Do oncologists engage in bereavement practices? A survey of the Israeli Society of Clinical Oncology and Radiation Therapy (ISCORT)

Bereavement Practices Among Head and Neck Cancer Surgeons

OBJECTIVES

Head and neck cancer surgeons frequently interact with dying patients with advanced disease and their families, but little is known about their bereavement practices after a patient's death. The aim of this study is to elucidate the frequency of common bereavement practices, cited barriers to bereavement, and predictive physician factors that lead to an increase in bereavement practices among head and neck cancer surgeons.

METHODS

A 20-item survey was sent to 827 active surgeons of the American Head and Neck Society. Approval was obtained and the survey was distributed through the American Head and Neck Society. Demographics, frequency of common bereavement practices, empathy, and barriers were assessed. Multiple linear regression was performed to determine physician factors associated with more frequent bereavement follow-up.

RESULTS

There were 156 respondents (18.9% response rate). Overall, surgeons were more likely to usually/always call (48.5%) or send a letter (42.4%) compared with other practices such as attending funerals (0%), offering family meetings (18.6%), or referring family members to counseling (7.7%). Many barriers were cited as being at least somewhat important: being unaware about a patient's death (67.3%) was the most cited, whereas 51.3% cited a lack of mentorship/training in this area. Scoring higher on empathy questions (P ≤ .001) was associated with more frequent surgeon bereavement follow-up with the family of deceased patients.

CONCLUSION

There is substantial practice variation among surgeons suggesting a lack of consensus on their roles in bereavement follow-up. Having higher empathy was predictive of higher engagement.

LEVEL OF EVIDENCE

NA Laryngoscope, 2022.

Anaesthetists' attitudes towards attending the funerals of their patients: A cross-sectional study among Australian and New Zealand anaesthetists

A patient’s death can pose significant stress on the family and the treating anaesthetist. Anaesthetists’ attitudes about the benefits of and barriers to attending a patient’s funeral are unknown. Therefore, we performed a prospective, cross-sectional study to ascertain the frequency of anaesthetists’ attendance at a patient’s funeral and their perceptions about the benefits and barriers. The primary aim was to investigate the attitudes of anaesthetists towards attending the funeral of a patient. The secondary aims were to examine the perceived benefits of and barriers to attending the funeral and to explore the rate of bonds being formed between anaesthetists, patients and families. Of the 424 anaesthetists who completed the survey (response rate 21.2%), 25 (5.9%) had attended a patient’s funeral. Of the participants, 364 (85.9%) rarely formed special bonds with patients or their families; 233 (55%) believed that forming a special bond would increase the likelihood of their attendance. Showing respect to patients or their families was the most commonly perceived benefit of attending a funeral. Participants found expression of personal grief and caring for the patient at the end-of-life and beyond beneficial to themselves and the family. Fear of their attendance being misinterpreted or perceived as not warranted by the family as well as time restraints were barriers for their attendance. Most anaesthetists had never attended a patient’s funeral. Few anaesthetists form close relationships with patients or their families. Respect, expression of grief and caring beyond life were perceived benefits of attendance. Families misinterpreting the purpose of attendance or not expecting their attendance and time restraints were commonly perceived barriers.

Trial registration:ACTRN 12618000503224.

Bereavement practices employed by hospitals and medical practitioners toward attending funeral of patients: A systematic review

OBJECTIVES

To ascertain bereavement practices offered by hospitals and medical practitioners (MPs), factors that influence the likelihood of MPs' involvement in funeral attendance, the benefits and barriers to attendance to a patient's funeral as perceived by MPs and the rate of attendance to patients' funeral by MPs.

DESIGN

MEDLINE (Ovid), Embase, PubMed, and Google Scholar were searched with a systematic search structure for randomized controlled trials, comparative observational studies, case series, cross-sectional studies, editorials, and letters. The search was limited to English only. The study was registered with Prospero (Registration Number: CRD42018095368).

RESULTS

A total of 381 articles were identified with 46 articles meeting the inclusion criteria. Of the 46, 16 were editorials and 12 were letters. Eighteen were cross-sectional studies conducted in the United States, Canada, Australia, Israel, and Ireland. Year of publication ranged from 1990 to 2017. Of these, 12 were quantitative, 3 were qualitative, and 3 were mixed-method studies. Two of the cross-sectional studies involved family members of deceased patients while others involved MPs. Bereavement practices offered by hospitals included memorial services, letters, and services provided by bereavement coordinators. Bereavement practices employed by MPs included answering or making phone calls, attending family meetings, and sending condolence letters. MPs' attendance at a patient's funeral was influenced by MPs' gender, age years of experience the medical specialty. Perceived benefits of MPs' attendance at a patient's funeral included providing support to the family, extending the professional relationship, illustrating respect to the patient and the family, resolving guilt and personal growth. Barriers to the attendance included a lack of time, blurring of professional boundaries, personal discomfort with death, emotional arousal, and discouragement by colleagues. General practice had an attendance rate of 71%. Attendance rates for palliative care, oncology, and psychiatrists ranged from 63% to 81%, 7.1% to 67%, and 15% to 67%, respectively. Intensivists had an attendance rate of 22%.

