, quality of life, and grief. Setting/Subjects: The 16 caregivers who volunteered to be interviewed were compared to the 20 who did not. Measurements: Comparisons were made in terms of the caregivers' demographic characteristics as well as measures of their quality of life, general health, general grief, and caregiver prolonged grief (i.e., before death). Results: Compared to caregivers who did not volunteer for an interview, those who volunteered were significantly older and reported less caregiver prolonged grief. Logistic regression showed that for each 1-unit increase in the caregiver prolonged grief score, individuals were 13% less likely to agree to an interview. Conclusions: Research findings based upon family caregivers who volunteer for research interviews might not provide a full picture of their experiences and needs. Researchers are encouraged to consider strategies that sample broadly and promote the participation of the full range of family caregivers in research to address the neglected areas of pre- and postdeath bereavement care.
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Affiliation(s)
- Lauren J Breen
- School of Psychology, Curtin University, Perth, Western Australia, Australia
| | - Andrew R Johnson
- School of Psychology, Curtin University, Perth, Western Australia, Australia
| | - Moira O'Connor
- School of Psychology, Curtin University, Perth, Western Australia, Australia
| | - Denise Howting
- Centre for Medical Research, University of Western Australia, Perth, Western Australia, Australia.,Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia
| | - Samar M Aoun
- Public Health Palliative Care Unit, La Trobe University, Melbourne, Victoria, Australia
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32
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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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33
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Breen LJ, Kawashima D, Joy K, Cadell S, Roth D, Chow A, Macdonald ME. Grief literacy: A call to action for compassionate communities. DEATH STUDIES 2020; 46:425-433. [PMID: 32189580 DOI: 10.1080/07481187.2020.1739780] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The compassionate communities movement challenges the notion that death and dying should be housed within clinical and institutional contexts, and works to normalize conversations about death and dying by promoting death literacy and dialogue in public spaces. Community-based practices and conversations about grief remain marginal in this agenda. We aimed to theorize how grief could be better conceptualized and operationalized within the compassionate communities movement. We develop the concept of Grief Literacy and present vignettes to illustrate a grief literate society. Grief literacy augments the concept of death literacy, thereby further enhancing the potential of the compassionate communities approach.
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Affiliation(s)
- Lauren J Breen
- School of Psychology, Faculty of Health Sciences, Curtin University, Perth, Australia
| | | | - Karima Joy
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Susan Cadell
- Renison University College, University of Waterloo, Waterloo, Canada
| | - David Roth
- Pütz-Roth Bestattungen und Trauerbegleitung oHG, Bergisch Gladbach, Germany
| | - Amy Chow
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, China
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34
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Weber Falk M, Alvariza A, Kreicbergs U, Sveen J. The grief and communication family support intervention: Intervention fidelity, participant experiences, and potential outcomes. DEATH STUDIES 2020; 46:233-244. [PMID: 32072870 DOI: 10.1080/07481187.2020.1728429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This study aimed to evaluate intervention fidelity and explore participants' experiences and potential outcomes after participating in the intervention. Using a pretest post-test pilot study, 10 parentally bereaved families completed the three-session manual-based intervention with a family therapist. Sessions were audio-recorded. Therapists completed an adherence checklist to assess fidelity. Assessments via questionnaires and interviews occurred at one month post-intervention and via questionnaires at baseline and six months post-intervention. This study showed a high level of fidelity. The study shows preliminary evidence of the intervention's capacity to improve communication and relationships in parentally bereaved families.
