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Haxel CS, Belser AH, DeSarno M, Glickstein J, Flyer JN. Pediatric Cardiology Condolence Letter Writing: Does a Fellowship Curriculum Impact Practice? J Pain Symptom Manage 2023; 66:e343-e352. [PMID: 37327916 DOI: 10.1016/j.jpainsymman.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 06/03/2023] [Indexed: 06/18/2023]
Abstract
CONTEXT Condolence letter (CL) writing after the death of a child is an important opportunity for humanism. Pediatric cardiology fellowship training now recognizes the importance of palliative care, but rarely includes CL education, despite its fragile patient population. OBJECTIVES To address this professionalism gap, a formal CL writing curriculum was created and implemented in a pediatric cardiology fellowship. This study investigated the impact of the curriculum on pediatric cardiology CL writing, and broader CL practices and beliefs. METHODS Pediatric cardiology fellows at a high volume urban academic program from 2000 to 2022 were divided into two cohorts (exposure to CL curriculum [2014-2022] vs. no exposure [2000-2013]) and responded by anonymous electronic multiple choice and open ended survey to assess the CL curriculum and describe current CL practices and beliefs. Impact of curriculum elements was determined by ordinal ranking. A 5-point Likert scale was used to report physician behaviors. Chi-square tests of independence were utilized for group comparisons. RESULTS The overall survey response rate was 59% (63/107). Cardiologists who participated in the curriculum (64%, 35/55) were more likely to report writing CLs (80% vs. 40%; P < 0.01). Impactful curriculum elements included the opportunity for all fellows to contribute to a CL (78%) and identifying a primary fellow to write the CL (66%). A majority (>75%) of curriculum participants agreed that formal teaching increased their frequency, ability, and comfort in writing CLs. CONCLUSION Development of condolence expression educational programs in pediatric cardiology training should be expanded.
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Affiliation(s)
- Caitlin S Haxel
- Department of Pediatric (C.S.H, J.N.F.), The Robert Larner M.D. College of Medicine at the University of Vermont, Burlington, VT; Division of Pediatric Cardiology (C.S.H.), University of Vermont Children's Hospital, Burlington, VT, USA.
| | - Abigail H Belser
- Boston Combined Residency Program (A.H.B.), Boston Children's Hospital, Boston, MA, USA
| | - Michael DeSarno
- Department of Medical Biostatistics (M.D.), The Robert Larner M.D. College of Medicine at the University of Vermont, Colchester, VT, USA
| | - Julie Glickstein
- Department of Pediatrics, Division of Pediatric Cardiology (J.G.), Morgan Stanley Children's Hospital of New York Presbyterian, New York, NY, USA
| | - Jonathan N Flyer
- Department of Pediatric (C.S.H, J.N.F.), The Robert Larner M.D. College of Medicine at the University of Vermont, Burlington, VT; Division of Pediatric Cardiology (C.S.H.), University of Vermont Children's Hospital, Burlington, VT, USA
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Kentish-Barnes N, Poujol AL, Banse E, Deltour V, Goulenok C, Garret C, Renault A, Souppart V, Renet A, Cariou A, Friedman D, Chalumeau-Lemoine L, Guisset O, Merceron S, Monsel A, Lesieur O, Pochard F, Azoulay E. Giving a voice to patients at high risk of dying in the intensive care unit: a multiple source approach. Intensive Care Med 2023; 49:808-819. [PMID: 37354232 DOI: 10.1007/s00134-023-07112-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 05/28/2023] [Indexed: 06/26/2023]
Abstract
PURPOSE Data are scarce regarding the experience of critically ill patients at high risk of death. Identifying their concerns could allow clinicians to better meet their needs and align their end-of-life trajectory with their preferences and values. We aimed to identify concerns expressed by conscious patients at high risk of dying in the intensive care unit (ICU). METHODS Multiple source multicentre study. Concerns expressed by patients were collected from five different sources (literature review, panel of 50 ICU experts, prospective study in 11 ICUs, in-depth interviews with 17 families and 15 patients). All qualitative data collected were analyzed using thematic content analysis. RESULTS The five sources produced 1307 concerns that were divided into 7 domains and 41 sub-domains. After removing redundant items and duplicates, and combining and reformulating similar items, 28 concerns were extracted from the analysis of the data. To increase accuracy, they were merged and consolidated, and resulted in a final list of 15 concerns pertaining to seven domains: concerns about loved-ones; symptom management and care (including team competence, goals of care discussions); spiritual, religious, and existential preoccupations (including regrets, meaning, hope and trust); being oneself (including fear of isolation and of being a burden, absence of hope, and personhood); the need for comforting experiences and pleasure; dying and death (covering emotional and practical concerns); and after death preoccupations. CONCLUSION This list of 15 concerns may prove valuable for clinicians as a tool for improving communication and support to better meet the needs of patients at high risk of dying.
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Affiliation(s)
- Nancy Kentish-Barnes
- Famiréa Research Group, Medical Intensive Care, AP-HP, Saint Louis Hospital, 1 Avenue Claude Vellefaux, 75010, Paris, France.
| | - Anne-Laure Poujol
- Famiréa Research Group, Medical Intensive Care, AP-HP, Saint Louis Hospital, 1 Avenue Claude Vellefaux, 75010, Paris, France
- VCR-School of Psychologist Practitioners, Paris, France
- Department of Anesthesiology and Critical Care, Multidisciplinary Intensive Care Unit, AP-HP, La Pitié-Salpétrière Hospital, Paris, France
| | - Emilie Banse
- Famiréa Research Group, Medical Intensive Care, AP-HP, Saint Louis Hospital, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | | | - Cyril Goulenok
- Intensive Care Unit, Ramsay Générale de Santé, Jacques Cartier Private Hospital, Massy, France
| | - Charlotte Garret
- Medical Intensive Care, Hôtel Dieu University Hospital, Nantes, France
| | - Anne Renault
- Medical Intensive Care, Cavale Blanche University Hospital, Brest, France
| | - Virginie Souppart
- Famiréa Research Group, Medical Intensive Care, AP-HP, Saint Louis Hospital, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Anne Renet
- Famiréa Research Group, Medical Intensive Care, AP-HP, Saint Louis Hospital, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Alain Cariou
- Medical Intensive Care, AP-HP, Cochin Hospital, Paris, France
| | - Diane Friedman
- Intensive Care Unit, AP-HP, Raymond Poincaré Hospital, Garches, France
| | - Ludivine Chalumeau-Lemoine
- Intensive Care Unit, Ramsay Générale de Santé, Claude Galien Private Hospital, Quincy Sous Sénart, France
| | - Olivier Guisset
- Medical Intensive Care, Saint André University Hospital, Bordeaux, France
| | - Sybille Merceron
- Medical Intensive Care, André Mignot Hospital, Le Chesnay, France
| | - Antoine Monsel
- Department of Anesthesiology and Critical Care, Multidisciplinary Intensive Care Unit, AP-HP, La Pitié-Salpétrière Hospital, Paris, France
- UMR-S 959, Immunology-Immunopathology-Immunotherapy (I3), Institut National de La Santé Et de La Recherche Médicale (INSERM), Paris, France
- Biotherapy (CIC-BTi) and Inflammation-Immunopathology-Biotherapy Department (DHU i2B), Hôpital Pitié-Salpêtrière, AP-HP, Paris, France
| | - Olivier Lesieur
- Medical and Surgical Intensive Care, La Rochelle Hospital, La Rochelle, France
| | - Frédéric Pochard
- Famiréa Research Group, Medical Intensive Care, AP-HP, Saint Louis Hospital, 1 Avenue Claude Vellefaux, 75010, Paris, France
| | - Elie Azoulay
- Famiréa Research Group, Medical Intensive Care, AP-HP, Saint Louis Hospital, 1 Avenue Claude Vellefaux, 75010, Paris, France
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Zaza SI, Zimmermann CJ, Taylor LJ, Kalbfell EL, Stalter L, Brasel K, Arnold RM, Cooper Z, Schwarze ML. Factors Associated With Provision of Nonbeneficial Surgery: A National Survey of Surgeons. Ann Surg 2023; 277:405-411. [PMID: 36538626 PMCID: PMC9905263 DOI: 10.1097/sla.0000000000005765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE We tested the association of systems factors with the surgeon's likelihood of offering surgical intervention for older adults with life-limiting acute surgical conditions. BACKGROUND Use of surgical treatments in the last year of life is frequent. Improved risk prediction and clinician communication are solutions proposed to improve serious illness care, yet systems factors may also drive receipt of nonbeneficial treatment. METHODS We mailed a national survey to 5200 surgeons randomly selected from the American College of Surgeons database comprised of a clinical vignette describing a seriously ill older adult with an acute surgical condition, which utilized a 2×2 factorial design to assess patient and systems factors on receipt of surgical treatment to surgeons. RESULTS Two thousand one hundred sixty-one surgeons responded for a weighted response rate of 53%. For an 87-year-old patient with fulminant colitis and advanced dementia or stage IV lung cancer, 40% of surgeons were inclined to offer an operation to remove the patient's colon while 60% were inclined to offer comfort-focused care only. Surgeons were more likely to offer surgery when an operating room was readily available (odds ratio: 4.05, P <0.001) and the family requests "do everything" (odds ratio: 2.18, P <0.001). CONCLUSIONS Factors outside the surgeon's control contribute to nonbeneficial surgery, consistent with our model of clinical momentum. Further characterization of the systems in which these decisions occur might expose novel strategies to improve serious illness care for older patients and their families.
