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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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Sánchez-Cárdenas MA, León-Delgado MX, Rodríguez-Campos LF, Correa-Morales JE, González-Salazar LV, Cañón Piñeros ÁM, Fuentes-Bermúdez GP, María Vargas-Escobar L. Building an action plan to tackle palliative care inequality through multi-stakeholder platforms. Palliat Care Soc Pract 2023; 17:26323524231189520. [PMID: 37584058 PMCID: PMC10424546 DOI: 10.1177/26323524231189520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/05/2023] [Indexed: 08/17/2023] Open
Abstract
Background To achieve universal care and overcome existing barriers, the most effective strategy is to devise an action plan that incorporates palliative care into primary health care (PHC), as recommended by the World Health Organization's (WHO) Astana Declaration. In Colombia, a country with an upper-middle-income status, about 128,000 individuals experience severe health-related suffering (SHS) that necessitates palliative care. Although the country's healthcare system has made steady strides in the integration and development of palliative care, there is still no national plan in place for palliative care. Objective Build up Colombia's palliative care plan through stakeholder consensus. Method Based on the participatory action research method and the multi-stakeholder platforms model, this study convened 142 stakeholders from different levels of the health system (patient representatives, journalists, health professionals, government entities, insurance companies, universities, and drug regulatory authorities). Results The national plan aims to achieve its objectives through a series of strategic actions. These include integrating and diversifying palliative care services, improving access to opioids, increasing palliative care education, promoting community-based palliative care programs, securing funding, and implementing a regulatory framework for palliative care by public policymakers. Conclusions The national palliative care is an alliance that aims to reduce palliative care inequity in Colombia by 2026 by empowering stakeholders nationwide to collaborate around specific goals and objectives.
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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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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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Palliative Care in Older People with Multimorbidities: A Scoping Review on the Palliative Care Needs of Patients, Carers, and Health Professionals. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063195. [PMID: 35328881 PMCID: PMC8954932 DOI: 10.3390/ijerph19063195] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/23/2022] [Accepted: 03/03/2022] [Indexed: 12/30/2022]
Abstract
Although numerous studies have been conducted previously on the needs of cancer patients at the end of their life, there is a lack of studies focused on older patients with non-oncological complex chronic multipathologies. Examining these needs would help to gain a greater understanding of the profile of this specific population within the palliative care (PC) pathway and how the health and care systems can address them. The aim of this review was to identify the needs influencing PC among older patients with multimorbidities, their relatives or informal caregivers, and the health professionals who provide care for these patients. A scoping literature review guided by the Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist was carried out with literature searched in the Medline, Embase, CINAHL, WoS, Cochrane Library, PsycINFO, and Scopus databases from 2009 to 2022. Eighty-one studies were included, demonstrating a great variety of unaddressed needs for PC among chronic older patients and the complexity in detecting those needs and how to refer them to PC pathways. This review also suggested a scarcity of tools and limited pathways for professionals to satisfy their needs for these patients and their families, who often felt ignored by the system. Substantial changes will be needed in health and care systems at the institutional level, providing more specialized PC environments and systematizing PC processes.
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Boven C, Dillen L, Van den Block L, Piers R, Van Den Noortgate N, Van Humbeeck L. In-Hospital Bereavement Services as an Act of Care and a Challenge: An Integrative Review. J Pain Symptom Manage 2022; 63:e295-e316. [PMID: 34695567 DOI: 10.1016/j.jpainsymman.2021.10.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/13/2021] [Accepted: 10/15/2021] [Indexed: 10/20/2022]
Abstract
CONTEXT Globally, people most often die within hospitals. As such, healthcare providers in hospitals are frequently confronted with dying persons and their bereaved relatives. OBJECTIVES To provide an overview of the current role hospitals take in providing bereavement care. Furthermore, we want to present an operational definition of bereavement care, the way it is currently implemented, relatives' satisfaction of receiving these services, and finally barriers and facilitators regarding the provision of bereavement care. METHODS An integrative review was conducted by searching four electronic databases, from January 2011 to December 2020, resulting in 47 studies. Different study designs were included and results were reported in accordance with the theoretical framework of Whittemore and Knafl (2005). RESULTS Only four articles defined bereavement care: two as services offered solely post loss and the other two as services offered pre and post loss. Although different bereavement services were delivered the time surrounding the death, the follow-up of bereaved relatives was less routinely offered. Relatives appreciated all bereavement services, which were rather informally and ad-hoc provided to them. Healthcare providers perceived bereavement care as important, but the provision was challenged by numerous factors (such as insufficient education and time). CONCLUSION Current in-hospital bereavement care can be seen as an act of care that is provided ad-hoc, resulting from the good-will of individual staff members. A tiered or stepped approach based on needs is preferred, as it allocates funds towards individuals-at-risk. Effective partnerships between hospitals and the community can be a useful, sustainable and cost-effective strategy.