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Affiliation(s)
- Megan Weber Falk
- Department of Caring Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
| | - Anette Alvariza
- Department of Caring Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Capio Palliative Care, Dalen Hospital, Stockholm, Sweden
| | - Ulrika Kreicbergs
- Department of Caring Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Department of Women and Child's Health, Karolinska Institute, Stockholm, Sweden
| | - Josefin Sveen
- Department of Caring Sciences, Palliative Research Centre, Ersta Sköndal Bräcke University College, Stockholm, Sweden
- Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden
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35
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Aoun SM. Bereavement support: From the poor cousin of palliative care to a core asset of compassionate communities. PROGRESS IN PALLIATIVE CARE 2020. [DOI: 10.1080/09699260.2019.1706277] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Samar M. Aoun
- Public Health Palliative Care Unit, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
- Perron Institute for Neurological and Translational Science, Perth, Australia
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36
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Griffiths N, Mazzucchelli TG, Skinner S, Kane RT, Breen LJ. A pilot study of a new bereavement program for children: Lionheart Camp for Kids. DEATH STUDIES 2019; 46:780-790. [PMID: 31858883 DOI: 10.1080/07481187.2019.1702121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
We assessed the acceptability and effectiveness of a new childhood bereavement service known as Lionheart Camp for Kids. Using a pre-post-follow-up design, data pertaining to 12 bereaved children (aged 5-12 years) and their primary caregivers were obtained. Results showed that caregivers reported decreases in children's peer relationship problems, improvements in parental consistency, and reductions in coercive parenting, and there was a trend toward lower self-reported grief by the children. Caregivers were highly satisfied with the program. There is a need for a wait-list or randomized controlled trial over a longer time period to determine the full benefits of the camp.
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Affiliation(s)
| | | | - Shelly Skinner
- Lionheart Camps for Kids, Perth, Australia
- Perth Children's Hospital, Perth, Australia
| | - Robert T Kane
- School of Psychology, Curtin University, Perth, Australia
| | - Lauren J Breen
- School of Psychology, Curtin University, Perth, Australia
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37
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Obst KL, Due C. Men's grief and support following pregnancy loss: A qualitative investigation of service providers' perspectives. DEATH STUDIES 2019; 45:772-780. [PMID: 31709921 DOI: 10.1080/07481187.2019.1688430] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
This study explores service providers' experiences of supporting men following a miscarriage or stillbirth in Australia. In-depth, semi-structured interviews were completed with seven service providers including midwives, grief counselors and social workers. Participants highlighted that, despite the individual nature of men's grief, there is a need to recognize and address the additional expectations and responsibilities that may compound their experience. Within an environment focused on woman-centered care, participants described creative strategies and inclusive language to promote engagement of men. Further research exploring men's grief is needed to inform training and guidelines for healthcare professionals who work with bereaved families.
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Affiliation(s)
- Kate Louise Obst
- School of Psychology, University of Adelaide, Adelaide, Australia
| | - Clemence Due
- School of Psychology, University of Adelaide, Adelaide, Australia
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Disadvantaged and disenfranchised in bereavement: A scoping review of social and structural inequity following expected death. Soc Sci Med 2019; 242:112599. [PMID: 31644975 DOI: 10.1016/j.socscimed.2019.112599] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 10/03/2019] [Accepted: 10/10/2019] [Indexed: 11/20/2022]
Abstract
An emphasis on individual intervention and psychological complexity has characterised research on bereavement following an experience of life-limiting illness. Exploration of "structural vulnerability" as a positionality produced by social and structural inequity could provide insights into areas of practice and policy in need of development. This scoping review sought to summarise published research on experiences of social and structural inequities in the context of bereavement due to life-limiting illness. Underpinned by recognised methodological frameworks, systematic searches were conducted of four electronic databases. Eligible studies attended to bereavement experience following the death of an adult due to life-limiting illness, included consideration of social and structural inequities, and were undertaken in high income countries between 1990 and 2018. Following thematic analysis, a conceptual framework was developed. Of 322 records, 62 full text articles were retrieved and 15 papers met inclusion criteria. Studies highlighted unequal social status in bereavement related to gender, class, sexuality, ethnicity and age, with structural inequity experienced in interactions with institutions and social networks. Studies also identified that the experience of bereavement itself may be accompanied by exposure to disenfranchising systems and processes. Structural vulnerability appeared to be associated with outcomes including psychological distress, social disenfranchisement and practical concerns such as financial strain, housing insecurity and employment issues. Social and structural inequities potentially contribute to layered and patterned experiences of disadvantage and disenfranchisement following expected death, with implications for individual agency. Findings point to the need for consideration of socio-ecological approaches within and beyond specialist palliative care, involving development of more responsive social policy, coordinated advocacy, and systemic capacity building regarding experiences of grief, to better support populations positioned as structurally vulnerable in bereavement.