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Affiliation(s)
- Sarah I Zaza
- Department of Surgery, University of Wisconsin. Madison, WI
| | | | | | | | - Lily Stalter
- Department of Surgery, University of Wisconsin. Madison, WI
| | - Karen Brasel
- Department of Surgery, Oregon Health and Science University, Portland, OR
| | - Robert M Arnold
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Zara Cooper
- Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Ramstad ES, Thegen LS, Guldin MB, Neergaard MA, Nielsen MK. Experiencing Missing Contact With Professionals and Long Term Bereavement Outcome. J Pain Symptom Manage 2023; 65:38-46. [PMID: 36115501 DOI: 10.1016/j.jpainsymman.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 08/29/2022] [Accepted: 09/05/2022] [Indexed: 02/03/2023]
Abstract
CONTEXT The Danish health care system provides palliative care for terminally ill patients and their family caregivers. However, initiatives to support family caregivers are not systematically organized. OBJECTIVES We aimed to examine the association between self-reported experience of missing contact to health care professionals involved in palliative care, and symptoms of grief and depression three years post-loss. METHODS We conducted a prospective population-based survey of 3635 family caregivers to terminally ill patients. At six months follow-up, the caregivers reported whether they missed contact to the general practitioner, home care nurse, hospital staff, and/or palliative care team. Associations between missing contact and symptoms of prolonged grief (Prolonged-Grief-13) and depression (Beck Depression Inventory-II) three years after bereavement were analyzed with multivariable logistic regression analysis. RESULTS We found that an experience of missing contact with health care professionals six months after bereavement was significantly associated with symptoms indicative of prolonged grief disorder and depression after three years. The strongest association was found for missing contact with the general practitioner with an adjusted OR = 4.0 (95%CI: 1.9;8.3) for prolonged grief and an adjusted OR = 5.2 (95% CI: 3.4;7.9) for depression. CONCLUSION Experiencing missing contact with health care professionals shortly after bereavement was associated with adverse psychological reactions. Family caregivers may benefit from bereavement support to prevent further complications. A proactive approach with assessment of support needs and risk of complications early during the patient's illness trajectory may target support at those who needs it.
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Affiliation(s)
- Emilie Stendahl Ramstad
- Research Unit for General Practice (E.S.R, L.S.T, M.G, M.K.N), Aarhus, Denmark; Aarhus University (E.S.R, L.S.T).
| | - Laura Sabroe Thegen
- Research Unit for General Practice (E.S.R, L.S.T, M.G, M.K.N), Aarhus, Denmark; Aarhus University (E.S.R, L.S.T)
| | - Mai-Britt Guldin
- Research Unit for General Practice (E.S.R, L.S.T, M.G, M.K.N), Aarhus, Denmark
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Tantrarungroj T, Ocharoen P, Sachdev V. Grief reaction, depression, anxiety, and coping of relatives after palliative patients' death in Thailand. PLoS One 2022; 17:e0276583. [PMID: 36279272 PMCID: PMC9591054 DOI: 10.1371/journal.pone.0276583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 10/11/2022] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Grief is a normal psychological response in relatives after the loss of their loved ones, which has shown to be associated with psychological reactions like depression, anxiety, and significant stress that many relatives have to cope with. In Thailand, there are limited research studies on grief, especially in palliative settings. This study aims to examine grief reaction, depression, anxiety, and coping of relatives after palliative patients' death. MATERIALS AND METHODS A multi-method design was applied. The authors completed the demographic data questionnaire, and the participants finished other measures which included the Hospital Anxiety and Depression Scale (HADS), the Inventory of Complicated Grief (ICG), and the Brief-Coping Orientation to Problems Experienced (Brief-COPE). The qualitative data from the focus group interview was analyzed with thematic analysis. RESULTS From the quantitative study, the mean scores of HADS for anxiety and depression subscales were 5.05 and 6.34, respectively, which indicated no anxiety and depressive disorders. The mean score of ICG was 19.51 with highest score on acceptance coping subscale. In contrast, the lowest score was on dealing with the substance subscale. There were significant correlations between anxiety subscale from HADS and ICG (r = 0.73), depression subscale from HADS and ICG(r = 0.85), and anxiety and depression subscale from the HADS (r = 0.79). From the qualitative study, the factors associated with grief reaction could be thoroughly explained according to the perceived character of deceased, perceived character of relatives, relationship characteristics, disease, medical care, and support systems. CONCLUSION The correlations among grief reaction, depression, and anxiety of relatives after palliative patients' death were high. The grief reaction was associated with many factors, including communication from medical personnel. This finding emphasized the importance of assessing the reactions after loss and associated factors in the relatives after palliative patients' death. Also, evaluating the ways that the relatives use to cope with their loss, expressing empathy, and supporting the relatives to cope with loss in an adaptive way were recommended.
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Affiliation(s)
- Thanita Tantrarungroj
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- * E-mail:
| | - Pornpimon Ocharoen
- Department of Family Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Veerachai Sachdev
- Department of Family Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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McGill K, Bhullar N, Pearce T, Batterham PJ, Wayland S, Maple M. Effectiveness of Brief Contact Interventions for Bereavement: A Systematic Review. OMEGA-JOURNAL OF DEATH AND DYING 2022:302228221108289. [PMID: 35758167 DOI: 10.1177/00302228221108289] [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: 11/16/2022]
Abstract
Brief contact interventions are an efficient and cost-effective way of providing support to individuals. Whether they are an effective bereavement intervention is not clear. This systematic review included articles from 2014 to 2021.711 studies were identified, with 15 meeting inclusion criteria. The brief contact interventions included informational and emotional supports. Narrative synthesis identified that participants valued brief contact interventions, however some did not find them helpful. Exposure to a brief contact intervention was typically associated with improvements in wellbeing. Studies with comparison groups typically found significant but modest improvements in grief, depression symptoms and wellbeing associated with the intervention. However, one intervention was associated with significant deterioration of depression symptoms. Existing brief contact interventions for bereavement appear feasible, generally acceptable to the target population and are associated with improvements in wellbeing. Further development and evaluation to account for why improvements occur, and to identify any unintended impacts, is required.