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Affiliation(s)
- Charlotte Boven
- Department of Geriatric Medicine (C.B., R.P., N.V.D.N., L.V.H.), Ghent University Hospital, Ghent, Belgium.
| | - Let Dillen
- Department of Geriatric Medicine and Palliative Care Unit (L.D.), Ghent University Hospital, Ghent, Belgium
| | - Lieve Van den Block
- End-of-life Care Research Group (L.V.D.B.), Vrije Universiteit Brussel (VUB) & Ghent University, Brussels Health Campus (Building C), Laarbeeklaan 103, 1090 Brussels, Belgium & Campus Ghent University Hospital (Entrance 42 K3), Ghent, Belgium; Department of Family Medicine and Chronic Care (L.V.D.B.), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| | - Ruth Piers
- Department of Geriatric Medicine (C.B., R.P., N.V.D.N., L.V.H.), Ghent University Hospital, Ghent, Belgium
| | - Nele Van Den Noortgate
- Department of Geriatric Medicine (C.B., R.P., N.V.D.N., L.V.H.), Ghent University Hospital, Ghent, Belgium
| | - Liesbeth Van Humbeeck
- Department of Geriatric Medicine (C.B., R.P., N.V.D.N., L.V.H.), Ghent University Hospital, Ghent, Belgium
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Keegan O, Murphy I, Benkel I, Limonero JT, Relf M, Guldin MB. Using the Delphi technique to achieve consensus on bereavement care in palliative care in Europe: An EAPC White Paper. Palliat Med 2021; 35:1908-1922. [PMID: 34488504 DOI: 10.1177/02692163211043000] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The WHO definition of palliative care includes bereavement support as integral to palliative care, yet a previous survey of bereavement support in palliative care in Europe has shown a range of service responses to loss. A rigorous approach to agreeing and implementing a palliative care bereavement framework was required. AIM The aim of this study was to develop consensus on best-practice recommendations for bereavement care principles, structures, processes and delivery based on current practice and evidence. DESIGN In accordance with Guidance on Conducting and Reporting Delphi Studies, a consensus-building five-round Delphi technique was performed. A scoping review of research literature informed drafting of 54 statements by the EAPC Bereavement Task Force. Evaluation of the statements was performed by an expert panel using a 5-point Likert scale. ⩾80% agreement were defined as essential items and 75%-79% agreement were defined as desirable items. Items with a consensus rating <75% were revised during the process. SETTING/PARTICIPANTS The Delphi study was carried out by an expert panel among membership organisations of the European Association for Palliative Care. RESULTS In total, 376 email requests to complete Delphi questionnaire were distributed with a response rate of 23% (n = 87) and a follow-up response-rate of 79% (n = 69). Of the initial 54 statements in six dimensions, 52 statements were endorsed with 26 essential statements and 26 desirable statements. CONCLUSIONS The six dimensions and 52 statements agreed through this Delphi study clarify a coherent direction for development of bereavement services in palliative care in Europe.
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Affiliation(s)
- Orla Keegan
- Head of Education & Bereavement, Irish Hospice Foundation, Dublin, Ireland
| | - Irene Murphy
- Maymount University Hospital and Hospice, Cork, Ireland
| | | | - Joaquim T Limonero
- Facultat de Psicologia, Universitat Autonoma de Barcelona, Barcelona, Spain
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8
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Pattison NA, White C, Lone NI. Bereavement in critical care: A narrative review and practice exploration of current provision of support services and future challenges. J Intensive Care Soc 2021; 22:349-356. [PMID: 35154374 PMCID: PMC8829769 DOI: 10.1177/1751143720928898] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023] Open
Abstract
This special article outlines the background to bereavement in critical care and scopes the current provision and evidence for bereavement support following death in critical care. Co-authored by a family member and former critical care patient, we aim to draw out the current challenges and think about how and where support can be implemented along the bereavement pathway. We draw on the literature to examine different trajectories of dying in critical care and explore how these might impact bereavement, highlighting important points and risk factors for complicated grief. We present graphic representation of the critical junctures for bereavement in critical care. Adjustment disorders around grief are explored and the consequences for families, including the existing evidence base. Finally, we propose new areas for research in this field.