CONCLUSION

Several bereavement practices are provided by hospitals and MPs. Funeral attendance is an uncommon bereavement practice. MPs' attitudes toward attending a patient's funeral are understudied in many specialties. Patient factors that influence MPs' participation in bereavement practices are poorly understood.

Attending patient funerals: Practices and attitudes of Australian medical practitioners

The appropriateness of attending a patient's funeral is a medical dilemma. This article focuses on 437 doctors who participated in an online survey. Seventy-one percent of general practitioners, 67% of oncologists, 67% of psychiatrists, 63% of palliative medicine specialists, 52% of surgeons, and 22% of intensive care specialists had attended patient funerals. Significant differences in demographics and between specialties were identified in terms of barriers and benefits associated with attendance. Although attendance is a personal decision, there is a need for open discussions in medical education and professional development concerning death and the role of doctors after a patient dies.

Factors Affecting Communication Patterns between Oncology Staff and Family Members of Deceased Patients: A Cross-Sectional Study

Objective

Perceptions of the role of oncology medical staff in supporting bereaved families have evolved with the transition to interdisciplinary cancer care. We investigated the interactions between oncology professionals and bereaved families.

Methods

This cross-sectional study involved all oncology medical staff at the Davidoff Center. Participants were given a questionnaire relating to bereavement follow-up. Responses were measured using a 5-point Likert scale.

Results

Of 155 staff members, 107 filled questionnaires with <20% missing data and were included in the analysis (α = 0.799; corrected, α = 0.821). Respondents included physicians (35%), nurses (46%), social workers (7%), psychologists (4%), or unspecified (8%); 85% were Jewish, and 60% had ≥10 years of oncology experience. Most respondents thought that contacting bereaved families was important (73%), and that it provided closure for staff (79%); 41% indicated that they contacted >50% of the families of their deceased patients. Contacting bereaved families was considered the responsibility of the physicians (90%), nurses (84%), or social workers (89%). The main barriers to contacting bereaved families were emotional overload (68%) and lack of time (63%); 60% indicated a need for additional communication tools for bereavement follow-up. In a multivariate analysis, profession (physician vs. nurse), primary workplace (outpatient setting vs. other), and self-defined religion were significant variables with respect to the perceived importance of contacting bereaved families and to actually contacting them. Other factors (e.g., age, gender) were non-significant.

Conclusions

Perspectives regarding bereavement actions differ significantly across medical professions, work settings, and self-defined religions. Additional guidance and education regarding bereavement actions is warranted.

Letters of condolence: assessing attitudes and variability in practice amongst oncologists and palliative care doctors in Yorkshire

Background

Following a patient’s death, some doctors routinely write a letter of condolence to the bereaved family. Practice appears to vary widely but this is poorly documented, particularly in the UK setting. We wished to explore the attitudes of oncologists and palliative care consultants towards writing letters of condolence to patient’s families.

Methods

A sample of oncology and palliative care consultants from across Yorkshire were invited via email to complete an anonymous online survey. The survey aimed to identify current practice regarding condolence letter writing and respondents attitudes towards this.

Results

A total of 47 (72%) recipients completed the survey, comprised of clinical oncologists (45%), medical oncologists (42%), and palliative care consultants (13%). The majority (87%) reported sending condolence letters, but amongst this group, only 49% indicated they do this ‘often’ or ‘always’. When asked whether they would use a standard template letter, should it be made available, 77% of participants responded negatively. Many later commented that a template with room for flexibility would be better received. The majority (72%) were also not in favour of the introduction of policies to try to unify practices.

Conclusions

Practices and attitudes towards condolence letter writing are variable. The participants in this study felt strongly about when and how they wished to express condolences. A single unifying policy seems unlikely to be appropriate or feasible.

Bereavement Services Offered in Adult Intensive Care Units in the United States

BACKGROUND

Losing a loved one in the intensive care unit (ICU) is stressful for family members. Providing bereavement support to them is recommended. However, little is known about the prevalence of bereavement services implemented in adult ICUs.

OBJECTIVE

To describe current bereavement follow-up services in adult ICUs.

METHOD

A cross-sectional prospective study design was used. ICU nurse leaders completed a 26-item online survey posted in the American Association of Critical-Care Nurses e-newsletter. The survey contained questions about current practices in bereavement care. Data were collected for 1 month and were analyzed by using descriptive statistics and binary logistic regression.

RESULTS

A total of 237 ICU nurse leaders responded to the survey. Hospital and ICU types were diverse, with most being community (n = 81, 34.2%) and medical (n = 61, 25.7%). Most respondents reported that their ICUs (n = 148, 62.4%) did not offer bereavement follow-up services, and many barriers were noted. When bereavement follow-up care was offered, it was mainly informal (eg, condolence cards, brochures). Multiple logistic regression indicated that ICUs in hospitals with palliative care were almost 8 times (odds ratio, 7.66) more likely to provide bereavement support than were ICUs in hospitals without palliative care.