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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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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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Kmetec S, Štiglic G, Lorber M, Mikkonen I, McCormack B, Pajnkihar M, Fekonja Z. Nurses’ perceptions of early person‐centred palliative care: a cross‐sectional descriptive study. Scand J Caring Sci 2019; 34:157-166. [DOI: 10.1111/scs.12717] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 05/05/2019] [Indexed: 01/03/2023]
Affiliation(s)
- Sergej Kmetec
- Faculty of Health Science University of Maribor Maribor Slovenia
| | - Gregor Štiglic
- Faculty of Health Science University of Maribor Maribor Slovenia
- Faculty of Electrical Engineering and Computer Science University of Maribor Maribor Slovenia
| | - Mateja Lorber
- Faculty of Health Science University of Maribor Maribor Slovenia
| | - Irma Mikkonen
- Health Care Savonia University of Applied Sciences Kuopio Finland
| | - Brendan McCormack
- Faculty of Health Science University of Maribor Maribor Slovenia
- Division of Nursing Queen Margaret University Edinburgh Edinburgh UK
| | - Majda Pajnkihar
- Faculty of Health Science University of Maribor Maribor Slovenia
| | - Zvonka Fekonja
- Faculty of Health Science University of Maribor Maribor Slovenia
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Sullivan R, Ugalde A, Sinclair C, Breen LJ. Developing a Research Agenda for Adult Palliative Care: A Modified Delphi Study. J Palliat Med 2018; 22:480-488. [PMID: 30461347 DOI: 10.1089/jpm.2018.0462] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background: Little is known about research priorities in adult palliative care. Identifying research priorities for adult palliative care will help in increasing research quality and translation. Objective: The aim was to identify the views of health professionals' research priorities in adult palliative care that lead to development of a palliative care research agenda in Australia. Design: A modified three-round Delphi survey. Setting/Subjects: Palliative care researchers and clinicians in Australia were invited to participate. Results: A total of 25 panelists completed round 1, 14 completed round 2, and 13 completed round 3. Round 1 resulted in 90 research priorities in 13 categories. Round 2 showed consensus agreement on 19/90 research priorities. Round 3 resulted in the top 10 research priorities of the 19 achieving consensus in round 2. Panelists agreed that research is needed on the transition to palliative care; improving communication about prognosis; increasing access to palliative care for indigenous communities, people who wish to remain at home, and people in aged care; addressing family caregivers' needs; promoting patients' and families' decision making; improving cross-cultural aspects of palliative care; determining the effects of assisted dying legislation; and improving bereavement care in rural, remote, and Aboriginal populations. Conclusions: The expert panelists identified the top 10 research priorities for adult palliative care. These identified research priorities are the most urgent topics requiring attention to increase the quality of life of patients requiring palliative care and their family members.
