The role of volunteers in hospice bereavement support in New Zealand

You're Teaching Me Something About Living: Australian Palliative Care Volunteers' Evolving Experiences of Grief and Loss

Palliative care volunteers play a crucial role in supporting people who are terminally ill. Previous studies have indicated that a personal experience of grief and bereavement is a motivating factor for wanting to be a palliative care volunteer. Using reflexive thematic analysis as a methodological approach, the aim of this qualitative study was to explore the lived experience of grief and bereavement in a group of 11 Australian volunteers in adult palliative care settings. Three themes were identified from the dataset: witnessing and finding community; approaching death and dying with curiosity and openness; living well through death awareness. Importantly, death awareness was felt by volunteers to be an essential part of sense making around their past grief and a source of guidance for appreciating life. The findings of this study contribute to a deeper understanding of volunteering motivations, end-of-life care, and the changing nature of grief as a lived experience.

The challenges of formal volunteering in hospitals

The role and tasks performed by hospital volunteers (HV), their relationship with other stakeholders and the management of volunteers, are controversial topics, not widely explored in literature. Through an exploratory study, which incorporated the collection and analysis of qualitative data, involving 46 interviews with volunteers, staff and hospital administration from three hospitals in Portugal, we analyze hospital volunteers, as well as the tasks they perform, how these tasks are assigned, and how they relate to other stakeholders. As a result, we conclude that the job definition of HV is generic, open to different interpretations and that the assigned functions of HV are not known from all stakeholders. This problem can have negative repercussions in the relationship between volunteers and health professionals, potentially fostering conflict. Nevertheless, most respondents are satisfied with the current format of volunteer management.

What motivates individuals to volunteer in Ebola epidemic response? A structural approach in Guinea

BACKGROUND

The 2014-2016 Ebola epidemic in West Africa placed greater demands on the affected countries' already scarce health workforce. Consequently, governments in the most affected West African countries made appeals for volunteers to join Ebola response programs. Those volunteers played an important yet high-risk role in aiding the victims of the Ebola epidemic and in limiting its spread. However, little is known as to what motivated those volunteers to commit themselves to the Ebola response programs. This information is important for planning for volunteer recruitment strategies during future epidemics. The aim of the present study, therefore, was to identify and assess the motivations that led individuals to volunteer for Ebola response programs in West Africa.

METHODS

The study participants were 600 persons who volunteered through the Guinean Ebola response program during the 2014-2016 epidemic. From February to May 2016, they were presented with a questionnaire that contained 50 assertions referring to possible motives for volunteering in the Ebola response program and indicated their degree of agreement with each of them on a scale of 0-10. The responses were analyzed using factor analysis.

RESULTS

Seven separable volunteer motivations were identified. "Feeling of patriotic duty" (M = 9.02) and "Feeling of moral responsibility" (M = 8.12) clearly emerged as the most important. Second-tier motivations were "Compliance with authority" (M = 6.66), "Desire to use one's skills for a collective good" (M = 6.49), "Seeking personal growth" (M = 5.93), "Desire to gain community recognition" (M = 5.13), and "Hoping for a career reorientation" (M = 4.52).

CONCLUSIONS

These findings strongly suggest that volunteer recruitment, if needed in future Ebola epidemics, must adopt a multifaceted motivational approach rather than focus on one single motivator. Putting relatively more emphasis on motivational messages referring to patriotic values, as well as to moral responsibility, would likely increase volunteering.

Palliative Care Volunteers: Why Do They Do It?

Two studies were conducted to examine people's motives for joining a palliative care volunteer program. To generate a pool of reasons for becoming a palliative care volunteer, previous studies of motivations relevant to palliative care were reviewed and interviews were conducted with 15 palliative care volunteers (Study 1). Combining the literature review and interviews, a total of 22 distinct reasons for volunteering were identified and used to create an Inventory of Motivations for Palliative Care Voluntarism (IMPCV). In Study 2, 113 palliative care volunteers responded to the IMPCV. “To help ease the pain of those living with a life-threatening illness” was rated as the most influential reason for becoming a palliative care volunteer. A principal components factor analysis was conducted on the IMPCV. It was decided that four factors adequately represented the items: Leisure, Personal Gain, Altruism, and Civic Responsibility.