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Affiliation(s)
- Natalie A Pattison
- East and North Herts NHS Trust, Hertfordshire, UK; University of Hertfordshire, Hertfordshire, UK; the Florence Nightingale Foundation, London, UK
| | | | - Nazir I Lone
- University of Edinburgh School of Molecular Genetic and Population Health Sciences, Edinburgh, 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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10
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Naef R, Peng-Keller S, Rettke H, Rufer M, Petry H. Hospital-based bereavement care provision: A cross-sectional survey with health professionals. Palliat Med 2020; 34:547-552. [PMID: 31868555 DOI: 10.1177/0269216319891070] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND An in-hospital death is a profound experience for those left behind and has been associated with family members' psychological morbidity. Supporting bereaved family members is an essential part of end-of-life care and includes attentive presence, information-giving, and emotional and practical support. The actual adoption of hospital-based bereavement care, however, remains little understood. AIM To investigate hospital-based bereavement care provision and associated barriers. DESIGN Cross-sectional survey using an online questionnaire. SETTING/PARTICIPANTS Health professionals (n = 196) from two University-affiliated acute and psychiatric hospitals in Switzerland. RESULTS The most frequent bereavement services (⩾40%) were viewing the deceased, giving information on available support, and making referrals; the most often named barriers were lack of time and organizational support. Acute care health professionals faced statistically significant more structural barriers (55.1% vs 21.4% lack of time, 47.8% vs 25.9% lack of organizational support) and felt insufficiently trained (38.4% vs 20.7%) compared to mental health professionals (p ⩽ 0.05). Nurses provided more immediate services compared to physicians, such as viewing the deceased (71.3% vs 49.0%) and sending sympathy cards (37.4% vs 16.3%) (p ⩽ 0.01). In contrast, physicians screened more often for complex bereavement disorders (10.2% vs 2.6%) and appraised bereavement care as beyond their role (26.5% vs 7.8%) (p ⩽ 0.05). CONCLUSION The study indicates that many barriers to bereavement care exist in hospitals. More research is required to better understand enabling and limiting factors to bereavement care provision. A guideline-driven approach to hospital-based bereavement care that defines best practice and required organizational support seems necessary to ensure needs-based bereavement care.
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Affiliation(s)
- Rahel Naef
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
| | | | - Horst Rettke
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
| | - Michael Rufer
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Heidi Petry
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
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11
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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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12
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Breen LJ, Aoun SM, O'Connor M, Johnson AR, Howting D. Effect of caregiving at end of life on grief, quality of life and general health: A prospective, longitudinal, comparative study. Palliat Med 2020; 34:145-154. [PMID: 31659934 DOI: 10.1177/0269216319880766] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Determining the effect of caregiving and bereavement remains a challenge. To date, no study has employed a comparison group to investigate caregivers' grief, quality of life and general health in relation to non-caregivers. AIM We aimed to determine how caregivers' grief, quality of life and general health changed following death compared to non-caregivers and whether pre-death grief predicted these outcomes. DESIGN A prospective, longitudinal study of family caregivers and a comparison group matched for age, gender and postcode was conducted. All participants completed questionnaires at four points - once pre-death and three times post-death (3-4 months, 6-7 months and 9-10 months). SETTING/PARTICIPANTS Participants (N = 70) were family caregivers of persons receiving palliative care, mostly for cancer, recruited from three palliative care providers in Western Australia and matched comparisons recruited from advertisements. RESULTS There were significant differences between the caregivers' and comparisons' grief, general health and quality of life at pre-death, 3-4 months and 6-7 months post-death, but not at 9-10 months post-death. The rate of progression in these constructs following death was independent from the intensity of pre-death grief. However, caregiver prolonged grief score significantly predicted prolonged grief score at 6-7 and 9-10 months post-death. CONCLUSION It took 9-10 months for the caregivers' grief, general health and quality of life to correspond to the comparison group. These findings present an opportunity for palliative care research and practice to consider how best to support the majority of caregivers without grief complications so that their pre- and post-death support needs are realised.