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Affiliation(s)
- Katie McGill
- School of Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
| | - Navjot Bhullar
- School of Psychology, University of New England, Armidale, NSW, Australia
| | - Tania Pearce
- School of Health, University of New England, Armidale, NSW, Australia
| | - Philip J Batterham
- Centre for Mental Health Research, College of Health and Medicine, The Australian National University, Canberra, ACT, Australia
| | - Sarah Wayland
- School of Health, University of New England, Armidale, NSW, Australia
| | - Myfanwy Maple
- School of Health, University of New England, Armidale, NSW, Australia
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Sedhom R, Gupta A, Von Roenn J. Case for Focused Bereavement Education in Oncology Training. J Clin Oncol 2021; 39:2964-2965. [PMID: 34086507 DOI: 10.1200/jco.21.01135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ramy Sedhom
- Ramy Sedhom, MD, and Arjun Gupta, MD, Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; and Jamie Von Roenn, MD, American Society of Clinical Oncology, Alexandria, VA
| | - Arjun Gupta
- Ramy Sedhom, MD, and Arjun Gupta, MD, Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; and Jamie Von Roenn, MD, American Society of Clinical Oncology, Alexandria, VA
| | - Jamie Von Roenn
- Ramy Sedhom, MD, and Arjun Gupta, MD, Department of Oncology, Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD; and Jamie Von Roenn, MD, American Society of Clinical Oncology, Alexandria, VA
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Dekeyser T, Sejourné C, Marzouk M, Rahmani I, Vinsonneau C. Combined psychologist-physician post-death meeting as part of an integrated bereavement program for families. Intensive Care Med 2021; 47:795-797. [PMID: 34009449 DOI: 10.1007/s00134-021-06430-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Thibault Dekeyser
- Service de Médecine Intensive Réanimation, Hôpital de Béthune, 27 rue Delbecque, 62660, Beuvry, France.
| | - Caroline Sejourné
- Service de Médecine Intensive Réanimation, Hôpital de Béthune, 27 rue Delbecque, 62660, Beuvry, France
| | - Mehdi Marzouk
- Service de Médecine Intensive Réanimation, Hôpital de Béthune, 27 rue Delbecque, 62660, Beuvry, France
| | - Imen Rahmani
- Service de Médecine Intensive Réanimation, Hôpital de Béthune, 27 rue Delbecque, 62660, Beuvry, France
| | - Christophe Vinsonneau
- Service de Médecine Intensive Réanimation, Hôpital de Béthune, 27 rue Delbecque, 62660, Beuvry, France
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Riordan PA, Price M, Robbins-Welty GA, Leff V, Jones CA, Prigerson HG, Galanos A. Top Ten Tips Palliative Care Clinicians Should Know About Bereavement and Grief. J Palliat Med 2020; 23:1098-1103. [PMID: 32614632 DOI: 10.1089/jpm.2020.0341] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Palliative care (PC) focuses on caring for the whole person, from birth to death, while managing symptoms and helping to navigate medical complexities. Care does not stop at the time of death, however, as assisting patients, families, and fellow clinicians through grief and bereavement is within PC's purview. Unfortunately, many clinicians feel unprepared to deal with these topics. In this article, PC and hospice clinicians define and explain bereavement, distinguish normative grief from pathological grief, offer psychometrically sound scales to screen and follow those suffering from grief, and discuss the interaction between grief and bereavement and the physical and mental health of those who are left behind after the death of a loved one.
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Affiliation(s)
- Paul A Riordan
- Division of Psychiatry, Durham VA Medical Center, Durham, North Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Meghan Price
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Gregg A Robbins-Welty
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
| | - Victoria Leff
- Duke HomeCare and Hospice, Durham, North Carolina, USA
| | - Christopher A Jones
- Department of Medicine and Palliative and Advanced Illness Research Center, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Holly G Prigerson
- Department of Medicine and Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, New York, USA
| | - Anthony Galanos
- Department of Medicine, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Palliative Care, Duke University School of Medicine, Durham, North Carolina, USA
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Kalocsai C, des Ordons AR, Sinuff T, Koo E, Smith O, Cook D, Golan E, Hales S, Tomlinson G, Strachan D, MacKinnon CJ, Downar J. Critical care providers' support of families in bereavement: a mixed-methods study. Can J Anaesth 2020; 67:857-865. [PMID: 32240521 DOI: 10.1007/s12630-020-01645-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 01/13/2020] [Accepted: 02/05/2020] [Indexed: 11/30/2022] Open
Abstract
PURPOSE When people die in intensive care units (ICUs), as many as half of their family members may experience a severe grief reaction. While families report a need for bereavement support, most ICUs do not routinely follow-up with family members. Clinicians are typically involved in supporting families during death and dying, yet little is known about how they work with families in bereavement. Our goal was to explore how clinicians support bereaved families, identify factors that facilitate and hinder support, and understand their interest and needs for follow-up. METHODS Mixed-methods study of nurses and physicians working in one of nine adult medical-surgical ICUs in academic hospitals across Canada. Qualitative interviews followed quantitative surveys to reflect, expand, and explain the quantitative results. RESULTS Both physicians and nurses perceived that they provided empathetic support to bereaved families. Emotional engagement was a crucial element of support, but clinicians were not always able to engage with families because of their roles, responsibilities, experiences, or unit resources. Another important factor that could facilitate or challenge engagement was the degree to which families accepted death. Clinicians were interested in participating in a follow-up bereavement program, but their participation was contingent on time, training, and the ability to manage their own emotions related to death and bereavement in the ICU. CONCLUSIONS Multiple opportunities were identified to enhance current bereavement support for families, including the desire of ICU clinicians for formal follow-up programs. Many psychological, sociocultural, and structural factors would need to be considered in program design.
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Affiliation(s)
- Csilla Kalocsai
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.
- Centre for Addiction and Mental Health, CAMH Education, 33 Russell Street, Rm. 2054, Toronto, ON, M5S 2S1, Canada.
| | - Amanda Roze des Ordons
- Division of Palliative Medicine, Department of Critical Care Medicine, Department of Oncology, Department of Anesthesiology, University of Calgary, Calgary, AB, Canada
| | - Tasnim Sinuff
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Ellen Koo
- University Health Network, Toronto, ON, Canada
| | - Orla Smith
- St. Michael's Hospital, Toronto, ON, Canada
| | - Deborah Cook
- Departments of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Eyal Golan
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Sarah Hales
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - George Tomlinson
- University Health Network, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | | | | | - James Downar
- Division of Palliative Care, University of Ottawa, Ottawa, ON, Canada
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Downar J, Sinuff T, Kalocsai C, Przybylak-Brouillard A, Smith O, Cook D, Koo E, Vanderspank-Wright B, des Ordons AR. A qualitative study of bereaved family members with complicated grief following a death in the intensive care unit. Can J Anaesth 2020; 67:685-693. [PMID: 32052371 DOI: 10.1007/s12630-020-01573-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/06/2019] [Accepted: 12/06/2019] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Grief is a normal reaction, and most family members (FMs) experience grief following a death. Typically, grief subsides without any major psychological or medical impairment. Nevertheless, some FMs may experience complicated grief (CG) reactions, with symptoms lasting months or years, and CG is particularly prominent among FMs of those who die in the intensive care unit (ICU). The purpose of this study was to examine how FMs experience grief, particularly CG, to inform future early screening and support programs in the ICU. METHODS This was a multicentre qualitative study focusing on semi-structured interviews with FMs who displayed symptoms of CG. Family members of patients who died in the ICU and who had a six-month inventory of CG score > 25 were included. Semi-structured interviews were conducted with FMs post-loss, with follow-up interviews three months after the initial interviews. RESULTS Major themes identified following thematic analysis from eight participants with CG included 1) ante-mortem experience: the impact of the ICU experience prior to death of a loved on subsequent grief; 2) post-mortem experience: unpredictable post death reactions; 3) coping strategies: techniques used to reduce the severity of grief reactions; 4) sources of support: focusing on resources that the FM draws from for emotional support; and 5) perspectives on future ICU bereavement screening and support programs: advice that FM participants provided for future bereavement support. CONCLUSION Bereaved FMs with CG described their experiences with grief, how ICU events influenced their bereavement, their coping strategies and sources of support, and their advice for future bereavement support programs for FMs of deceased ICU patients.
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Affiliation(s)
- James Downar
- Division of Palliative Care, Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
- Department of Critical Care, The Ottawa Hospital, 43 Bruyere St. Ste 267J, Ottawa, ON, K1N 5C8, Canada.
- University Health Network, Toronto, ON, Canada.
| | - Tasnim Sinuff
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Csilla Kalocsai
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | - Orla Smith
- St. Michael's Hospital, Toronto, ON, Canada
| | - Deborah Cook
- Departments of Medicine and Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Ellen Koo
- University Health Network, Toronto, ON, Canada
| | - Brandi Vanderspank-Wright
- Faculty of Health Sciences, School of Nursing, University of Ottawa, Ottawa, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Amanda Roze des Ordons
- Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
- Division of Palliative Medicine, Department of Oncology, University of Calgary, Calgary, AB, Canada
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Habeck-Fardy A. Passing on death: An audit of the terminology utilized in discharge summaries for deceased patients. DEATH STUDIES 2019; 45:413-419. [PMID: 31393236 DOI: 10.1080/07481187.2019.1648335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A retrospective audit of terminology utilized in discharge summaries to convey the death of inpatients in an Australian tertiary hospital was undertaken. Completion rates of summaries for this patient cohort were also assessed. Less than 60% had a summary finalized, and for those that did, euphemisms were utilized most commonly; passed away was employed in >70% of cases. There is no difference in terminology choice between doctors at the beginning, compared to the end, of their first year as a doctor, nor between first year or more experienced doctors. Irrespective of clinician level, doctors use euphemisms to convey a death.