Volunteers in Palliative Care Make A Difference

Family care giving is important for the quality of life of terminally ill patients and their family members. Although family caregivers are generally eager to provide palliative care, at some point it may become too demanding, and then volunteers can make a difference. This four-study paper presents the experiences of families of terminally ill patients with volunteer support. In four sequential studies, information was gathered from focus groups (n=22), a survey (n=237), individual interviews (n=6), and an Internet panel (n=1,712). The focus groups revealed that volunteers can make the last phase of life less stressful for family caregivers by offering practical and emotional support, and this was confirmed by the survey; however, one improvement is needed: every volunteer support should be concluded with a closing contact. The individual interviews showed that in the end-of-life stage the crucial decision is whether the patient can remain at home, not whether the caregiver needs volunteer support; and in such extreme situations, it is understood that volunteer support must involve more than one volunteer. The Internet panel revealed that in the Netherlands the general public is aware that volunteers can provide palliative care support, but many people don't know how to contact these volunteers. We must find ways to extend volunteer support in palliative care in the Netherlands and elsewhere. We must also study further the experiences of caregivers of terminally ill patients with volunteers and others who provide palliative care.

Hospice volunteers: bridging the gap to the community?

Current demographic, policy and management changes are a challenge to hospices to develop their volunteering practices. The study upon which this paper is based aimed to explore good practice in volunteer involvement and identify ways of improving care through developing volunteering. The project consisted of a narrative literature review; a survey of volunteer managers; and organisational case studies selected through purposive diversity sampling criteria. A total of 205 staff, volunteers, patients and relatives were interviewed across 11 sites in England in 2012. This article focuses on one of the findings - the place that volunteers occupy between the hospice and the community beyond its walls. External changes and pressures in society were impacting on volunteer management, but were viewed as requiring a careful balancing act to retain the 'spirit' of the hospice philosophy. Honouring the developmental history of the hospice was vital to many respondents, but viewed less positively by those who wished to modernise. Hospices tend to be somewhat secluded organisations in Britain, and external links and networks were mostly within the end-of-life care arena, with few referring to the wider volunteering and community fields. Volunteers were seen as an informal and symbolic 'link' to the local community, both in terms of their 'normalising' roles in the hospice and as providing a two-way flow of information with the external environment where knowledge of hospice activities remains poor. The diversity of the community is not fully represented among hospice volunteers. A few hospices had deliberately tried to forge stronger interfaces with their localities, but these ventures were often controversial. The evidence suggests that there is substantial scope for hospices to develop the strategic aspects of volunteering through greater community engagement and involvement and by increasing diversity and exploiting volunteers' 'boundary' position more systematically to educate, recruit and raise awareness.

Building Community Capacity in Bereavement Support

Background:

Most bereaved people do not require specialist intervention, yet building community capacity in providing bereavement support is underdeveloped. While family caregivers indicate a need for more information about bereavement, there is little evidence to guide what this information might contain.

Objective:

The study’s purpose was to inform bereavement support by determining the advice people bereaved through expected deaths in palliative care have for others in that situation.

Design:

Four funeral providers posted a questionnaire to previous clients who had used their services 6 to 24 months prior and 678 bereaved people responded.

Setting/Participants:

The sample size for this study comprised 265 bereaved people whose relative used palliative care services.

Measurements:

The questionnaire comprised 82 questions about caregiving, bereavement support, current bereavement-related distress, and 2 open-ended questions concerning their bereavement, one of them on advice they have to other people in the same situation.

Results:

Family caregivers (n = 140) of people who received palliative care responded to the open-ended question about advice for others. An open content analysis yielded 3 themes—preparations for bereavement, utilizing social networks, and strategies for dealing with grief.

Conclusions:

Bereaved family caregivers’ experiential knowledge can be harnessed to progress the development of bereavement care strategies for the good of the community. These responses could be incorporated into information brochures, posters, and other community education avenues in order to upskill palliative care bereavement volunteers and the wider community so that bereaved family caregivers are best supported.

Palliative care volunteerism among college students in Canada

The goal of Study 1 was to investigate whether young Canadian adults were interested in becoming involved in palliative care volunteer work. After reading a brief description of what volunteering in a palliative care environment typically involves, participants (undergraduate students) were asked to indicate whether they would be interested in this kind of volunteer experience and to provide a written explanation of their answer.

