Providing support at time of death from cancer: results of a 5-year post-bereavement group study

The lived experiences of young adults grieving an intimate partner or spouse: A phenomenological pilot study

This pilot study explored the lived experiences of six young adults between the ages of 18-32 years grieving an intimate partner or spouse. Through Moustakas's (1994) steps of transcendental phenomenological analysis, four key themes revealed a traumatic initial period after the death, the importance of helpful vs dismissive community support, a continuation of meaningful activities and ritual to honor the deceased, and significant shifts in participants' life plans and worldviews. These themes suggest that clinicians may consider facilitating identity-restructuring exercises (e.g., journaling) and inclusive community spaces to support this unique population of grievers. Implications for future research are discussed, including the suggestion to create more targeted inclusion criteria to improve the clinical relevance of results in future studies.

Application of Acceptance and Commitment Therapy (ACT) in Hospice and Palliative Care Settings

Many terminally ill cancer patients grapple with a range of physical, psychological, and social challenges. Therefore, it is critical to offer effective psychological interventions to assist them in managing these issues and enhancing their quality of life. This brief communication provides a concise overview of acceptance and commitment therapy (ACT), along with empirical evidence of its application for patients, caregivers, and healthcare professionals in hospice and palliative care settings and an overview of future directions of ACT interventions in South Korea. ACT, a third-wave type of cognitive behavioral therapy, is a model of psychological flexibility that promotes personal growth and empowerment across all life areas. Currently, there is substantial evidence from overseas supporting the effectiveness of ACT on health-related outcomes among patients with various diseases, caregivers, and healthcare professionals. The necessity and significance of conducting ACT-based empirical research in hospice and palliative care settings in South Korea are discussed.

The Me in We dyadic communication intervention is feasible and acceptable among advanced cancer patients and their family caregivers

BACKGROUND

Advanced cancer affects the emotional and physical well-being of both patients and family caregivers in profound ways and is experienced both dyadically and individually. Dyadic interventions address the concerns of both members of the dyad. A critical gap exists in advanced cancer research, which is a failure of goals research and dyadic research to fully account for the reciprocal and synergistic effects of patients' and caregivers' individual perspectives, and those they share.

AIM

We describe the feasibility and acceptability of the Me in We dyadic intervention, which is aimed at facilitating communication and goals-sharing among caregiver and patient dyads while integrating family context and individual/shared perspectives.

DESIGN

Pilot study of a participant-generated goals communication intervention, guided by multiple goals theory, with 13 patient-caregiver dyads over two sessions.

SETTING/PARTICIPANTS

Patients with advanced cancer and their self-identified family caregivers were recruited from an academic cancer center. Dyads did not have to live together, but both had to consent to participate and all participants had to speak and read English and be at least 18 years or age.

RESULTS

Of those approached, 54.8% dyads agreed to participate and completed both sessions. Participants generated and openly discussed their personal and shared goals and experienced positive emotions during the sessions.

CONCLUSIONS

This intervention showed feasibility and acceptability using participant-generated goals as personalized points of communication for advanced cancer dyads. This model shows promise as a communication intervention for dyads in discussing and working towards individual and shared goals when facing life-limiting or end-of-life cancer.

Cancer Caregivers' Preparedness for Loss and Bereavement Outcomes: Do Preloss Caregiver Attributes Matter?

Past studies examining the relationship between preparedness for loss and bereavement outcomes among caregivers of spouses/partners with life-limiting illness did not adequately account for preloss caregiver attributes that could potentially confound the relationship. Using a sample of spouse/partner cancer caregivers (N = 226), we examined how preloss caregiver attributes were associated with how prepared one felt for loss and their role in the relationship between preparedness and later bereavement outcomes. Nearly half reported they were not emotionally prepared, and 35% were not prepared for the practical challenges associated with the loss. Although attributes such as depression, anxiety, competence in daily activities, and financial adequacy were associated with both preparedness and bereavement outcomes, regression analyses revealed that preparedness remained the strongest predictor in all models. We suggest that early interventions enhancing caregivers' preparedness for loss may hold considerable promise for improved bereavement outcome.

Feasibility randomised controlled trial of a self-help acceptance and commitment therapy intervention for grief and psychological distress in carers of palliative care patients

We tested the feasibility and preliminary effectiveness of an acceptance and commitment therapy self-help intervention for grief and psychological distress in carers of patients in palliative care. Carers were randomised to the control group, which received treatment as usual, or the intervention group, which received treatment as usual plus an acceptance and commitment therapy–based self-help booklet and telephone support call. Questionnaires were completed at baseline, 1-month post-allocation and 6 months post-loss. Results indicated that the intervention was generally feasible and viewed as acceptable to carers. Preliminary effectiveness analyses showed at least a small effect in acceptance, valued-living, grief and psychological distress.

Caregiver characteristics and bereavement needs: Findings from a population study

BACKGROUND

Globally, most care for people with life-limiting illnesses is provided by informal caregivers. Identifying characteristics of caregivers that may have unmet needs and negative outcomes can help provide better support to facilitate adjustment.

AIM

We compared characteristics, expressed unmet needs and outcomes for spousal caregivers, with other caregivers at the end of life, by gender and age.