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Affiliation(s)
- Anna Habeck-Fardy
- Canberra Health Services, Canberra, Australian Capital Territory, Australia
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13
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Morris S, Schaefer K, Rosowsky E. Primary Care for the Elderly Bereaved: Recommendations for Medical Education. J Clin Psychol Med Settings 2019; 25:463-470. [PMID: 29500657 DOI: 10.1007/s10880-018-9556-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The aim of this study was to explore the current practices of primary care physicians (PCPs) in providing bereavement care to elderly patients, with implications for medical education. A total of 63 PCPs answered a brief online survey about their typical practices, barriers, comfort level with bereavement, and confidence in their ability to diagnose prolonged grief disorder (PGD). They were recruited through an online newsletter and contacts of one of the authors. The results found that two-thirds of the PCPs do not routinely screen their elderly patients for recent losses, nor do they refer to mental health clinicians when loss is identified. Barriers included not learning of the deaths in patients' lives and lack of time during clinic visits. Those PCPs who had experienced their own losses were significantly more comfortable in speaking to patients about recent losses and more confident in their ability to diagnose PGD. We recommend bereavement education be incorporated into the medical school curriculum from the outset, utilizing the psychological principle of graded exposure to bereaved individuals.
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Affiliation(s)
- Sue Morris
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston Children's Hospital and Brigham and Women's Hospital, Harvard Medical School, 450 Brookline Avenue, DA 2016A, Boston, MA, 02215, USA.
| | - Kristen Schaefer
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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Chamberlin P, Lambden J, Kozlov E, Maciejewski R, Lief L, Berlin DA, Pelissier L, Yushuvayev E, Pan CX, Prigerson HG. Clinicians' Perceptions of Futile or Potentially Inappropriate Care and Associations with Avoidant Behaviors and Burnout. J Palliat Med 2019; 22:1039-1045. [PMID: 30874470 DOI: 10.1089/jpm.2018.0385] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Futile or potentially inappropriate care (futile/PIC) for dying inpatients leads to negative outcomes for patients and clinicians. In the setting of rising end-of-life health care costs and increasing physician burnout, it is important to understand the causes of futile/PIC, how it impacts on care and relates to burnout. Objectives: Examine causes of futile/PIC, determine whether clinicians report compensatory or avoidant behaviors as a result of such care and assess whether these behaviors are associated with burnout. Design: Online, cross-sectional questionnaire. Setting/Subjects: Clinicians at two academic hospitals in New York City. Methods: Respondents were asked the frequency with which they observed or provided futile/PIC and whether they demonstrated compensatory or avoidant behaviors as a result. A validated screen was used to assess burnout. Measurements: Descriptive statistics, odds ratios, linear regressions. Results: Surveys were completed by 349 subjects. A majority of clinicians (91.3%) felt they had provided or "possibly" provided futile/PIC in the past six months. The most frequent reason cited for PIC (61.0%) was the insistence of the patient's family. Both witnessing and providing PIC were statistically significantly (p < 0.05) associated with compensatory and avoidant behaviors, but more strongly associated with avoidant behaviors. Provision of PIC increased the likelihood of avoiding the patient's loved ones by a factor of 2.40 (1.82-3.19), avoiding the patient by a factor of 1.83 (1.32-2.55), and avoiding colleagues by a factor of 2.56 (1.57-4.20) (all p < 0.001). Avoiding the patient's loved ones (β = 0.55, SE = 0.12, p < 0.001), avoiding the patient (β = 0.38, SE = 0.17; p = 0.03), and avoiding colleagues (β = 0.78, SE = 0.28; p = 0.01) were significantly associated with burnout. Conclusions: Futile/PIC, provided or observed, is associated with avoidance of patients, families, and colleagues and those behaviors are associated with burnout.
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Affiliation(s)
- Peter Chamberlin
- Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, New York
| | - Jason Lambden
- Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, New York
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Elissa Kozlov
- Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, New York
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Renee Maciejewski
- Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, New York
| | - Lindsay Lief
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - David A Berlin
- Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Latrice Pelissier
- New York Presbyterian/Queens, Division of Geriatrics and Palliative Care, Flushing, New York
| | - Elina Yushuvayev
- New York Presbyterian/Queens, Division of Geriatrics and Palliative Care, Flushing, New York
| | - Cynthia X Pan
- New York Presbyterian/Queens, Division of Geriatrics and Palliative Care, Flushing, New York
| | - Holly G Prigerson
- Center for Research on End-of-Life Care, Weill Cornell Medicine, New York, New York
- Department of Medicine, Weill Cornell Medicine, New York, New York
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15
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Is There Anybody Out There? Attachment Style and Interpersonal Facilitators as Protective Factors Against Complicated Grief Among Suicide-Loss Survivors. J Nerv Ment Dis 2019; 207:131-136. [PMID: 30720603 DOI: 10.1097/nmd.0000000000000940] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Losing a loved one to suicide may have detrimental effects, one of them being suffering from complicated grief (CG). To date, no studies have fully examined the psychological processes that delineate the risk and resilience factors that contribute to CG among suicide-loss survivors (SLSs). We hypothesized that social support and self-disclosure would moderate the relationship between attachment styles and CG for SLS. Questionnaires assessing attachment style, self-disclosure, social support, and CG were completed by 156 SLS participants. A regression model revealed that secure attachment negatively predicted CG, but self-disclosure moderated this association. Secure attachment seems to be a resilient factor for CG. However, SLS with low secure attachment but high in self-disclosure ability use this behavior as a way to impede CG. The capacity to seek out other people, to share experiences with them, and to accept comfort from them may offer a means for SLS to better deal with their tragedy.
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Milic J, Saavedra Perez H, Zuurbier LA, Boelen PA, Rietjens JA, Hofman A, Tiemeier H. The Longitudinal and Cross-Sectional Associations of Grief and Complicated Grief With Sleep Quality in Older Adults. Behav Sleep Med 2019; 17:31-40. [PMID: 28107032 DOI: 10.1080/15402002.2016.1276016] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE/BACKGROUND About 15% of grievers experience complicated grief. We determined cross-sectional and longitudinal relations of grief and complicated grief with sleep duration and quality in the general population of elderly adults. PARTICIPANTS We included 5,421 men and women from the prospective population-based Rotterdam Study. METHODS The Inventory of Complicated Grief was used to define grief and complicated grief. We assessed sleep with the Pittsburgh Sleep Quality Index. RESULTS After 6 years, 3,511 (80% of survivors) underwent the follow-up interview. Complicated grief was cross-sectionally associated with shorter sleep duration and lower sleep quality. These associations were explained by the presence of depressive symptoms. The prospective analyses showed that sleep duration and sleep quality did not decline further during follow-up of persons who experienced grief or complicated grief. CONCLUSION In community-dwelling, middle-aged and older adults, persons with normal and complicated grief had both a shorter sleep duration and a lower sleep quality, mainly explained by depressive symptoms. However, prospective analyses showed that sleep quality and sleep duration do not decline further in persons with normal grief and complicated grief.