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Affiliation(s)
- Lauren J Breen
- School of Psychology, Curtin University, Perth, WA, Australia
| | - Samar M Aoun
- Palliative Care Unit, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia.,The Perron Institute for Neurological and Translational Science, Perth, WA, Australia
| | - Moira O'Connor
- School of Psychology, Curtin University, Perth, WA, Australia
| | | | - Denise Howting
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, WA, Australia.,Centre for Medical Research, The University of Western Australia, Perth, WA, Australia.,Harry Perkins Institute of Medical Research, Perth, WA, Australia
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13
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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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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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15
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Martins Pereira S, Araújo J, Hernández-Marrero P. Towards a public health approach for palliative care: an action-research study focused on engaging a local community and educating teenagers. BMC Palliat Care 2018; 17:89. [PMID: 29958534 PMCID: PMC6025723 DOI: 10.1186/s12904-018-0344-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 06/20/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Education sessions about palliative care among teenagers are uncommon in developed countries. However, very little is known either about the impact of this type of intervention or about how this age-group perceives its impact. The purpose of this study was therefore to (i) implement an education program about palliative care among teenagers and (ii) to investigate the impact of the program on the participants. METHODS An action-research study was conducted at a local community parish in Portugal in November 2015. An education programme was purposively built about palliative care, using active educational strategies adapted for teenagers. Quantitative and qualitative techniques and instruments were used for data collection: questionnaire; reflective diaries; interviews and written testimony. The program had three stages: preparation; intervention; and evaluation. Qualitative data were analysed using thematic content analysis; quantitative data were analysed descriptively. RESULTS 69 people (47 teenagers) participated in the education program. Findings show that the education program contributed to creating awareness about palliative care. Both the teenagers and other participants assessed the education program positively. At the end of the program, teenagers had a constructive message about palliative care. CONCLUSIONS The education-intervention contributed to create awareness about palliative care among the participant teenagers, who ended the program with a positive message about palliative care. Based on our findings, the following policy implications can be drawn: (1) Further research is needed to evaluate the effect of education programs about palliative care among younger age groups (teenagers and children), particularly in relation to the changing of attitudes toward palliative care. (2) Education about palliative care should be promoted to local communities, involving all age groups, to foster involvement, participation and empowerment. (3) Compassionate communities should be promoted to enhance the health and wellbeing of all citizens at the end of their life.
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Affiliation(s)
- Sandra Martins Pereira
- Instituto de Bioética, Universidade Católica Portuguesa, Rua Diogo Botelho, 1327 4169-005 Porto, Portugal
- UNESCO Chair in Bioethics Instituto de Bioética, Universidade Católica Portuguesa, Porto, Portugal
- CEGE: Centro de Estudos em Gestão e Economia [Research Centre in Management and Economics Católica Porto Business School, Universidade Católica Portuguesa, Porto, Portugal
| | - Joana Araújo
- Instituto de Bioética, Universidade Católica Portuguesa, Rua Diogo Botelho, 1327 4169-005 Porto, Portugal
- UNESCO Chair in Bioethics Instituto de Bioética, Universidade Católica Portuguesa, Porto, Portugal
- CEGE: Centro de Estudos em Gestão e Economia [Research Centre in Management and Economics Católica Porto Business School, Universidade Católica Portuguesa, Porto, Portugal
| | - Pablo Hernández-Marrero
- Instituto de Bioética, Universidade Católica Portuguesa, Rua Diogo Botelho, 1327 4169-005 Porto, Portugal
- UNESCO Chair in Bioethics Instituto de Bioética, Universidade Católica Portuguesa, Porto, Portugal
- CEGE: Centro de Estudos em Gestão e Economia [Research Centre in Management and Economics Católica Porto Business School, Universidade Católica Portuguesa, Porto, Portugal
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Breen LJ, Szylit R, Gilbert KR, Macpherson C, Murphy I, Nadeau JW, Reis E Silva D, Wiegand DL. Invitation to grief in the family context. DEATH STUDIES 2018; 43:173-182. [PMID: 29733763 DOI: 10.1080/07481187.2018.1442375] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Grief is a family affair, yet it is commonly viewed as an individual phenomenon. As an international, interdisciplinary team, we explore grief within a family context across theoretical, research, practice, and educational domains. Families are complex and working with this complexity is challenging but necessary for a holistic view of grief. We therefore encourage an increased focus on theorizing, researching, practicing, and educating using innovative approaches to address the complexities of grief within the context of families. Learnings from within each domain will affirm and enhance the development of family-level thinking and approaches.
