Complicated Grief in Canada: Exploring the Client and Professional Landscape

To identify relatives at risk for Prolonged Grief Disorder symptomatology: A cross-sectional study

CONTEXT

While most bereaved can navigate a death-related loss, some face persistent and disabling challenges, a condition known as Prolonged Grief Disorder (PGD). Early identification of PGD can prevent adverse health outcomes. The effectiveness of healthcare providers' clinical intuition versus relatives' self-report surveys in estimating the risk of developing PGD remains uncertain.

OBJECTIVES

The study evaluates the accuracy of healthcare providers' subjective risk estimates and self-reported surveys from relatives, conducted close to the cancer patient's death, in predicting ICD-11 PGD symptomatology seven months post-loss.

METHODS

The study involved specialist palliative care healthcare providers and bereaved relatives of oncology patients in ten hospital and five home settings. Subjective risk estimates from healthcare providers (N=75) and relatives' self-report surveys (N=75) using the Pre-Loss Grief-12 (PG-12) were compared with Traumatic Grief Inventory-Self Report Plus (TGI-SR+) total scores seven months post-loss. Diagnostic efficacy was evaluated using the Receiver Operating Characteristic and Area Under Curve.

RESULTS

In the sample of 75 relatives, 8% had ICD-11 PGD symptomatology. The Receiver Operating Characteristic analysis of the PG-12 (N=75) yielded an Area Under Curve of 0.891, 95% CI [0.782 - 1], while the healthcare providers' subjective estimates (N=75) resulted in an Area Under Curve of 0.549, 95% CI [0.299 - 0.799]. The optimal Pre-Loss Grief-12 cut-off score for identifying relatives at risk for PGD was 30 with a sensitivity of 100% and a specificity of 64.7%.

CONCLUSION

The Pre-Loss Grief-12 accurately predicted PGD symptomatology seven months post-loss, while clinical intuition did not perform better than chance. Future research should compare the predictive value of self-report data with clinical interviews.

How can we know what we don't know? An exploration of professionals' engagement with complicated grief

OBJECTIVE

Research has shown that complicated grief has the potential to adversely affect bereaved individuals, and in this context, understanding how mental health professionals engage with it in practice is of relevance. Gaining an understanding of professionals' knowledge, attitudes, skills and training in relation to complicated grief could provide insights that will inform their training and professional development. The aim of this study was to consider professionals' engagement with complicated grief, as represented by self-reported knowledge, attitudes, skills and training.

METHODS

The study used a three-phase mixed methods design (systematic review, qualitative interviews, and a quantitative survey) with empirical data being collected from psychologists, psychiatrists and counselor/psychotherapists.

RESULTS

Analysis yielded 15 integrated findings across the three phases, which were grouped into two clusters: the first highlighted tension between professionals' reported confidence and competence and the second explored the parameters and contribution of research and training in this area.

CONCLUSION

Professionals' perception of their competence to work with complicated grief seems overstated and research and professional practice are not aligned.

PRACTICE IMPLICATIONS

These findings are positioned to inform empirically supported training that addresses identified deficits in professionals' knowledge, attitudes and skills. It is important therefore that training is reflective of the needs of different professional groups.

Experiences of participation in bereavement groups from significant others' perspectives; a qualitative study

Background

When death ends a life, the impact of caring for person who suffered a period of illness or disease continues for significant others who are left to grieve. They should be offered support to avoid complicated grief. This can be provided in different ways and individually or in groups. This study aims to describe significant others’ experiences of participation in bereavement groups.

Methods

Ten bereavement groups that each met five times offered support for the significant others of deceased loved ones who had been cared for by a palliative-care team. After the five meetings, the grieving members (n = 46) completed written comments about the role of the groups; they also commented one year after participating (n = 39). Comments were analyzed with qualitative content analysis with a directed approach using the theory of a good death according to the 6S’s: self-image, self-determination, social relationships, symptom control, synthesis and summation, and surrender.

Results

Bereavement groups were found to be a source for alleviating grief for some significant others, but not all experienced relief. Moreover, grief was found to persist during participation. Another finding involved the impact of the role of the palliative home-care team on bereavement support. To evaluate the experience of participating in a bereavement group, the use the 6S’s as a model was a strength of the analysis. Bereavement groups could enhance the self and offer relief from grief. Participation was described as social relationships that offered a sense of coherence and understanding in grief. The effects of participation were more meaningful close to the loss and could lose efficacy over time. Bereavement support provided before a loved one’s death was seen as valuable.

Conclusion

Overall, the bereavement groups eased the grief of significant others close to the death of their loved one. However, moving forward, several of the significant others were not sure that their participation eased their grief. To identify persons who may remain in a state of complicated grief, a routine of planned contacts with the bereaved should begin before death and be followed up later than six months after the death of a loved one.

Complicated grief knowledge, attitudes, skills, and training among mental health professionals: A qualitative exploration

The knowledge, attitudes, skills, and training of professionals regarding complicated grief influence their practice. We conducted 30 semi-structured interviews with psychiatrists, psychologists, and counselor/psychotherapists; the preliminary findings were contextualized via interviews with three experts in complicated grief research/practice. Findings suggest that professionals did not substantially rely on research evidence, favoring instead personal and professional knowledge. They expressed concern regarding the possible pathologization of normal grief that might arise from having a diagnosis of complicated grief. Deficits in professional training were evident. A need for an improved culture of collaboration between researchers and practitioners was identified.

Cartography of Factors Influencing Caregivers' Experiences of Loss: A Promising Tool to Help Social Workers Support Caregivers

This article introduces a cartography tool to help social workers work with and support family caregivers. This tool aims to determine (1) which caregivers are likely to need additional support during bereavement and (2) what resources the caregiver has that care teams can rely on for decision-making and planning. The purpose of this article is to present a preliminary assessment of the cartography based on the feedback collected from potential users regarding the tool's content and usage.

Psychiatrists', psychologists' and counselors' attitudes regarding complicated grief

BACKGROUND

Complicated grief encompasses various presentations where aspects of grief do not become integrated into the bereaved person's life. Professionals' attitudes to complicated grief may impact how they engage with bereaved patients/clients. The aim of this study was to empirically examine the attitudes of mental health professionals, specifically psychologists, psychiatrists and counselor/psychotherapists, regarding complicated grief and to investigate any between profession-differences.

METHOD

Psychiatrists, counselor/psychotherapists and psychologists were recruited using publicly available databases managed by professional bodies. A total of 185 professionals (71.8% female), returned a questionnaire containing usable data (23.8% response rate).

RESULTS

Over two-thirds of the professionals (68.5%) supported the inclusion of complicated grief in diagnostic manuals while only a quarter (25.1%) thought that recognition of complicated grief might lead to the pathologization of 'normal' grief. The majority of respondents (83.0%) thought that diagnosing complicated grief would increase the likelihood of clients accessing support and there was no significant difference between the groups.

LIMITATIONS

Although the response rate compares favorably with other studies it is nonetheless somewhat lower than optimum, and it is possible that those who responded were more interested in bereavement and consequently, that the attitudes held by participants are different from those who did not participate.

CONCLUSION

The attitude to a diagnosis of complicated grief was more positive than the specialist literature suggests, with the benefits of having a diagnosis of complicated grief outweighing the risks of pathologization.