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Affiliation(s)
- Jelena Milic
- a Department of Epidemiology , Erasmus Medical Center , Rotterdam , The Netherlands
| | - Heidi Saavedra Perez
- a Department of Epidemiology , Erasmus Medical Center , Rotterdam , The Netherlands
| | - Lisette A Zuurbier
- a Department of Epidemiology , Erasmus Medical Center , Rotterdam , The Netherlands
| | - Paul A Boelen
- b Department of Clinical and Health Psychology , Utrecht University , Utrecht , The Netherlands
| | - Judith A Rietjens
- c Department of Public Health , Erasmus Medical Center , Rotterdam , The Netherlands
| | - Albert Hofman
- a Department of Epidemiology , Erasmus Medical Center , Rotterdam , The Netherlands
| | - Henning Tiemeier
- a Department of Epidemiology , Erasmus Medical Center , Rotterdam , The Netherlands.,d Department of Psychiatry , Erasmus Medical Center , Rotterdam , The Netherlands.,e Department of Child and Adolescent Psychiatry , Erasmus Medical Center , Rotterdam , The Netherlands
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17
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Jou “Lavender” She W, Prigerson HG. "Caregrieving" in palliative care: Opportunities to improve bereavement services. Palliat Med 2018; 32:1635-1636. [PMID: 29978734 PMCID: PMC6661889 DOI: 10.1177/0269216318780587] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Wan Jou “Lavender” She
- Department of Medicine, Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York City, New York, United States 10021
- Cornell Center for Research on End-of-Life Care, Weill Cornell Medicine, 420 East 70 Street, New York City, New York 10021
| | - Holly G. Prigerson
- Department of Medicine, Division of Geriatrics and Palliative Medicine, Weill Cornell Medical College, New York City, New York, United States 10021
- Cornell Center for Research on End-of-Life Care, Weill Cornell Medicine, 420 East 70 Street, New York City, New York 10021
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18
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Ishida M, Onishi H, Morita T, Uchitomi Y, Shimizu M, Tsuneto S, Shima Y, Miyashita M. Communication Disparity Between the Bereaved and Others: What Hurts Them and What Is Unhelpful? A Nationwide Study of the Cancer Bereaved. J Pain Symptom Manage 2018; 55:1061-1067.e1. [PMID: 29329691 DOI: 10.1016/j.jpainsymman.2017.12.493] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 12/29/2017] [Accepted: 12/29/2017] [Indexed: 12/28/2022]
Abstract
CONTEXT The importance of communication between the cancer bereaved and others has been emphasized, but little is known about the more problematic aspects of this communication such as "unhelpful communication." OBJECTIVES The aim of this study was to establish which types of communication are perceived by the bereaved to be unhelpful. METHODS We conducted a cross-sectional, anonymous, nationwide survey at 103 certified hospice facilities/palliative care units in Japan. RESULTS A total of 630 (63%) bereaved responded. Over 60% of the bereaved experiencing such communication considered it to be unhelpful, with the most unhelpful communication being "They emphasized the positive aspects of death." Thirteen items related to communication were separated into two factors ("advice for recovery" and "comments on cancer") by factor analysis. "Comments on cancer" were more unhelpful to them and were more often provided by those around them. With regard to "advice for recovery," losing a spouse was a stronger predictor with a higher odds ratio for communication distress than losing a parent (odds ratio, 5.34; 95% CI, 1.63-17.57). CONCLUSION A number of the bereaved have experienced unhelpful communication regarding advice on dealing with bereavement and cancer. To prevent putting an unnecessary burden on the bereaved with such unhelpful communication, it is essential to understand problematic aspects. Even when people have no intention of hurting the bereaved, some communication may do so. Communication with the bereaved is also a core clinical skill required by health professionals, and further efforts are required to support the grieving process.
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Affiliation(s)
- Mayumi Ishida
- Department of Psycho-Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan.
| | - Hideki Onishi
- Department of Psycho-Oncology, Saitama Medical University International Medical Center, Hidaka, Saitama, Japan
| | - Tatsuya Morita
- Department of Palliative and Supportive Care, Palliative Care Team and Seirei Hospice, Seirei Mikatagahara Hospital, Hamamatsu, Shizuoka, Japan
| | - Yosuke Uchitomi
- Innovation Center for Supportive, Palliative and Psychosocial Care, National Cancer Center, Chuo-ku, Tokyo, Japan
| | - Megumi Shimizu
- Clinical Research, Innovation and Education Center, Tohoku University Hospital, Sendai, Miyagi, Japan
| | - Satoru Tsuneto
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yasuo Shima
- Department of Palliative Medicine, Tsukuba Medical Center Hospital, Tsukuba, Ibaraki, Japan
| | - Mitsunori Miyashita
- Division of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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19
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Bellini S, Erbuto D, Andriessen K, Milelli M, Innamorati M, Lester D, Sampogna G, Fiorillo A, Pompili M. Depression, Hopelessness, and Complicated Grief in Survivors of Suicide. Front Psychol 2018; 9:198. [PMID: 29568278 PMCID: PMC5852099 DOI: 10.3389/fpsyg.2018.00198] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 02/05/2018] [Indexed: 01/07/2023] Open
Abstract
Suicide often has a severe impact on the surviving family and friends. There is a need to better understand the psychological and psychopathological consequences of losing a significant other by suicide. The aim of the present study was to assess hopelessness, depression, suicide risk, complicated grief, intrusive memories, and avoidance in a sample of suicide survivors. In this observational study, 35 bereaved individuals were recruited at the Suicide Prevention Centre of Sant’Andrea Hospital in Rome. Individuals were administered a series of validated instruments: the Beck Depression Inventory II (BDI), the Beck Hopelessness Scale (BHS), the Inventory of Complicated Grief (ICG), the Impact of Event Scale (IES), the Subjective Happiness Scale (SHS), and the Satisfaction With Life Scale (SWLS). Most survivors (62.8%) obtained high scores on measures of complicated grief. Scores on the measure of complicated grief were associated with intrusiveness of thoughts and memories, attempts to prevent the thoughts and emotions related to the event, depressive symptoms and hopelessness, and lower scores for feelings of happiness and satisfaction with life. A subgroup of suicide survivors may be at risk of severe psychological distress and suicidal behavior. Identification of these survivors is a necessary step for providing appropriate counseling and psychotherapy.
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Affiliation(s)
- Samantha Bellini
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Denise Erbuto
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Karl Andriessen
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Mariantonietta Milelli
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Marco Innamorati
- Department of Human Sciences, Università Europea di Roma, Rome, Italy
| | - David Lester
- Stockton University, Galloway Township, NJ, United States
| | - Gaia Sampogna
- Department of Psychiatry, University of Campania "Luigi Vanvitelli" Naples, Naples, Italy
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "Luigi Vanvitelli" Naples, Naples, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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20
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21
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Abstract
Despite advances in surgical critical care, critical illness remains traumatic and has long-term adverse sequelae. Unrealistic expectations and erroneous assumptions about outcomes acceptable to patients have been identified as drivers of goal-discordant treatment. Goal setting in the ICU begins with compassionately delivered, accurate, and honest prognostic information. Through skilled communication and shared decision making, clinicians forge a mutual understanding of patient values and priorities and the role of therapeutic options in achieving patient goals. Ensuring that treatment is goal-concordant and meets physical, psychosocial, existential, and spiritual needs is crucial for attaining optimal patient and caregiver outcomes, independent of survival.
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Affiliation(s)
- Ana Berlin
- Department of Surgery, Rutgers New Jersey Medical School, Medical Science Building G-506, 185 South Orange Avenue, Newark, NJ 07103, USA.
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22
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How Medicine Has Changed the End of Life for Patients With Cardiovascular Disease. J Am Coll Cardiol 2017; 70:1276-1289. [DOI: 10.1016/j.jacc.2017.07.735] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 07/13/2017] [Accepted: 07/19/2017] [Indexed: 12/20/2022]
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Robson K, Williams CM. Dealing with the death of a long term patient; what is the impact and how do podiatrists cope? J Foot Ankle Res 2017; 10:36. [PMID: 28804519 PMCID: PMC5549399 DOI: 10.1186/s13047-017-0219-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 08/03/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is common for podiatrists and patients to develop long term professional relationships. Patient's decline in health or death may impact a practitioner's mental wellbeing. This research aimed to understand the impact of long term patient death on podiatrists and identify coping strategies. METHOD Australian podiatrists were eligible to participate if they had been practicing longer than 5 years and experienced the death of a long term patient in the previous 12 months. Individual semi-structured interviews were conducted with podiatrists and were audio-recorded, transcribed verbatim and individually analysed to identify key themes. Interpretative phenomenological analysis was used to explore the perceptions of podiatrists on the personal and professional impact following the death of a long term patient. RESULTS Fifteen podiatrists (11 female) with a median of 15 (range 8-50) years' experience participated. Three major themes emerged: acknowledging connections, willing to share and listen, and creating support through starting the conversation. Participants indicated importance in recognition of the emotional influence of professional-patient relationships. They also discussed the importance of debriefing about death with the right person, which was most commonly colleagues. Participants talked about the emotional impact of death, suggesting the need for supporting discussion and resources, especially for new graduates. CONCLUSION Death and dying can be an emotive topic and one which podiatrists may not be prepared for, yet likely to have to deal with throughout their career. These findings enable a better understanding of the impact of patient death and provide possible future directions for the profession to better support podiatrists in this area.
