Making end-of-life health disparities in the U.S. visible through family bereavement narratives

Objective

End-of-life experiences can have important implications for the meaning-making and communication of bereaved family members, particularly due to (in)access to formal healthcare services (i.e., palliative care and hospice). Grounded in Communicated Narrative Sense-Making theory, this study extends knowledge about how the stories told about end-of-life by bereaved family members affect and reflect their sense-making, well-being and importantly, potential disparities in end-of-life care.

Methods

Semi-structured interviews with 25 bereaved individuals were conducted regarding their experiences with the terminal illness and death of an immediate family member. Using a framework of family bereavement narratives, a cross-case data analysis demonstrated qualitative patterns between (in)access to end-of-life care and how participants framed bereavement stories.

Results

Four themes illustrated the continuum of communication that families engaged in when making sense of end-of-life experiences, including reflections on silence, tempered frustrations, comfort with care, and support from beyond.

Innovation

This innovative qualitative connection between family members' bereavement stories and end-of-life care emphasizes the importance of employing a health equity lens within hospice and palliative care, especially in addressing the important aim of comprehensively supporting families even when illness ends. This study demonstrates that access to, quality of, and imagining beyond current structures for EOL may be vital factors for facilitating effective sense-making for the dying and their family systems.

Conclusion

These findings illustrate the potential interconnections between (in)access to end-of-life care, sense-making, and communication for individuals and families experiencing terminal illness and bereavement.

Testing Cognitive Models to Characterize Trauma Anniversary Reactions Marked by Stress and Growth

OBJECTIVE

Contemporary theories conceptualize the anniversary of a traumatic event as a trauma reminder capable of activating posttraumatic stress disorder (PTSD) symptoms. The current study uses the cognitive stress and growth model to examine this model's usefulness in characterizing anniversary reactions.

METHOD

Participants (N = 197) were MTurk workers who endorsed an "emotionally charged reaction on or near the anniversary of a tragic event." They completed assessments of PTSD, posttraumatic growth (PTG), sense of control, rumination, and trauma centrality.

RESULTS

Multiple regression analyses found both anniversary-related stress and PTSD symptoms were associated with similar factors with similar magnitude across both outcomes. Trauma centrality was uniquely associated with anniversary-related PTG.

CONCLUSIONS

Anniversaries marked by stress are characterized by factors similar to PTSD generally, but growth-related reactions have different correlates compared to PTG outside the reaction. These findings suggest the anniversary period may be a time of self-reflection about the event and its impact.

Revisiting the Factor Structure of the Centrality of Event Scale

Traumatic experiences that become self-defining impact posttraumatic outcomes, yet exact mechanisms are currently being studied. Recent research has used the Centrality of Event Scale (CES). However, the factor structure of the CES has been in question. We analyzed archival data (N = 318) split into homogenous groups of participants to examine whether the factor structure of the CES differed based on event type (bereavement vs. sexual assault) or by levels of PTSD (meeting clinical cut off score vs. group of lowest scorers). Exploratory factor analyses with subsequent confirmatory analyses revealed a single factor model in the bereavement group, sexual assault group, and the low PTSD group. A three-factor model emerged in the high PTSD group, with the factors' themes matching previous findings. Event centrality appears to be a universal theme when people endure and process a diversity of adverse events. These distinct factors may illuminate pathways in the clinical syndrome.

Psychometric properties of the full-form and short-form versions of the Integration of Stressful Life Experiences Scale (ISLES) among Iranian university students

BACKGROUND

Making adaptive meaning of stressful life experiences has been identified as an important determinant of adjustment. The Integration of Stressful Life Experiences Scale (ISLES) was developed to assess the outcome of meaning-making processes in the face of negative events.

AIMS

The psychometric properties of this scale have not been measured in Iranian populations. The purpose of the present study was to examine the psychometric properties of the 16-item and 6-item versions of ISLES with a sample of 502 university students who had experienced relationship dissolution.

RESULTS

Findings support a two-factor structure with acceptable validity and reliability. Positive correlations between the scores of ISLES with Centrality of Event Scale and PTSD symptoms provided evidence of concurrent validity.

CONCLUSION

The results of measurement invariance indicated that both the 16-item and 6-item versions of ISLES are gender invariant and can be used to assess meaning-made in both men and women.

Constructivist Correlates to Anniversary Reactions Across Bereavement and Sexual Violence

Anniversary reactions are an accepted part of bereavement, but recent research demonstrates that ARs can be seen across many traumatic events. The present study explores how constructivist theories could characterize ARs caused by the death of a loved one or sexual violence. N = 234 women answered questionnaires regarding their posttraumatic adjustment, meaning made of the trauma, trauma centrality, and social validation or invalidation of their trauma. Our data demonstrate that ARs are marked by statistically and clinically significant increases posttraumatic stress disorder symptoms. Participants in this study did not endorse significant posttraumatic growth during their AR. The women in the sexual violence group endorsed more social validation and invalidation as well as less meaning made of their trauma compared to the bereavement group. There were no group differences regarding trauma centrality. Results of this study provide empirical support for an understudied yet significant phenomenon and directions of future study.