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Affiliation(s)
| | - Anna Ugalde
- 2 School of Nursing and Midwifery, Deakin University, Geelong, Australia
| | - Craig Sinclair
- 3 Rural Clinical School of Western Australia, University of Western Australia (Albany Centre), Albany, Australia
| | - Lauren J Breen
- 1 School of Psychology, Curtin University, Perth, Australia
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Aoun SM, Breen LJ, White I, Rumbold B, Kellehear A. What sources of bereavement support are perceived helpful by bereaved people and why? Empirical evidence for the compassionate communities approach. Palliat Med 2018; 32:1378-1388. [PMID: 29754514 PMCID: PMC6088515 DOI: 10.1177/0269216318774995] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS To determine who provides bereavement support in the community, what sources are perceived to be the most or least helpful and for what reason, and to identify the empirical elements for optimal support in developing any future compassionate communities approach in palliative care. DESIGN A population-based cross-sectional investigation of bereavement experiences. Sources of support (informal, community and professional) were categorised according to the Public Health Model of Bereavement Support; most helpful reasons were categorised using the Social Provisions Scale, and least helpful were analysed using inductive content analysis. SETTING AND PARTICIPANTS Bereaved people were recruited from databases of funeral providers in Australia via an anonymous postal survey (2013-2014). RESULTS In total, 678 bereaved people responded to the survey. The most frequently used sources of support were in the informal category such as family, friends and funeral providers. While the professional category sources were the least used, they had the highest proportions of perceived unhelpfulness whereas the lowest proportions of unhelpfulness were in the informal category. The functional types of helpful support were Attachment, Reliable Alliance, Social Integration and Guidance. The five themes for least helpful support were: Insensitivity, Absence of Anticipated Support, Poor Advice, Lack of Empathy and Systemic Hindrance. CONCLUSION A public health approach, as exemplified by compassionate communities policies and practices, should be adopted to support the majority of bereaved people as much of this support is already provided in informal and other community settings by a range of people already involved in the everyday lives of those recently bereaved. This study has provided further support for the need to strengthen the compassionate communities approach, not only for end of life care for dying patients but also along the continuum of bereavement support.
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Affiliation(s)
- Samar M Aoun
- 1 Palliative Care Unit, Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia.,2 Institute for Health Research, Notre Dame University, Fremantle, WA, Australia
| | - Lauren J Breen
- 3 School of Psychology, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Ishta White
- 3 School of Psychology, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Bruce Rumbold
- 1 Palliative Care Unit, Department of Public Health, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Allan Kellehear
- 4 School of Nursing and Healthcare Leadership, Faculty of Health Studies, University of Bradford, Bradford, UK
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Makarem M, Mohammed S, Swami N, Pope A, Kevork N, Krzyzanowska M, Rodin G, Hannon B, Zimmermann C. Experiences and Expectations of Bereavement Contact among Caregivers of Patients with Advanced Cancer. J Palliat Med 2018; 21:1137-1144. [DOI: 10.1089/jpm.2017.0530] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Maisam Makarem
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Supportive Care, University Health Network, Toronto, Ontario, Canada
| | - Shan Mohammed
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
- Department of Supportive Care, University Health Network, Toronto, Ontario, Canada
| | - Nadia Swami
- Department of Supportive Care, University Health Network, Toronto, Ontario, Canada
| | - Ashley Pope
- Department of Supportive Care, University Health Network, Toronto, Ontario, Canada
| | - Nanor Kevork
- Department of Supportive Care, University Health Network, Toronto, Ontario, Canada
| | - Monika Krzyzanowska
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Medical Oncology and Haematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Gary Rodin
- Department of Supportive Care, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Campbell Family Cancer Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
| | - Breffni Hannon
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Supportive Care, University Health Network, Toronto, Ontario, Canada
| | - Camilla Zimmermann
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Supportive Care, University Health Network, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Campbell Family Cancer Research Institute, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
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Breen LJ, Aoun SM, O'Connor M, Howting D, Halkett GKB. Family Caregivers' Preparations for Death: A Qualitative Analysis. J Pain Symptom Manage 2018; 55:1473-1479. [PMID: 29499235 DOI: 10.1016/j.jpainsymman.2018.02.018] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 02/20/2018] [Accepted: 02/20/2018] [Indexed: 10/17/2022]
Abstract
CONTEXT Many family caregivers are not prepared for the death of their family member or friend. Palliative care services tend to emphasize the patients' preparation for death rather than caregivers' preparation for, or living after, death. Caregivers' perspectives on anticipating and preparing for death are under-researched, despite preparation being associated with better bereavement outcomes. OBJECTIVES The objective was to explore family caregivers' preparations for death. METHODS A total of 16 family caregivers of people in receipt of palliative care participated in semi-structured, face-to-face interviews. Transcripts were coded and analyzed using grounded theory techniques. RESULTS Analysis yielded two overarching themes: Here and Now centered on the caregivers' focus on the multidimensional and all-consuming nature of caregiving for someone who is near death. Negotiating the Here/After described the tension the caregivers faced in vacillating between focusing on the care during the illness trajectory (Here) and worries and plans for the future (After). CONCLUSION This exploratory study is the first to focus solely on family caregivers' experiences of preparing for a death. The caregivers described the complexities of trying to prepare while feeling overwhelmed with demands of caregiving throughout an unpredictable illness trajectory. The caregivers in the present study were cognitively prepared, some were behaviorally prepared, but emotional preparedness was challenging. Services should not assume that all family caregivers are well-prepared for the death. Caregivers would likely benefit from the assessment and promotion of their death preparedness.