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Affiliation(s)
- Kristy Robson
- School of Community Health, Charles Sturt University, Albury, NSW 2640 Australia
| | - Cylie M Williams
- Department of Physiotherapy, Monash University, Frankston, VIC 3199 Australia.,Peninsula Health Allied Health, Frankston, VIC 3199 Australia
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24
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Dodd A, Guerin S, Delaney S, Dodd P. Complicated grief: Knowledge, attitudes, skills and training of mental health professionals: A systematic review. PATIENT EDUCATION AND COUNSELING 2017; 100:1447-1458. [PMID: 28320560 DOI: 10.1016/j.pec.2017.03.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Revised: 02/28/2017] [Accepted: 03/05/2017] [Indexed: 06/06/2023]
Abstract
OBJECTIVE A systematic review and qualitative synthesis was undertaken to deduce the knowledge, attitudes, skills and training of mental health professionals regarding complicated grief (CG). METHODS PsychInfo, Embase, Medline, CINAHL, PBSC, Web of Science and ERIC databases were used to identify relevant literature. Searches were executed from inception to September 2014. RESULTS The electronic search yielded 305 results. Forty-one papers were selected for full text review, 20 were included for analysis. 6 examined primary data, the remaining 14 being reviews, opinion or guideline pieces. CONCLUSIONS Despite the lack of consensus on terminology, criteria and diagnosis, it appears that there is more than sufficient agreement within the CG research community regarding the knowledge and skills required to assist someone presenting with CG. A palpable fear of medicalising grief exists, but this would seem to be based on a conflation of normal grief and CG. This review highlights the mainly unidirectional nature of current research, the voice of the practitioner being largely unheard. A need for and an interest in training in CG was expressed. PRACTICE IMPLICATIONS There is an urgent need to translate research findings into clinical practice. Training must take account of attitudinal barriers to implementation, balancing evidence and stories.
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Affiliation(s)
- Anne Dodd
- UCD School of Psychology, Newman Building, University College Dublin, Belfield, Dublin 4, Ireland; UCD Centre for Disability Studies, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Suzanne Guerin
- UCD School of Psychology, Newman Building, University College Dublin, Belfield, Dublin 4, Ireland; UCD Centre for Disability Studies, University College Dublin, Belfield, Dublin 4, Ireland.
| | - Susan Delaney
- Irish Hospice Foundation, Morrison Chambers, Nassau St, Dublin 2, Ireland.
| | - Philip Dodd
- St Michael's House Intellectual Disability Service, Ballymun Rd, Dublin 9, Ireland; UCD Centre for Disability Studies, University College Dublin, Belfield, Dublin 4, Ireland.
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25
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Gijzen S, L’Hoir MP, Boere-Boonekamp MM, Need A. How do parents experience support after the death of their child? BMC Pediatr 2016; 16:204. [PMID: 27927172 PMCID: PMC5142355 DOI: 10.1186/s12887-016-0749-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Accepted: 12/02/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A child's death is an enormous tragedy for both the parents and other family members. Support for the parents can be important in helping them to cope with the loss of their child. In the Netherlands little is known about parents' experiences of the support they receive after the death of their child. The purpose of this study is to determine what support parents in the Netherlands receive after the death of their child and whether the type of care they receive meets their needs. METHOD Parents who lost a child during pregnancy, labour or after birth (up to the age of two) were eligible for participation. They were recruited from three parents' associations. Sixty-four parents participated in four online focus group discussions. Data on background characteristics were gathered through an online questionnaire. SPSS was used to analyse the questionnaires and Atlas ti. was used for the focus group discussions. RESULTS Of the 64 participating parents, 97% mentioned the emotional support they received after the death of their child. This kind of support was generally provided by family, primary care professionals and their social network. Instrumental and informational support, which respectively 80% and 61% of the parents reported receiving, was mainly provided by secondary care professionals. Fifty-two per cent of the parents in this study reported having received insufficient emotional support. Shortcomings in instrumental and informational support were experienced by 25% and 19% of the parents respectively. Parental recommendations were directed at ongoing support and the provision of more information. CONCLUSION To optimise the way Dutch professionals respond to a child's death, support initiated by the professional should be provided repeatedly after the death of a child. Parents appreciated follow-up contacts with professionals at key moments in which they were asked whether they needed support and what kind of support they would like to receive.
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Grants
- INTERREG Deutschland-Nederland, as the leading financer, The Ministry for Youth and Families, Land NRW, Land Niedersachsen, University of Twente, University of Münster, TNO Child Health, Menzis Health Insurance, MKB Netherlands, Foundation ‘Kinderpostzegel
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Affiliation(s)
- Sandra Gijzen
- Department HTSR, IGS Institute for Innovation and Governance Studies, University of Twente, PO Box 217, 7500 AE Enschede, Netherlands
| | | | - Magda M. Boere-Boonekamp
- Department HTSR, IGS Institute for Innovation and Governance Studies, University of Twente, PO Box 217, 7500 AE Enschede, Netherlands
| | - Ariana Need
- Department Public Administration, IGS Institute for Innovation and Governance Studies, University of Twente, PO Box 217, 7500 AE Enschede, Netherlands
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Abstract
Management of the bereaved is an important element in trauma care. Clinicians need to be familiar with the features of normal and pathological grief reactions. The latter have important implications for the physical and mental welfare of the bereaved. Trauma staff are not expected to provide specialist bereavement care for bereaved relations and families, but there is much they can do by way of providing information for the bereaved as well as through their attitudes and behaviour toward them. What happens in the immediate aftermath of the patient’s death is likely to influence the outcome for the bereaved. We need also to remember that grief itself is not a clinical pathology and that most individuals do learn to adjust satisfactorily without specialist help. Indeed, many will come through a bereavement the stronger.
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Affiliation(s)
- Susan Klein
- Aberdeen Centre for Trauma Research, Aberdeen, UK,
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27
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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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Pereira M, Dyregrov K, Hauken MA, Senneseth M, Dyregrov A. Systematic Early Intervention for Bereaved: Study Protocol of a Pilot Randomized Controlled Trial With Families Who Suddenly Lose a Partner and a Parent. JMIR Res Protoc 2016; 5:e152. [PMID: 27487723 PMCID: PMC4989119 DOI: 10.2196/resprot.5765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Revised: 06/02/2016] [Accepted: 06/24/2016] [Indexed: 11/13/2022] Open
Abstract
Background Grief has been associated with several long-term negative outcomes for both surviving parents and bereaved children, especially when it is preceded by unnatural and violent deaths. Nevertheless, it has been an underestimated public health problem with few, if any, empirically documented early preventive intervention programs. The best time to start them is also a major question that requires further evidence. Objective The overall aim of this study is to assess the feasibility of a future larger trial, informing sample size calculation, recruitment/randomization procedures, retention rates, data collection forms, and outcomes. This study will also explore: (1) the early effects of Systematic Early Intervention for Bereaved (SEIB) compared with the early effects of care as usual, and (2) the effects of the immediate SEIB version compared with the effects of the delayed SEIB version. Methods In a pilot randomized controlled trial (RCT) with a delayed intervention design, suddenly bereaved families will be assigned to: the immediate-SEIB intervention group, or the delayed-SEIB intervention group. Participants will fill in a set of self-report measures at baseline, and after 3, 6, and 9 months follow-up. Quantitative data on traumatic stress symptoms, complicated grief, psychological wellbeing, daily functioning, social support, parental capacity, parenting practices, and family functioning will be collected to inform power calculations and explore SEIB’s preliminary effects. Data on the flow of participants throughout the trial will be analyzed in order to estimate recruitment and retention rates. Two brief questionnaires were developed to assess recruitment procedures, randomization, and data collection materials. Results Recruitment for this project started in August 2015, and follow-up data collection will be completed in June 2017. Conclusions This study prepares the ground work for the design and implementation of a main trial and may add preliminary knowledge to the significance of early supportive practices that have been commonly used regardless of their sparse evidence.