Of the 105 participating students, only 39 (37.1 percent) expressed an interest in volunteering, while 66 (62.9 percent) were not interested. Not surprisingly, the results revealed that significantly more females than males were interested in palliative care volunteer work (45.9 percent and 25.0 percent, respectively). The most common reason students gave for wanting to become a palliative care volunteer was to help others; the reason given most often for not wanting to volunteer was that it would be too emotionally demanding. It is important to note that prior to taking part in this study the majority of the participating students (75.9 percent) did not know what palliative care was.

The goal of Study 2 was to investigate undergraduate students’ interest in volunteering in a nursing home, in a classroom, and at a food bank. Of the 111 participating students, 74 (66.7 percent) expressed an interest in volunteering at a food bank and in a nursing home, and 89 (80.2 percent) were interested in becoming a classroom volunteer. Together, the results of Studies 1 and 2 support the view that young people in Canada (especially males) are not interested in becoming involved in the care of dying persons. However, the results also indicate that they are very interested in volunteering with other populations (e.g., the elderly, school children) and in other settings (e.g., food bank).

Informal support needs of cancer patients who are living alone: a qualitative insight

OBJECTIVE

Staying independent is an important need for cancer patients living alone. Such patients might have specific informal support needs in order to stay independent. We want to explore which informal support patients living alone perceive as helpful along the cancer care continuum.

METHODS

A purposeful sample of 32 patients living alone and undergoing cancer treatment were interviewed, using a semi-structured interview guide. Seventeen of them were interviewed a second time, 8 months to 1 year later. Analysis was conducted using grounded theory techniques.

RESULTS

The informal support patients received was not experienced unconditionally positive. We found that an equilibrium was necessary between reducing the disadvantages of living alone while not endangering the advantages of living alone, resulting in a need for an equilibrium between distance and proximity with their informal network. The needed equilibrium was influenced by the patients' history of living alone, the perception of helpfulness of the informal network, the acuteness of side-effects and prognosis of the disease. We found that, as treatment progressed, patients tended to favor proximity and needed a greater share of the support to be provided by professionals.

CONCLUSIONS

Cancer patients living alone experience informal support as an ambiguous blessing. Such support has to be given in a fine balance in order to be perceived as helpful. Health care providers should educate the informal network of the patient about which support is helpful, and under what circumstances.

Hospice palliative care volunteers: The benefits for patients, family caregivers, and the volunteers

Objective:

Terminally ill patients and family caregivers can benefit greatly from the support and care provided by trained hospice palliative care volunteers. The benefits of doing this kind of volunteer work also extend to the volunteers themselves, who often say they receive more than they give from the patients/families they are “privileged” to be with. The purpose of this article is to demonstrate how hospice palliative care volunteerism benefits both the patients and families who utilize this service as well as the volunteers.

Method:

A review of studies demonstrating how terminally ill patients, and especially family caregivers, can benefit from the use of hospice palliative care volunteers and how the volunteers themselves benefit from their experiences.

Results:

Terminally ill patients and families receive many benefits from using the services of hospice palliative care volunteers, including emotional support, companionship, and practical assistance (e.g., respite or breaks from caregiving). Volunteering in hospice palliative care also provides many benefits for the volunteers, including being able to make a difference in the lives of others, personal growth, and greater appreciation of what is really important in life.

Significance of results:

More needs to be done to promote the value of hospice palliative care volunteers to those who can really benefit from their support and care (i.e., patients and their families) as well as to help people recognize the potential rewards of being a hospice palliative care volunteer. It is a win–win situation.

Volunteers in specialist palliative care: a survey of adult services in the United Kingdom

BACKGROUND

Worldwide, the demand for specialist palliative care is increasing but funding is limited. The role of volunteers is underresearched, although their contribution reduces costs significantly. Understanding what volunteers do is vital to ensure services develop appropriately to meet the challenges faced by providers of palliative care.

OBJECTIVE

The study's objective is to describe current involvement of volunteers with direct patient/family contact in U.K. specialist palliative care.

DESIGN

An online survey was sent to 290 U.K. adult hospices and specialist palliative care services involving volunteers covering service characteristics, involvement and numbers of volunteers, settings in which they are involved, extent of involvement in care services, specific activities undertaken in each setting, and use of professional skills.

RESULTS

The survey had a 67% response rate. Volunteers were most commonly involved in day care and bereavement services. They entirely ran some complementary therapy, beauty therapy/hairdressing, and pastoral/faith-based care services, and were involved in a wide range of activities, including sitting with dying patients.