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Affiliation(s)
- Lauren J Breen
- School of Psychology, Curtin University, Perth, Australia.
| | - Samar M Aoun
- Palliative Care Unit, School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Moira O'Connor
- School of Psychology, Curtin University, Perth, Australia
| | - Denise Howting
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia
| | - Georgia K B Halkett
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Australia
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"You either need help…you feel you don't need help…or you don't feel worthy of asking for it:" Receptivity to bereavement support. Palliat Support Care 2018; 17:172-185. [PMID: 29352832 DOI: 10.1017/s1478951517001122] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Although the needs of the bereaved have been identified widely in the literature, how these needs translate into meaningful, appropriate, and client-centered programs needs further exploration. The application of receptivity to support is a critical factor in participation by the bereaved in palliative care bereavement programs. Receptivity is a complex multifactorial phenomenon influenced by internal and external factors that ultimately influences engagement in psychosocial support in bereavement. This study explored factors that influence receptivity to bereavement support from palliative care services in rural, regional, and remote Western Australia. METHOD The study comprised a qualitative descriptive research design using semistructured interviews with 24 bereaved individuals, nine palliative care health professionals, and four Aboriginal Health Professionals. Participants were recruited via palliative care services in country Western Australia. Interviews were transcribed verbatim and thematically analyzed. RESULT Findings revealed that a range of individual, social, and geographical factors influence receptivity to bereavement support and can impact on utilization of bereavement support services. SIGNIFICANCE OF RESULTS Receptivity provides a frame of reference to enhance understanding of factors influencing engagement in psychosocial support in bereavement. Receptivity promotes a shift of service provider perspectives of effective supportive care to consumer-centric reasons for engagement.
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Burns E, Prigerson HG, Quinn SJ, Abernethy AP, Currow DC. Moving on: Factors associated with caregivers' bereavement adjustment using a random population-based face-to-face survey. Palliat Med 2018. [PMID: 28627971 DOI: 10.1177/0269216317717370] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Providing care at end of life has consequences for caregivers' bereavement experience. 'Difficulty moving on with life' is an informative and unbiased symptom of prolonged grief disorder. Predictors of bereaved caregivers' ability to 'move on' have not been examined across the population. AIM To identify the characteristics of bereaved hands-on caregivers who were, and were not, able to 'move on' 13-60 months after the 'expected' death of someone close. DESIGN The South Australian Health Omnibus is an annual, random, cross-sectional community survey. From 2000 to 2007, respondents were asked about providing care for someone terminally ill and their subsequent ability to 'move on'. Multivariable logistic regression models explored the characteristics moving on and not moving on. SETTING Respondents were aged ⩾15 years and lived in households within South Australia. They had provided care to someone who had died of terminal illness in the preceding 5 years. RESULTS A total of 922 people provided hands-on care. In all, 80% of caregivers (745) had been able to 'move on'. Closeness of relationship to the deceased, increasing caregiver age, caregiver report of needs met, increasing time since loss, sex and English-speaking background were significantly associated with 'moving on'. A closer relationship to the deceased, socioeconomic disadvantage and being male were significantly associated with not 'moving on'. CONCLUSION These results support the relevance of 'moving on' as an indicator of caregivers' bereavement adjustment. Following the outcomes of bereaved caregivers longitudinally is essential if effective interventions are to be developed to minimise the risk of prolonged grief disorder.