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Affiliation(s)
- Lauren J Breen
- a School of Psychology , Curtin University , Perth, Western Australia, Australia
| | - Regina Szylit
- b School of Nursing, University of São Paulo , São Paulo , Brazil
| | | | - Catriona Macpherson
- d Fife Specialist Palliative Care, Victoria Hospice, Kirkcaldy , Fife , Scotland
| | - Irene Murphy
- e Marymount University Hospital and Hospice , Cork , Ireland
| | | | - Daniela Reis E Silva
- g Laboratory for Research and Intervention on Grief and Bereavement, Pontifical Catholic University of São Paulo, São Paulo , Brazil
| | - Debra L Wiegand
- h School of Nursing , University of Maryland , Baltimore, Maryland, USA
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Wenn J, O'Connor M, Breen LJ, Rees CS. Exploratory study of metacognitive beliefs about coping processes in prolonged grief symptomatology. DEATH STUDIES 2018; 43:143-153. [PMID: 29474138 DOI: 10.1080/07481187.2018.1440032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Despite research examining the role of metacognitive beliefs about coping processes in maintaining psychological disorders, to date, no studies have explored their role in the maintenance of prolonged grief. Twelve semistructured interviews were conducted with bereavement specialists and bereaved people with elevated grief to identify metacognitive beliefs about coping processes relevant to prolonged grief. Analysis revealed several metacognitive beliefs potentially driving maladaptive coping processes used by people with prolonged grief symptomatology. Findings may underpin the development of interventions that aim to modify unhelpful metacognitive beliefs that perpetuate maladaptive coping processes.
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Affiliation(s)
- Jenine Wenn
- a School of Psychology, Faculty of Health Sciences , Curtin University , Perth , Western Australia , Australia
| | - Moira O'Connor
- a School of Psychology, Faculty of Health Sciences , Curtin University , Perth , Western Australia , Australia
| | - Lauren J Breen
- a School of Psychology, Faculty of Health Sciences , Curtin University , Perth , Western Australia , Australia
| | - Clare S Rees
- a School of Psychology, Faculty of Health Sciences , Curtin University , Perth , Western Australia , Australia
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Aoun SM, Ewing G, Grande G, Toye C, Bear N. The Impact of Supporting Family Caregivers Before Bereavement on Outcomes After Bereavement: Adequacy of End-of-Life Support and Achievement of Preferred Place of Death. J Pain Symptom Manage 2018; 55:368-378. [PMID: 29030206 DOI: 10.1016/j.jpainsymman.2017.09.023] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 09/21/2017] [Accepted: 09/21/2017] [Indexed: 11/17/2022]
Abstract
CONTEXT The investigation of the situation of bereaved family caregivers following caregiving during the end-of-life phase of illness has not received enough attention. OBJECTIVES This study investigated the extent to which using the Carer Support Needs Assessment Tool (CSNAT) intervention during the caregiving period has affected bereaved family caregivers' perceptions of adequacy of support, their grief and well-being, and achievement of their preferred place of death. METHOD All family caregivers who participated in a stepped-wedge cluster trial of the CSNAT intervention in Western Australia (2012-2014) and completed the pre-bereavement study (n = 322) were invited to take part in a caregiver survey by telephone four to six months after bereavement (2015). The survey measured the adequacy of end-of-life support, the level of grief, the current physical and mental health, and the achievement of the preferred place of death. RESULTS The response rate was 66% (152, intervention; 60, control). The intervention group perceived that their pre-bereavement support needs had been adequately met to a significantly greater extent than the control group (d = 0.43, P < 0.001) and that patients have achieved their preferred place of death more often according to their caregivers (79.6% vs. 63.6%, P = 0.034). There was also a greater agreement on the preferred place of death between patients and their caregivers in the intervention group (P = 0.02). CONCLUSIONS The results from this study provide evidence that the CSNAT intervention has a positive impact on perceived adequacy of support of bereaved family caregivers and achievement of preferred place of death according to caregivers. The benefits gained by caregivers in being engaged in early and direct assessment of their support needs before bereavement reinforce the need for palliative care services to effectively support caregivers well before the patient's death.