CONCLUSIONS

This comprehensive survey of volunteer activity in U.K. specialist palliative care provides an up-to-date picture of volunteer involvement in direct contact with patients and their families, such as providing emotional care, and the extent of their involvement in day and bereavement services. Further research could focus on exploring their involvement in bereavement care.

Role Ambiguity, Role Conflict, or Burnout

Objective:

To determine whether burnout, role ambiguity, or conflict affects Australian hospice volunteers.

Method:

Hospice volunteers (n = 120) were invited to participate in this pilot survey. Quantitative data were analyzed using descriptive statistics, while the free-text responses were analyzed using thematic content analysis. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Guidelines have been used to report this data.

Results:

A total of 97 participants completed the survey. The majority were middle-aged women who had been palliative care volunteers for more than 7 years and volunteered 14 hours/week (median). Participants reported low levels of role ambiguity (x = 8.4, standard deviation [SD] ±3.0) and conflict (x = 9.8, SD ±3.4) and described enjoying their volunteering and having no symptoms of burnout (76%).

Significance:

Active hospice volunteers report low levels of role ambiguity, conflict, and burnout. Adopting a range of self-care strategies and working within a structured volunteer program appear to be important protective factors.

A narrative literature review of the contribution of volunteers in end-of-life care services

BACKGROUND

Volunteers are integral to the history of hospices and continue to play a vital role. However, economic, policy and demographic challenges in the twenty-first century raise questions about how best to manage this essential resource.

AIM

This narrative review explores the recent literature on end-of-life care volunteering and reflects upon the issues pertinent to current organisational challenges and opportunities.

DESIGN

The parameters of the review were set deliberately wide in order to capture some of the nuances of contemporary volunteer practices. Articles reporting on research or evaluation of adult end-of-life care services (excluding prison services) that use volunteers and were published in English between 2000 and 2011 were included.

DATA SOURCES

Seven electronic databases, key journals and grey literature databases.

RESULTS

Sixty-eight articles were included in the analysis. The articles were drawn from an international literature, while acknowledging that volunteer roles vary considerably by organisation and/or by country and over time. The majority of articles were small in scale and diverse in methodology, but the same topics repeatedly emerged from both the qualitative and quantitative data. The themes identified were individual volunteer factors (motivation, characteristics of volunteers, stress and coping, role boundaries and value) and organisational factors (recruiting for diversity, support and training and volunteers' place in the system).

CONCLUSIONS

The tensions involved in negotiating the boundary spaces that volunteers inhabit, informality and regulation, diversity issues and the cultural specificity of community models, are suggested as topics that merit further research and could contribute to the continuing development of the volunteer workforce.

Holding on to what you have got: keeping hospice palliative care volunteers volunteering

In all, 119 hospice palliative care volunteers from 3 community-based hospice programs completed the Volunteer Retention Questionnaire (VRQ), a 33-item survey designed for this study. The VRQ asks volunteers to rate the importance of each item to their decision to continue volunteering. The items that received the highest mean importance ratings included enjoying the work they do, feeling adequately prepared/trained to perform their role, and learning from their patients' experiences/listening to their patients' life stories. Being recognized (eg, pins for years of service or being profiled in the hospice newsletter), receiving phone calls/cards from their volunteer coordinator on special occasions, and being reimbursed for out-of-pocket expenses were among the items that received the lowest mean importance ratings. Suggestions for improving volunteer retention are provided.

The personal value of being a palliative care Community Volunteer Worker in Uganda: a qualitative study

BACKGROUND

Volunteers in palliative care play a key role, particularly in the hospice setting. The expansion of palliative care into developing countries has been accompanied by the emergence of volunteer workers, who are providing a main source of support and care for patients, many of whom never see a health professional.

AIM

The aim of this study was to evaluate the motivation for becoming a volunteer and the personal impact of being a palliative care Community Volunteer Worker in Uganda.

DESIGN

A qualitative methodology using semi-structured individual and group digitally recorded interviews was adopted for the study. Data were analysed for emerging themes using thematic analysis.

SETTING/PARTICIPANTS

Forty-three interviews were undertaken, 32 with Community Volunteer Workers and 11 with the Hospice clinical teams, using semi-structured digitally recorded individual, group and focus group interviews at the Hospice Africa sites in Uganda.