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Newsom JT, Prigerson HG, Schulz R, Reynolds CF. Investigating Moderator Hypotheses in Aging Research: Statistical, Methodological, and Conceptual Difficulties with Comparing Separate Regressions. Int J Aging Hum Dev 2016; 57:119-50. [PMID: 15151187 DOI: 10.2190/13lv-b3mm-pewj-3p3w] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Many topics in aging research address questions about group differences in prediction. Such questions can be viewed in terms of interaction or moderator effects, and use of appropriate methods to test these hypotheses are necessary to arrive at accurate conclusions about age differences. This article discusses the conceptual, methodological, and statistical problems in one approach to investigating moderator hypotheses. The subgroup regression approach, in which separate regression analyses are conducted in two or more groups, is widely used in aging research to examine group differences in prediction, but the approach can lead to erroneous conclusions. The moderated regression approach, involving the test of a product term, is described and recommended as an a alternative approach. The question of whether social support has greater beneficial effects for younger or older adults is investigated in a study of 287 recently-bereaved adults ranging in age from 20 to 91. Using the subgroup approach, findings indicated that social support significantly predicted depressive symptoms among younger adults and did not significantly predict depressive symptoms among older adults. The moderated regression analysis, however, indicated no significant age differences in the effect of social support. These results clearly illustrate that the analysis strategy researchers choose may have important bearing on theory in aging research such as conclusions regarding the role of social support across the life span.
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Affiliation(s)
- Jason T Newsom
- Institute on Aging, Portland State University, OR 97207-0751, USA.
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Hayward JS, Makinde O, Vasudev NS. Letters of condolence: assessing attitudes and variability in practice amongst oncologists and palliative care doctors in Yorkshire. Ecancermedicalscience 2016; 10:642. [PMID: 27347006 PMCID: PMC4898960 DOI: 10.3332/ecancer.2016.642] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Indexed: 11/17/2022] Open
Abstract
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.
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Affiliation(s)
| | | | - Naveen S Vasudev
- Leeds Institute of Cancer and Pathology, University of Leeds, LS9 7TF, UK; St James's Institute of Oncology, Leeds, LS9 7TF, UK
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Gilewski T. Encountering grief in patient care. Am Soc Clin Oncol Educ Book 2016:e81-4. [PMID: 24451837 DOI: 10.14694/edbook_am.2012.32.302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Grief is essentially unavoidable and is a normal reaction to loss. Grief may be experienced by patients and their loved ones as well as by physicians and members of the health care team in response to the consequences of illness or death. Grief is typified by certain indicators that may significantly effect one's emotional and physical well-being. Although these indicators tend to follow a general pattern, there is variability among individuals. Complicated grief may require psychiatric intervention. Caring for the seriously ill or dying patient may be particularly challenging from an emotional level and may increase the risk of burnout. Recognition of these emotions is a critical aspect of providing compassionate care on a sustainable level. Various strategies may be beneficial in coping with grief, and the exploration of grief may provide greater insight into the humanistic basis of medicine.
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Affiliation(s)
- Teresa Gilewski
- From the Memorial Sloan-Kettering Cancer Center, New York, NY
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32
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Lai C, Luciani M, Galli F, Morelli E, Moriconi F, Penco I, Aceto P, Lombardo L. Persistent complex bereavement disorder in caregivers of terminally ill patients undergoing supportive-expressive treatment: a pilot study. J Ment Health 2016; 26:111-118. [DOI: 10.3109/09638237.2016.1167855] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Carlo Lai
- Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy,
| | - Massimiliano Luciani
- Psychiatry and Psychology Institute, Catholic University of Sacred Heart, Rome, Italy,
| | | | | | - Federica Moriconi
- Dynamic and Clinical Psychology, Sapienza University of Rome, Rome, Italy,
| | | | - Paola Aceto
- Department of Anaesthesiology and Intensive Care, Catholic University of Sacred Heart, Rome, Italy
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Morris SE, Block SD. Adding Value to Palliative Care Services: The Development of an Institutional Bereavement Program. J Palliat Med 2015; 18:915-22. [DOI: 10.1089/jpm.2015.0080] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Sue E. Morris
- Dana-Farber/Brigham and Women's Cancer Center, Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Susan D. Block
- Department of Psychosocial Oncology and Palliative Care, Dana Farber Cancer Institute, Harvard Medical School Center for Palliative Care, Ariadne Labs, Brigham and Women's Hospital, Boston, Massachusetts
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Wilcox HC, Mittendorfer-Rutz E, Kjeldgård L, Alexanderson K, Runeson B. Functional impairment due to bereavement after the death of adolescent or young adult offspring in a national population study of 1,051,515 parents. Soc Psychiatry Psychiatr Epidemiol 2015; 50:1249-56. [PMID: 25552253 DOI: 10.1007/s00127-014-0997-7] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 12/14/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE This study addresses the burden of grief after the death of an adolescent or young adult offspring. Parental bereavement following the death of an adolescent or young adult offspring is associated with considerable psychiatric and somatic impairment. Our aim is to fill a research gap by examining offspring death due to suicide, accidents, or natural causes in relation to risk of parental sickness absence with psychiatric or somatic disorders. METHODS This whole population-based prospective study included mothers and fathers of all offspring aged 16-24 years in Sweden on December 31, 2004 (n = 1,051,515). This study had no loss to follow-up and exposure, confounders, and the outcome were recorded independently of each other. Cox survival analysis was used to model time to sickness absence exceeding 30 days, adjusting for parental demographic characteristics, previous parental sickness absence and disability pension, and inpatient and outpatient psychiatric and somatic healthcare prior to offspring death in 2001-2004. This large study population provided satisfactory statistical power for stratification by parents' sex and adolescent and young adults' cause of death. RESULTS Mothers and fathers of offspring suicide and accident decedents both had over tenfold higher risk for psychiatric sickness absence exceeding 30 days as compared to parents of live offspring. Fathers of suicide decedents were at 40 % higher risk for somatic sickness absence. CONCLUSIONS This is the largest study to date of parents who survived their offspring's death and the first study of work-related outcomes in bereaved parents. This study uses a broad metric of work-related functional impairment, sickness absence, for capturing the burden of sudden offspring death.
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Affiliation(s)
- Holly C Wilcox
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, 550 North Broadway Room 921, Baltimore, MD, 21205, USA,
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Affiliation(s)
- Holly G Prigerson
- Center for Research on End-of-Life Care, Cornell University, New York, New York2Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Kelly Trevino
- Center for Research on End-of-Life Care, Cornell University, New York, New York2Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
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36
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Lichtenthal WG, Corner GW, Sweeney CR, Wiener L, Roberts KE, Baser RE, Li Y, Breitbart W, Kissane DW, Prigerson HG. Mental Health Services for Parents Who Lost a Child to Cancer: If We Build Them, Will They Come? J Clin Oncol 2015; 33:2246-53. [PMID: 26033819 DOI: 10.1200/jco.2014.59.0406] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To examine bereavement mental health service use, barriers to use, and factors associated with use in parents bereaved by cancer. PATIENTS AND METHODS A multicenter, cross-sectional study of 120 parents bereaved by cancer between 6 months and 6 years after their loss was performed. Parents completed self-report assessments of mental health service use and barriers, prolonged grief, depression, anxiety, attachment styles, and sense of meaning by phone, in person, or on their own. RESULTS Forty-one percent of bereaved parents were currently using mental health services (talk therapy, psychotropic medication, and/or a support group), most commonly within the first 2 years after their loss. Talk therapy was the most frequently used service, although 36% of parents who discontinued therapy did so because it was not helpful. Forty percent of parents who wanted bereavement support reported they were not receiving services. The most common barriers to service use were that it was too painful to speak about the loss (64%) and too difficult to find help (60%). Factors associated with current mental health service use included more recent loss, prior mental health service use, subclinical/increased depression, insecure attachment styles, and a decreased sense of meaning. Minority parents were more likely to have unmet needs than nonminority parents. CONCLUSION Parents appear to need, want, and often access bereavement mental health services, which could be offered in oncology settings. However, barriers to service use must be addressed, particularly for those with more debilitating grief symptoms and for minorities. High treatment dropout rates suggest the importance of improving retention, training providers, and developing effective grief interventions.