DESIGN

The South Australian Health Omnibus is an annual, random, face-to-face, cross-sectional survey wherein respondents are asked about end-of-life care.

SETTING/PARTICIPANTS

Participants were aged over 15 years, resided in households in South Australia and had someone close to them die from a terminal illness in the last 5 years.

RESULTS

Of the 1540 respondents who provided hands-on care for someone close at the end of life, 155 were widows/widowers. Bereaved spousal caregivers were more likely to be older, female, better educated, have lower incomes, less full-time work, English as second language, sought help with grief and provided more day-to-day care for longer periods. Spousal caregivers were less likely to be willing to take on caregiving again, less able to 'move on' with life and needed greater emotional support and information about illness and services. The only difference between widows and widowers was older age of spouse in women. Younger spousal caregivers perceived greater unmet emotional needs and were significantly less likely to be able to 'move on'.

CONCLUSION

Spousal caregivers are different from other caregivers, with more intense needs that are not fully met. These have implications for bereavement, health and social services.

An acceptance and commitment therapy self-help intervention for carers of patients in palliative care: Protocol of a feasibility randomised controlled trial

Undertaking a caregiving role at end of life can have enduring psychological consequences for carers, including poor adjustment in bereavement. Acceptance and commitment therapy–based interventions have demonstrated effectiveness in helping people cope with a range of life challenges. This article presents the protocol of a feasibility randomised controlled trial of an acceptance and commitment therapy self-help intervention for psychological distress and grief in carers of patients in palliative care. We will assess feasibility and acceptability of the trial procedures and intervention as well as preliminary effectiveness of the intervention on carer well-being outcomes.

The effect of bereavement groups on grief, anxiety, and depression - a controlled, prospective intervention study

ABSTACT

BACKGROUND

Bereavement groups are believed to be beneficial as preventive interventions to reduce the development of complicated grief for people at risk after the death of a significant other. This study aimed to investigate whether measurable effects on grief, anxiety, and depression could be detected in those participating in bereavement groups compared to non-participating controls.

METHODS

Questionnaires covering the Texas Revised Inventory of Grief (TRIG), the Hospital Anxiety and Depression Scale (HADS), and background questions were handed out pre-intervention, five weeks and one year post-intervention to bereaved caregivers invited to bereavement groups. The results were analysed with non-parametric methods.

RESULTS

A total of 124 individuals answered the questionnaires, and were divided into three categories: participants, non-participants unable to participate, and non-participants not wanting to participate in bereavement groups. At the one-year follow up, participants and those unable to participate reported higher levels of grief and were more anxious than those not wanting to participate. Depression did not differ between the groups.

CONCLUSIONS

Participation in bereavement groups did not produce any effects on grief, anxiety, or depression in comparison to non-participants who were unable to participate. Non-participants who did not want to participate reported lower levels of grief and anxiety than the other two groups.

"One Size Doesn't Fit All" - Partners in Hospice Care, an Individualized Approach to Bereavement Intervention

We concluded in a recent study that a "one size fits all" approach typical of group interventions often does not adequately accommodate the range of situations, life experiences, and current needs of participants. We describe how this limitation informed the design and implementation of an individually-delivered intervention format more specifically tailored to the unique needs of each bereaved person. The intervention comprises one of three interrelated studies within Partners in Hospice Care (PHC), which examines the trajectory from end-of-life care through bereavement among cancer caregivers using hospice. The PHC intervention employs an initial needs assessment in order to tailor the session content, delivery, and sequencing to the most pressing, yet highly diverse needs of the bereaved spouses/partners. Although an individually-delivered format has its own challenges, these can be effectively addressed through standardized interventionist training, regular communication among staff, as well as a flexible approach toward participants' preferences and circumstances.

Group work with bereaved individuals: the power of mutual aid

Group work has been underused as an intervention with grieving clients. This is despite the fact that group membership offers bereaved individuals a number of unique advantages. In this article, the use of group work with bereaved individuals is examined, based on current theory and research. The role and skills of the group worker are identified and illustrated through the use of case examples. Challenges associated with working with groups for bereaved individuals also are discussed.

Spousal Bereavement Following Cancer Death

Loss due to cancer could predispose surviving spouses or partners to a variety of negative outcomes. Although a terminal prognosis may provide opportunities to prepare for the loss, existing evidence is inconclusive as to whether death expectedness buffers potentially negative bereavement outcomes. Using data from the Living After Loss study, we examined longitudinally outcomes of bereaved individuals whose spouses/partners died from cancer (n = 112) versus other causes (n = 213) while accounting for death expectedness. While most of the cancer deaths were expected, more than half of the non-cancer deaths were not. The lowest levels of depression, grief, and loneliness over time were among those whose spouses/partners died expectedly from causes other than cancer. Cancer-bereavement was as equally distressing as any unexpected death. Future efforts should focus on the mechanisms underlying these outcomes and develop effective and early interventions to those in greatest need.

Personal reflection: death brokering for critical care nurses

End-of-life care and the dying patient have been an area lightly covered in my nursing school experience. While I expected the topics to surface in more detail in conjunction with the critical care nursing unit, this was not the case. This article is a personal reflection on my experience in critical care nursing and the deficits involving death and dying education in both institutional and professional settings.