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Affiliation(s)
- Samar M Aoun
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia; Adjunct Professor, LaTrobe University, Melbourne, Victoria, Australia.
| | - Gail Ewing
- Centre for Family Research, University of Cambridge, Cambridge, United Kingdom
| | - Gunn Grande
- Division of Nursing, Midwifery & Social Work, The University of Manchester, Manchester, United Kingdom
| | - Chris Toye
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia; Centre for Nursing Research, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Natasha Bear
- Department of Clinical Research and Education, Child and Adolescent Health Services, Perth, Western Australia, Australia
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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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Thomsen KT, Guldin MB, Nielsen MK, Ollars CL, Jensen AB. A process evaluation of systematic risk and needs assessment for caregivers in specialised palliative care. BMC Palliat Care 2017; 16:23. [PMID: 28390401 PMCID: PMC5385034 DOI: 10.1186/s12904-017-0196-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 03/23/2017] [Indexed: 11/29/2022] Open
Abstract
Background Caregiving is strenuous and it may be associated with adverse psychological outcomes. During the palliative care trajectory, there are unique opportunities for providing support and preventing poor bereavement outcome. However, the tasks of palliative care staff in relation to caregivers are often unclear in the daily practice. Assessment is recommended to establish risk and needs and standards for caregiver support are available. Still, the feasibility of applying these standards among caregivers in everyday clinical practice has not been tested so far. Methods This study tested the feasibility of an intervention based on key elements of the “Bereavement support standards for specialist palliative care services” in a Danish specialised palliative home care team. We followed the UK Medical Research Council’s guidelines for the process evaluation of complex interventions. The intervention consisted of: 1. Systematic risk and needs assessment for caregivers at care entry; 2. Interdisciplinary conference to prepare a support plan; 3. Targeted support; 4. The establishment of an electronic medical record for caregivers to document targeted support. Outcomes included the reach, fidelity and acceptability of the intervention as well as the assessment of contextual factors. Results The intervention reached 76 of 164 caregivers (46%). The interdisciplinary risk assessment and documentation of a support plan was conducted in 57 (75%) of the enrolled caregivers. Finally, a separate medical record was established according to the intervention blueprint for 62% of caregivers receiving targeted support. After managing initial challenges, palliative care staff reported that the intervention was useful and acceptable. Conclusion The intervention proved feasible and useful. Still, we identified barriers to the implementation which should be taken into consideration when planning implementation of a systematic risk and needs assessment and in the establishment of medical records for caregivers.
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Affiliation(s)
- Kia Toft Thomsen
- Department of Oncology, Aarhus University Hospital, Noerrebrogade 44, Aarhus C, 8000, Denmark.
| | - Mai-Britt Guldin
- Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus C, 8000, Denmark.,The Palliative Team, Department of Oncology, Aarhus University Hospital, Noerrebrogade 44, Aarhus C, 8000, Denmark
| | - Mette Kjærgaard Nielsen
- Research Unit for General Practice, Department of Public Health, Aarhus University, Bartholins Allé 2, Aarhus C, 8000, Denmark
| | - Chaitali Laura Ollars
- Department of Oncology, Aarhus University Hospital, Noerrebrogade 44, Aarhus C, 8000, Denmark
| | - Anders Bonde Jensen
- Department of Oncology, Aarhus University Hospital, Noerrebrogade 44, Aarhus C, 8000, Denmark
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Development of the Bereavement Risk Inventory and Screening Questionnaire (BRISQ): Item generation and expert panel feedback. Palliat Support Care 2016; 15:57-66. [PMID: 27516152 DOI: 10.1017/s1478951516000626] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Following the loss of a loved one to cancer, a significant subset of bereaved family members are at heightened risk for mental and physical health problems; however, these family members often "fall through the cracks" of the healthcare system. A brief, clinically useful self-report bereavement risk-screening tool could facilitate more effective identification of family members in need of psychosocial support before and after a cancer loss. Thus, the purpose of this study was to develop and refine the Bereavement Risk Inventory and Screening Questionnaire (BRISQ), a self-report bereavement screening tool, and to assess its utility using feedback from bereavement experts. METHOD Quantitative and qualitative feedback from a panel of 15 clinical and research experts in bereavement was obtained through an online survey to identify the most clinically useful items and understand expert opinion on bereavement screening. RESULTS The qualitative and quantitative feedback were synthesized, resulting in a 22% reduction of the item pool. While there was a general consensus between experts on the most clinically useful risk factors for bereavement-related mental health challenges and on the utility of screening, they also offered feedback on language and formatting that guided substantial revisions to the BRISQ. SIGNIFICANCE OF RESULTS These findings were utilized to refine the BRISQ in preparation for a second study to obtain family member feedback on the measure. By incorporating both expert and family member feedback, the intention is to create a screening tool that represents top clinical and research knowledge in bereavement in a way that effectively addresses barriers to care.
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