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Affiliation(s)
- Emma Burns
- 1 Southern Adelaide Palliative Services, Daw Park, SA, Australia
| | - Holly G Prigerson
- 2 Department of Psychiatry, Harvard Medical School, Boston, MA, USA.,3 Center for Psycho-Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Steve J Quinn
- 4 Flinders Centre for Clinical Change, Flinders University, Bedford Park, SA, Australia
| | - Amy P Abernethy
- 5 ImPACT, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.,6 Division of Medical Oncology, Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - David C Currow
- 1 Southern Adelaide Palliative Services, Daw Park, SA, Australia.,5 ImPACT, Faculty of Health, University of Technology Sydney, Ultimo, NSW, Australia.,7 Hull York Medical School, University of Hull, Hull, UK
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Bereavement support for family caregivers: The gap between guidelines and practice in palliative care. PLoS One 2017; 12:e0184750. [PMID: 28977013 PMCID: PMC5627900 DOI: 10.1371/journal.pone.0184750] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 08/30/2017] [Indexed: 11/28/2022] Open
Abstract
Background Standards for bereavement care propose that support should be matched to risk and need. However, studies in many countries demonstrate that palliative care services continue to adopt a generic approach in offering support to bereaved families. Objective To identify patterns of bereavement support in palliative care services based upon the experience of bereaved people from a population based survey and in relation to clinical practice guidelines. Design An anonymous postal survey collected information from clients of six funeral providers in four Australian states (2014–15), 6 to 24 months after the death of their family member or friend, with 1,139 responding. Responses from 506 bereaved relatives of people who had terminal illnesses were analysed. Of these, 298 had used palliative care services and 208 had not. Results More people with cancer (64%) had received palliative care in comparison to other illnesses such as heart disease, dementia and organ failure (4–10%). The support for family caregivers before and after their relative’s death was not considered optimal. Only 39.4% of the bereaved reported being specifically asked about their emotional/ psychological distress pre-bereavement, and just half of the bereaved perceived they had enough support from palliative care services. Half of the bereaved had a follow up contact from the service at 3–6 weeks, and a quarter had a follow-up at 6 months. Their qualitative feedback underlined the limited helpfulness of the blanket approach to bereavement support, which was often described as “not personal” or “generic”, or “just standard practice”. Conclusions Timeliness and consistency of relationship is crucial to building rapport and trust in the service’s ability to help at post-bereavement as well as a focus on the specific rather than the generic needs of the bereaved. In light of these limitations, palliative care services might do better investing their efforts principally in assessing and supporting family caregivers during the pre-bereavement period and developing community capacity and referral pathways for bereavement care. Our findings suggest that bereavement support in Australian palliative care services has only a tenuous relationship with guidelines and assessment tools, a conclusion also drawn in studies from other countries, emphasizing the international implications of our study.
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Newsom C, Stroebe MS, Schut H, Wilson S, Birrell J, Moerbeek M, Eisma MC. Community-based counseling reaches and helps bereaved people living in low-income households. Psychother Res 2017; 29:479-491. [PMID: 28946801 DOI: 10.1080/10503307.2017.1377359] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
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.
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Affiliation(s)
- Catherine Newsom
- a Department of Clinical Psychology , Utrecht University , Utrecht , Netherlands
| | - Margaret S Stroebe
- a Department of Clinical Psychology , Utrecht University , Utrecht , Netherlands.,b Department of Clinical Psychology and Experimental Psychopathology , University of Groningen , Groningen , Netherlands
| | - Henk Schut
- a Department of Clinical Psychology , Utrecht University , Utrecht , Netherlands
| | | | - John Birrell
- c Cruse Bereavement Care Scotland , Edinburgh , UK
| | - Mirjam Moerbeek
- d Department of Methodology and Statistics , Utrecht University , Utrecht , Netherlands
| | - Maarten C Eisma
- b Department of Clinical Psychology and Experimental Psychopathology , University of Groningen , Groningen , Netherlands
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