RESULTS

The results identified the cultural wish to help people as a key motivator in becoming a volunteer. Additionally, the volunteers reported having a sense of pride in their volunteering role, and this role had a positive impact on their perceived status in their local community.

CONCLUSION

This model of volunteering is clearly having an impact on the volunteers, both personally and also in terms of how they are treated in their communities. Further research to explore the long-term personal benefits of being a palliative care volunteer is recommended.

Volunteer satisfaction and program evaluation at a pediatric hospice

RATIONALE

Volunteers are essential to the functioning of palliative care programs and serve as important members of the hospice team. They devote much time, effort, and diverse skills and talent to enhance the quality of care at Roger's House--a pediatric palliative care hospice.

OBJECTIVES

To evaluate volunteering in a pediatric palliative care hospice and to assess the level of satisfaction from the perspective of hospice volunteers.

METHODS

A survey was sent to all active Roger's House volunteers. Questions were related to their demographics, their overall impression of their volunteering experience, and 47 closed (fixed-choice) statements, divided into 6 parts: 1) Orientation; 2) Training; 3) Feedback/Performance; 4) Communication; 5) Social Contacts; and 6) Value and Respect. Each statement was rated by the participants using a six-point Likert rating scale.

RESULTS

Volunteers fully completing the survey were 159 online and 4 on paper, giving a response rate of 66%. The greater number (66, 40.5%) of respondents were 50 years or older and they were mostly female (141, 86.5%). Successes identified included the volunteers' orientation, training, and feedback and performance. Challenges identified included certain aspects of communication, social contacts, and respect/value for the volunteer.

CONCLUSION

Volunteers at Roger's House are generally satisfied with their volunteer position and the environment in which they work. Greater insight into volunteer satisfaction and factors that bring feelings of reward and/or dissatisfaction to the volunteers have allowed Roger's House to identify informed and effective interventions to improve the quality of and satisfaction with the hospice volunteer program.

Negotiating the boundary between paid and unpaid hospice workers: a qualitative study of how hospice volunteers understand their work

OBJECTIVE

To explore the nurse-volunteer relationship in a day hospice.

METHOD

Underpinned by an interpretive approach, face-to-face semistructured interviews were conducted with 12 day hospice volunteers.

FINDINGS

The nature and dynamics of the relationship between nursing staff and volunteers within the day hospice were characterized by increasing formality and changes in the division of labor, which challenged smooth working relationships.

CONCLUSIONS

Volunteers see their role as becoming increasingly formalized partly as a response to increasing administrative demands on hospice nurses. The willingness of volunteers to take on new roles is variable. For volunteers to feel secure and valued and working relationships to remain strong, the process of how boundaries between paid and unpaid workers are negotiated needs to be transparent.

Burnout and connectedness in the job demands-resources model: studying palliative care volunteers and their families

This study examined the role of burnout and connectedness in the job demands-resources (JD-R) model among palliative care volunteers. It was hypothesized that (a) exhaustion mediates the relationship between demands and depression, and between demands and retention; (b) cynicism mediates the relationship between resources and retention; and (c) connectedness mediates the relationship between resources and retention. Hypotheses were tested in 2 separate analyses: structural equation modeling (SEM) and path analyses. The first was based on volunteer self-reports (N = 204), while the second analysis concerned matched data from volunteers and their family members (N = 99). While strong support was found for cynicism and connectedness as mediators in both types of analyses, this was not altogether the case for exhaustion. Implications of these findings for the JD-R model and volunteer organizations are discussed.

Exploring the impact of training on the experience of Australian support group leaders: current practices and implications for research

BACKGROUND

Existing literature suggests that the effectiveness of a support group is linked to the qualifications, skills and experience of the group leader. Yet, little research has been conducted into the experiences of trained vs. untrained support group leaders of chronic-illness support groups. The current study aimed to compare the experience of leaders, trained vs. untrained in group facilitation, in terms of challenges, rewards and psychological wellbeing.

METHODS

A total of 358 Australian leaders of cancer and multiple sclerosis (MS) support groups, recruited through State Cancer Councils and the MS society (response rate of 66%), completed a mailed survey.