Resolving the paradox of posttraumatic growth and event centrality in trauma survivors

When a traumatic experience is central to an individual's identity and worldview, it can result in either severe posttraumatic stress disorder (PTSD) symptoms, perceived posttraumatic growth (PTG), or, paradoxically, both. To resolve this apparent paradox, we used network analytic methods to estimate the relations among components of event centrality (EC), PTSD symptoms, and PTG in 1,136 undergraduates who had experienced trauma. Participants completed surveys on their experiences with traumatic events as well as the degree to which they experienced PTSD symptoms, components of EC, and components of PTG. We performed network analysis to examine EC, PTSD, and PTG and identify which components of EC were most conducive to its associations with PTSD versus those with PTG. We found that the components of EC most associated with PTSD, the extent to which trauma serves as a script for the future, were markedly distinct from the components associated with PTG, the extent to which trauma is seen as a turning point in one's life. The combined findings suggest that EC may be a catalyst for subsequent positive or negative effects contingent upon how an individual interprets the centrality of their traumatic experience.

Spirituality for Coping with the Trauma of a Loved One's Death During the COVID-19 Pandemic: An Italian Qualitative Study

Spirituality may be a key factor in reducing the negative psychological effects of traumatic events and a means by which the experience of grief can be processed. The objective of the present research is to assess whether and how spirituality provided concrete support in those who lost a loved one during the COVID-19 pandemic. The participants are 8 people from the most affected cities in northern Italy. They were interviewed in depth, the interviews were transcribed and the texts were analyzed through Interpretive Phenomenological Analysis. The results show that spirituality has been found to be a protective factor with regard to the processing of grief in crisis situations such as the COVID-19 pandemic, in particular with regard to the belief that the deceased loved one is now in an otherworldly dimension. In addition, the celebration of a funeral rite offers support to the grieving person in the early stages of mourning thus laying the foundation for a healthy grieving process. It is therefore important to support individual spirituality, which can be a useful tool for processing the traumatic experience, especially in difficult times such as the COVID-19 pandemic.

A micro-sociological theory of adjustment to loss

Although grief is a reaction to a social loss, it has been viewed almost exclusively through the lens of individual psychology and not sociology. In this article, we suggest that more attention to sociological aspects of grief is warranted. We propose a micro-sociological theory of bereavement and grief to complement, not replace, psychological perspectives. We assert that bereavement represents a state of loss-associated social deprivations (e.g. social disconnection). Furthermore, we postulate that addressing social deprivations (e.g. enhancing social connection) will lessen severity of distressing, disabling grief and, thereby, promote adjustment to loss. Future research is needed to test our theory and the hypotheses that follow from it in the service of promoting adaptation to bereavement.

The Persian version of the centrality of event scale (CES): Assessment of validity and reliability among Iranian university students

BACKGROUND

Event centrality, the extent to which an experience is perceived as a central event in one's life, has been found to be a strong correlate of posttraumatic stress disorder (PTSD). The centrality of event scale (CES) is commonly used in different conditions and cultures to measure trauma-related effects. However, the psychometric properties of this scale have not been investigated in the Iranian context.

METHODS

The present study examined the psychometric properties of the Persian translation of the 7-item CES in a sample of 525 university students with a history of a romantic breakup.

RESULTS

Confirmatory factor analysis confirmed a one-factor structure. The CES score was positively correlated with psychological inflexibility and PTSD symptoms. The measurement invariance analyses showed that the 7-item CES is gender invariant and can be used for both men and women.

FINDINGS

Findings supported the good psychometric properties of the 7-item CES for measuring event centrality in Iranian university students.

Emotional processing during the therapy for complicated grief

OBJECTIVE

Prior research, mainly conducted on depression, observed that clients' improved capability to process their emotions predicted better therapeutic outcomes. The current comparative study aimed to investigate whether emotional processing was related to therapeutic change in complicated grief.

METHOD

We analyzed two contrasting cases (good or poor outcome) treated with grief constructivist therapy. In both cases we investigated the association of emotional processing (Experiencing Scale) to (1) therapeutic outcome (Inventory of Complicated Grief), and (2) change in the type of grief-related emotions (Emotions Episodes).

RESULTS

The session-by-session growth of clients' emotional processing and the change of grief-related emotions were qualitatively explored throughout both cases. Compared with the poor outcome case, the good outcome case achieved more improvement in the ability to process emotions. Such improvement occurred alongside a deeper change in the type of grief-related emotions aroused, from maladaptive to more adaptive responses.