CONCLUSIONS

The study findings provide insight into what type of bereavement evaluation methods are being used, what barriers are present that hinder use of bereavement follow-up services, and potential interventions to overcome those barriers in adult ICUs in the United States.

Impact of the condolence letter on the experience of bereaved families after a death in intensive care: study protocol for a randomized controlled trial

BACKGROUND

As intensive care mortality is high, end of life is a subject of major concern for intensivists. In this context, relatives are particularly vulnerable and prone to post-ICU syndrome, in the form of high levels of anxiety, depression, post-traumatic stress, and complicated grief. Grieving families suffer from a feeling of abandonment and evoke the need to get back in touch with the team to ask questions and remove doubts, but very few actually do. Aiding families during the grieving process is an important aspect of palliative care. A condolence letter represents an opportunity to recognize the pain of the family member and the strong tie that linked the family member to the ICU team, and to offer additional information if necessary. The goal of the study is to measure the impact of the condolence letter on the experience of bereaved families after a death in the ICU. Our hypothesis is that a post-death follow-up in the form of a condolence letter sent by the ICU physician who was in charge of the patient may help to reduce the risks of presenting symptoms of anxiety/depression, post-traumatic stress, and complicated grief.

METHODS/DESIGN

This is a randomized, controlled, multicenter study. Research will compare two groups of bereaved family members: one group that does not receive a condolence letter (control) and one group that receives a condolence letter 15 days after the death (intervention). Each of the 22 participating centers will include 12 relatives. Participating relatives will be followed up by phone with a call at 1 month and one at 6 months to complete questionnaires, permitting evaluation of post-ICU burden. The main outcome is anxiety and depression measured at 1 month. Other outcomes include evaluation of quality of dying and death, post-traumatic stress, and complicated grief.

DISCUSSION

This study will allow us to assess if sending a condolence letter can reduce the risks of presenting symptoms of anxiety and depression, complicated grief, and symptoms of post-traumatic stress disorder after the death of a loved one in the ICU.

TRIAL REGISTRATION

CLINICAL TRIALS REGISTRATION NUMBER

Clinicaltrials.gov NCT02325297 (23 December 2014).

Advance Care Planning and End-of-Life Management of Adult Patients With Congenital Heart Disease

As a result of advances in the diagnosis and treatment of congenital heart disease (CHD), it is now adult care providers, rather than pediatric providers, who are faced with the majority of patient deaths. Effective advance care planning and end-of-life (EOL) care require open communication and collaboration in order to benefit patients, family members, and clinicians. Published guidelines recommend early completion of advance directives and addressing EOL issues in routine care. This article reviews the pattern of shifting CHD mortality, current knowledge regarding advanced care planning and EOL discussions with adults with CHD (ACHD), and guidelines to facilitate and optimize these important discussions.

At Least we can Send Some Flowers…

Aims and background

Cancer may demand lengthy treatment and the emotional attachment between care providers and the patient may become intense, especially when the latter is a child. If patients die, their families and the care-providing staff need help to cope with the loss.

Short communication

We describe a procedure in use at the Istituto Nazionale Tumori in Milan for taking leave of families whose children die. This practice is based on simply sending flowers to families who have lost their child, and was started after an emotionally very demanding case.

Conclusion

Our sending flowers with a handwritten condolence letter is a simple gesture that seems to have helped both the patients' families and the members of our care-providing team in the process of mourning.

Survey of bereavement practices of cancer care and palliative care physicians in the Pacific Northwest United States

PURPOSE

Physicians caring for patients with cancer frequently encounter individuals who will die as a result of their disease. The primary aim of this study was to examine the frequency and nature of bereavement practices among cancer care and palliative care physicians in the Pacific Northwest United States. Secondary aims included identification of factors and barriers associated with bereavement follow-up.

METHODS

An institutional review board (IRB) -approved, anonymous online survey of cancer specialists and palliative care physicians in Alaska, Washington, Oregon, Idaho, Montana, and Wyoming was performed in fall 2010. Potential participants were identified through membership in national professional organizations. Summary statistics and logistic regression methods were used to examine frequency and predictors of bereavement practices.

RESULTS

A total of 194 (22.7%) of 856 physicians participated in the online survey, with 164 (19.1%) meeting study inclusion criteria. Overall, 70% of respondents reported always or usually making a telephone call to families, sending a condolence letter, or attending a funeral service after a patient's death. The most common perceived barriers to bereavement follow-up were lack of time and uncertainty of which family member to contact. Sixty-nine percent of respondents did not feel that they had received adequate training on bereavement follow-up during postgraduate training.

CONCLUSION

Although a significant portion of respondents engaged in some form of bereavement follow-up, the majority felt inadequately trained in these activities. Efforts to identify available resources and address bereavement activities in postgraduate training may contribute to improved multidisciplinary treatment of patients with cancer and their families.