RESULTS

Compared with untrained leaders, those with training were significantly younger, leading smaller groups and facilitating more groups, more frequently (all P < 0.05). Trained leaders were more likely to be female, educated beyond high school, paid to facilitate, a recipient of formal supervision and more experienced (in years) (all P < 0.01). Untrained leaders reported more challenges than trained leaders (P < 0.03), particularly struggling with being contacted outside of group meetings (52%) and a lack of leadership training (47%). Regardless of level of training, leaders identified a number of unmet support and training needs. Overwhelmingly, leaders found their facilitation role rewarding and the majority reported a high level of psychological wellbeing.

CONCLUSIONS

Group facilitator training has the potential to reduce the burden of support group leadership. Developing interventions to assist support group leaders will be particularly beneficial for leaders with minimal or no training group facilitation training.

How to attract more males to community-based hospice palliative care volunteer programs

Two separate studies were conducted to better understand why so few middle-aged and older men volunteer in hospice palliative care; only about 10% of the patient/family care volunteers in New Brunswick's community-based hospice palliative care volunteer programs are men. In study 1, 15 (22%) of the 68 men who read a brief description about the kinds of things that hospice palliative care volunteers do expressed an interest in this type of volunteerism. The main reasons given for their lack of interest included ''being too busy'' and ''not being able to handle it emotionally.'' At least one third of the men who said ''No'' to becoming a hospice palliative care volunteer expressed an interest in 10 of 13 other common volunteer activities (eg, driving). In study 2, 59 men were presented with a list of 25 tasks that hospice palliative care volunteers might perform when providing emotional, social, practical, and administrative support. The men were asked to indicate which tasks they would be willing to perform if they were a hospice palliative care volunteer. The men were least willing to serve on the board of directors (28%), provide hands on patient care (38%), and work in the volunteer program's office (42%); they were most willing to talk to the patient (97%), share hobbies and interests with the patient (92%), listen to the patient's memories and life stories (90%), and provide friendship and companionship (88%). The results of these studies may have implications for the recruitment of male volunteers to work with dying patients and their families.

Some issues in the provision of adult bereavement support by UK hospices

This paper considers some issues in the provision of adult bereavement support in UK hospices. The paper is based on the findings of a multi-method study conducted in two phases over 30 months (2003-2005) to examine the nature and quality of adult bereavement support in UK hospices from the perspectives of bereaved people and professional and volunteer bereavement workers [Field, Reid, Payne, & Relf (2005). Adult Bereavement Support in Five Hospices in England. Sheffield, UK: Palliative and End-of-Life Care Research Group, University of Sheffield. (Available from Professor Payne)]. It discusses the importance of continuity between pre-bereavement and bereavement support, the integration of bereavement services within hospices and the involvement of volunteers in bereavement support. It then discusses the engagement of UK hospices in the broader development of bereavement support. Although hospices have developed expertise in supporting bereaved people, our research suggests that they have not had a major impact on other health service providers, such as general practitioners and distinct nurses and staff in acute hospital trusts, in this area.

Qualitative study of Chinese widows in Hong Kong: insights for psycho-social care in hospice settings

In an exploratory, phenomenological study of seven Chinese widows in Hong Kong, five major themes are identified: relationship with the deceased, relationship with others, grief reactions, coping and emotional expression. This paper focuses on the first theme: the widows' relationship with the deceased husband along a timeline from the time of diagnosis to after death. The experiences in the final days with the deceased were frequently referred to when the informants talked about this theme. This paper aims to give added voice, based on the experience of Chinese widows, to the possible role of hospice and palliative care on influencing the bereavement experience. Issues of awareness and acceptance of death, the supportive environment and support for family carers, the moment of death, creation of legacies, and sensitivity towards cultural embedded practices, are discussed. It is hoped that the experiences of these bereaved widows will stimulate new research to elucidate and verify the findings reported in this paper.

Professionalization of hospice volunteer practices: what are the implications?

Volunteers are increasingly considered as core members of interdisciplinary palliative care teams, and thus no longer “informal providers.” The definitive trend towards formalizing the role of hospice volunteers is indicated not only by national work to develop best practices (Ferris et al., 2002), but also by efforts of the Canadian Council on Health Services Accreditation to develop quality indicators for accrediting volunteer agencies. This movement emerged from a need to coordinate, define and standardize the role of volunteers in palliative care settings, as well as to manage organizational resources and maintain standards of excellence. The purpose of this forum is to highlight the possible impact of this development on the nature of volunteer contribution to end-of-life care.