CONCLUSION

Our findings suggest that a higher emotional processing capability may be associated with the transformation of grief-related maladaptive emotions and with the improvement of complicated grief condition.

TAPS Suicide Postvention ModelTM: A comprehensive framework of healing and growth

The TAPS Suicide Postvention Model^TM is a three-phase approach to suicide grief that offers a framework for survivors and providers in the aftermath of a suicide. This framework proposes guidance on how to build a foundation for an adaptive grief journey and creates a research-informed, proactive, intentional pathway to posttraumatic growth. The Model follows the Tragedy Assistance Program for Survivors' peer-based model of care and has supported more than 16,000 military suicide loss survivors over the past decade. The Model is applicable to anyone grieving a suicide loss or coping with any associated trauma.

Preliminary Results of Caregiver Speaks: A Storytelling Intervention for Bereaved Family Caregivers

When bereaved cancer caregivers have the opportunity to tell stories about their caregiving and bereavement journey, they are better able to make meaning of these experiences. Creating a space where they can share stories with other bereaved caregivers increases social validation, facilitates the meaning-making process, and reduces distress and risk for complicated grief. This study explored the feasibility and acceptability of an innovative storytelling intervention for bereaved family caregivers of cancer patients. Twenty-one participants engaged in the intervention, and eleven were interviewed about their experience. Results indicated study feasibility and intervention acceptability. Suggestions for future intervention were also provided.

Do interpersonal events buffer or worsen depressive and grief related symptoms in people bereaved through suicide?

Life events can heighten emotional suffering related to the loss of a close relative or friend by suicide, while supportive social relationships may promote coping. We investigated the impact of stressful events and perceived social support on depressive and grief symptoms in 378 help-seeking Italians bereaved through suicide. While we did not observe a significant effect of interpersonal stressors, perceived social support did have a buffering role on the intensity of depressive symptoms but not of grief-related suffering. Focusing on expanding and capitalizing on clients' perceived social networks could strengthen postvention programs. Further research on the role of interpersonal factors is needed.

The effect of suppressing funeral rituals during the COVID-19 pandemic on bereaved families

Objective

amidst the greatest health crisis in history triggered by COVID-19, this documental study was intended to understand the meanings individuals who have lost loved ones in this context assign to the phenomenon of suppressed funeral rituals.

Method

based on the theory of grief, the corpus of this study was composed of documents published in digital media containing personal writings and reports of experiences freely and easily available to the public. Two researchers with expertise in the field used inductive thematic analysis to interpret data.

Results

the experiences shared in the reports reflect the suffering experienced by the sudden death of a significant person, which is amplified by the absence or impediment to performing familial farewell rituals. The suppression or abbreviation of funeral rituals is a traumatic experience because family members are prevented from fulfilling their last homage to the loved one who has suddenly passed away, causing feelings of disbelief and indignation.

Conclusion

alternatives and new ways to celebrate passage rituals in emergencies of strong social commotion such as a pandemic are needed to provide support and comfort to family members, friends, and relatives. These rituals help survivors to overcome the critical moment, decreasing the risk of developing complicated grief.

From hospitalization to grief: meanings parents assign to their relationships with pediatric oncology professional

OBJECTIVE

To understand the meanings assigned by bereaved parents to their relationships with healthcare professionals during the end-of-life hospitalization of their child.

METHOD

Qualitative-interpretative study based on hermeneutics. Data were collected from interviews with parents who were grieving the death of a child with cancer in the hospital and participant observation in an oncology ward. Deductive thematic analysis for data interpretation ensued.

RESULTS

The experience of parents is the sum of all relationships during treatment. Therefore, meanings form a tangle of interrelated senses built not only in the interaction with these professionals, but also with the child and with grief itself. In relationships with professionals, meanings related to the memories of the child, negative emotions and regret were identified.

CONCLUSION

The experiences and meanings of grief are shaped by the social processes and interactions experienced by the family in the hospital. The relationship with the professionals represents part of the support in coping with the grief after the child's death in the hospital, due to the perpetuity of the love shown for the child as a possible legacy in the legitimacy of the experienced interactions.

Differences in meanings made according to prolonged grief symptomatology

This study investigated differences in specific meanings made following bereavement, according to participants' prolonged grief symptomatology. A survey of 580 bereaved adults (M_age = 61.6 years, 70.7% female) showed 13 meanings predicted symptomatology, with the largest differences between the two lower symptomatology groups and the high symptomatology group; the latter was more likely to report no meaning. The results provide further support for empirically distinct groups within the bereaved population, not only in terms of symptoms, etiology, outcomes, courses, and treatment responses, but also in their meanings made, and may assist in advancing meaning reconstruction interventions.