Being a hospice volunteer

The aim of this study was to obtain an understanding of what it means to be a hospice volunteer in a country without a tradition of hospice or palliative volunteer care services. Ten volunteers from three different hospices in Sweden were interviewed. Their narratives were interpreted with a phenomenological hermeneutic method. Three themes were disclosed: motives for becoming involved in hospices, encountering the hospice and encountering the patient. The interpretations disclose a need for the volunteer to be affirmed as a caring person and received in fellowship at the hospice. Positive encounters with a hospice are closely related to personal growth. Volunteers feel rejected if their need for meaning and for belonging to the hospice is not satisfied. This shows that hospices need to set goals in terms of volunteer support, particularly regarding existential issues following the encounter with the hospice and the patient.

Find a way out: bereavement support in Taiwan hospice

GOALS OF WORK

The aim of the study was to explore one of the possibilities to enhance bereavement care in Taiwan hospice due to insufficient attention and resources. Meanwhile, a theoretical assumption about the relationship between anticipatory grief and postdeath grief was made and examined.

PATIENTS AND METHODS

Through convenience sampling, 109 most bereaved families of terminally ill cancer patients were included. Data were collected by the Anticipatory Grief Scale (Theut SK et al (1991) Caregiver's anticipatory grief in dementia: a pilot study. Int J Aging Hum Dev 32:113-118), Perinatal Grief Scale (Potvin L, Lasker J, Toediter T (1989) Measuring grief: a short version of the Perinatal grief scale. J Psychopathol Behav Assess 11:29-45), and a background information sheet.

MAIN RESULTS

Anticipatory grief was correlated with postdeath grief significantly but mildly. Age was associated with anticipatory grief, not with postdeath grief. However, relationship and gender did not statistically relate to anticipatory grief and postdeath grief.

CONCLUSIONS

Although anticipatory grief could predict postdeath grief, the result was not encouraging enough. Prevention is still the best way not only for the bereaved in theoretical point of view but also for hospice staff in practical application. However, how to screen out high-risk bereaved family in order to provide help in advance require more effort.

A national survey of health professionals and volunteers working in voluntary hospice services in the UK. I. Attitudes to current issues affecting hospices and palliative care

This paper reports results from a national survey in 1999 of voluntary hospice services in the UK. It focuses on volunteer and staff views of the purposes of hospice care, and on current debates within palliative care. Twenty-five hospice services, stratified by region, services provided (inpatient care, day care and/or home care) and number of beds were randomly sampled from amongst 175 voluntary hospices in the UK. Nineteen participated. Seventy per cent of a random sample of professional and voluntary staff within these hospices returned a postal questionnaire. Both volunteers and professionals considered care of the whole person, pain and symptom control, quality of life and dying peacefully to be important aspects of hospice care. Most doctors chose care of the whole person as the most important aspect, and they were more likely to choose this option than other staff. Hospice volunteers were less positive than hospice staff (particularly doctors and nurses) in their attitudes to extending hospice care to noncancer patients (where many volunteers held no strong view), to restricting care to patients with specialist palliative care needs, and less negative about euthanasia. These findings illustrate the importance of including hospice volunteers and the general public, as well as hospice staff, in debates about the future of hospice and palliative care in the UK. Further research is needed into lay and professional views of the role of hospices and palliative care services.

Survey of UK hospice and specialist palliative care adult bereavement services

METHOD

Postal survey of UK hospices and specialist palliative care services providing adult bereavement support.

ANALYSIS

Descriptive statistics and content analysis of free text replies.

RESULTS

Three hundred services were identified, with 248 valid responses (83%). Of these, 198 (80%) were in England and 180 (73%) were associated with inpatient units. Most had been in existence for at least 10 years. Paid staff were used by 219 services (88%) and volunteers were involved in 168 services (68%). A small minority did not provide supervision for their bereavement staff. A quarter of services had insufficient staff. The most common activities were individual support, telephone support, written information, memorialization events and group support. Ninety-five services (43%) formally assessed the need for individual support. One hundred and fourteen services (51%) had no formal mechanisms for bereaved people to provide feedback about such support. Formal audit and evaluation of bereavement services was uncommon.

CONCLUSIONS

The main elements of bereavement support can be identified but their combination varies. Assessment of people for individual support varies and the small size of many services may inhibit the effective delivery of support. Audit and evaluation of bereavement support may need to be developed.