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Affiliation(s)
- Wendy G Lichtenthal
- Wendy G. Lichtenthal, Geoffrey W. Corner, Corinne R. Sweeney, Kailey E. Roberts, Raymond E. Baser, Yuelin Li, William Breitbart, and David W. Kissane, Memorial Sloan Kettering Cancer Center; Holly G. Prigerson, Weill Cornell Medical College, New York, NY; Lori Wiener, National Cancer Institute, Bethesda, MD; and David W. Kissane, Monash University, Clayton, Victoria, Australia.
| | - Geoffrey W Corner
- Wendy G. Lichtenthal, Geoffrey W. Corner, Corinne R. Sweeney, Kailey E. Roberts, Raymond E. Baser, Yuelin Li, William Breitbart, and David W. Kissane, Memorial Sloan Kettering Cancer Center; Holly G. Prigerson, Weill Cornell Medical College, New York, NY; Lori Wiener, National Cancer Institute, Bethesda, MD; and David W. Kissane, Monash University, Clayton, Victoria, Australia
| | - Corinne R Sweeney
- Wendy G. Lichtenthal, Geoffrey W. Corner, Corinne R. Sweeney, Kailey E. Roberts, Raymond E. Baser, Yuelin Li, William Breitbart, and David W. Kissane, Memorial Sloan Kettering Cancer Center; Holly G. Prigerson, Weill Cornell Medical College, New York, NY; Lori Wiener, National Cancer Institute, Bethesda, MD; and David W. Kissane, Monash University, Clayton, Victoria, Australia
| | - Lori Wiener
- Wendy G. Lichtenthal, Geoffrey W. Corner, Corinne R. Sweeney, Kailey E. Roberts, Raymond E. Baser, Yuelin Li, William Breitbart, and David W. Kissane, Memorial Sloan Kettering Cancer Center; Holly G. Prigerson, Weill Cornell Medical College, New York, NY; Lori Wiener, National Cancer Institute, Bethesda, MD; and David W. Kissane, Monash University, Clayton, Victoria, Australia
| | - Kailey E Roberts
- Wendy G. Lichtenthal, Geoffrey W. Corner, Corinne R. Sweeney, Kailey E. Roberts, Raymond E. Baser, Yuelin Li, William Breitbart, and David W. Kissane, Memorial Sloan Kettering Cancer Center; Holly G. Prigerson, Weill Cornell Medical College, New York, NY; Lori Wiener, National Cancer Institute, Bethesda, MD; and David W. Kissane, Monash University, Clayton, Victoria, Australia
| | - Raymond E Baser
- Wendy G. Lichtenthal, Geoffrey W. Corner, Corinne R. Sweeney, Kailey E. Roberts, Raymond E. Baser, Yuelin Li, William Breitbart, and David W. Kissane, Memorial Sloan Kettering Cancer Center; Holly G. Prigerson, Weill Cornell Medical College, New York, NY; Lori Wiener, National Cancer Institute, Bethesda, MD; and David W. Kissane, Monash University, Clayton, Victoria, Australia
| | - Yuelin Li
- Wendy G. Lichtenthal, Geoffrey W. Corner, Corinne R. Sweeney, Kailey E. Roberts, Raymond E. Baser, Yuelin Li, William Breitbart, and David W. Kissane, Memorial Sloan Kettering Cancer Center; Holly G. Prigerson, Weill Cornell Medical College, New York, NY; Lori Wiener, National Cancer Institute, Bethesda, MD; and David W. Kissane, Monash University, Clayton, Victoria, Australia
| | - William Breitbart
- Wendy G. Lichtenthal, Geoffrey W. Corner, Corinne R. Sweeney, Kailey E. Roberts, Raymond E. Baser, Yuelin Li, William Breitbart, and David W. Kissane, Memorial Sloan Kettering Cancer Center; Holly G. Prigerson, Weill Cornell Medical College, New York, NY; Lori Wiener, National Cancer Institute, Bethesda, MD; and David W. Kissane, Monash University, Clayton, Victoria, Australia
| | - David W Kissane
- Wendy G. Lichtenthal, Geoffrey W. Corner, Corinne R. Sweeney, Kailey E. Roberts, Raymond E. Baser, Yuelin Li, William Breitbart, and David W. Kissane, Memorial Sloan Kettering Cancer Center; Holly G. Prigerson, Weill Cornell Medical College, New York, NY; Lori Wiener, National Cancer Institute, Bethesda, MD; and David W. Kissane, Monash University, Clayton, Victoria, Australia
| | - Holly G Prigerson
- Wendy G. Lichtenthal, Geoffrey W. Corner, Corinne R. Sweeney, Kailey E. Roberts, Raymond E. Baser, Yuelin Li, William Breitbart, and David W. Kissane, Memorial Sloan Kettering Cancer Center; Holly G. Prigerson, Weill Cornell Medical College, New York, NY; Lori Wiener, National Cancer Institute, Bethesda, MD; and David W. Kissane, Monash University, Clayton, Victoria, Australia
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Abstract
Suicide is the deliberate act of causing death by self-directed injurious behavior with intent to die. Assisted dying, also known as assisted suicide, involves others to help hasten death. Physician-assisted dying specifically refers to the participation of a physician in facilitating one's death by providing a lethal means. Any decision to actively end a life has profound emotional and psychological effects on survivors. The article discusses the effects that older adults' deaths through suicide, assisted dying, and physician-assisted dying have on survivors and the implications for clinical practice.
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38
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Merel SE, Stafford MM, White AA, Fligner CL, Amory JK, Hagman MM. Providers' Beliefs about Expressing Condolences to the Family of a Deceased Patient: A Qualitative and Quantitative Analysis. J Palliat Med 2015; 18:217-24. [PMID: 25493629 DOI: 10.1089/jpm.2014.0217] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Susan E. Merel
- University of Washington Medical Center, Seattle, Washington
| | | | - Andrew A. White
- University of Washington Medical Center, Seattle, Washington
| | | | - John K. Amory
- University of Washington Medical Center, Seattle, Washington
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Ghesquiere AR, Patel SR, Kaplan DB, Bruce ML. Primary care providers' bereavement care practices: recommendations for research directions. Int J Geriatr Psychiatry 2014; 29:1221-9. [PMID: 24955568 PMCID: PMC4418789 DOI: 10.1002/gps.4157] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2013] [Revised: 05/17/2014] [Accepted: 05/21/2014] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Bereaved patients are often seen in primary care settings. Although most do not require formal support, physicians may be called upon to provide support to some bereaved, particularly those with bereavement-related mental health disorders like complicated grief and bereavement-related depression. Research evidence on physician bereavement care is scant. We make recommendations for future research in this area. DESIGN Literature review focuses on studies conducted between 1996 and 2013 in the United States. Searches of Medline and PsychInfo, along with hand searches of reference sections, were conducted. RESULTS The limited existing research indicates substantial gaps in the research literature, especially in the areas of primary care physician skill and capacity, patient-level outcomes, and the quality of research methodology. No US studies have focused specifically on care for bereavement-related mental health disorders. We provide recommendations about how to improve research about primary care bereavement care. CONCLUSIONS The primary care sector offers ample opportunities for research on bereavement care. With greater research efforts, there may be improvements to quality of bereavement care in primary care, in general, and also to the accurate detection and appropriate referral for bereavement-related mental health conditions.
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Affiliation(s)
| | - Sapana R. Patel
- Department of Psychiatry, College of Physicians and Surgeons of Columbia University and the New York State Psychiatric Institute
| | - Daniel B. Kaplan
- Department of Geriatric Psychiatry, Weill Cornell Medical College
| | - Martha L. Bruce
- Department of Geriatric Psychiatry, Weill Cornell Medical College
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40
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Downar J, Barua R, Sinuff T. The desirability of an Intensive Care Unit (ICU) Clinician-Led Bereavement Screening and Support Program for Family Members of ICU Decedents (ICU Bereave). J Crit Care 2014; 29:311.e9-16. [DOI: 10.1016/j.jcrc.2013.11.024] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2013] [Revised: 09/27/2013] [Accepted: 11/15/2013] [Indexed: 01/10/2023]
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41
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The Relationship between Irrational Cognitions, Autobiographical Memory, Coping Strategies and Complicated Grief. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.sbspro.2014.03.303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Choi KH, Vasunilashorn S. Widowhood, age heterogamy, and health: the role of selection, marital quality, and health behaviors. J Gerontol B Psychol Sci Soc Sci 2013; 69:123-34. [PMID: 24128991 DOI: 10.1093/geronb/gbt104] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Although the impact of widowhood on the surviving spouse's health has been widely documented, there is little empirical research examining whether certain spousal choice decisions and marital sorting patterns predispose individuals to be more vulnerable to the adverse consequences of widowhood for health. DESIGN AND METHOD We use data from the Wisconsin Longitudinal Study and employ ordinary least squares models to (a) document variations in mental and physical health between married and widowed persons, (b) determine whether widowed persons in age heterogamous unions are especially vulnerable to the adverse consequences of widowhood, and (c) investigate to what extent differential selection, marital quality, and health practices account for health disparities by marital status and the spousal age gap. RESULTS Widowed persons, especially those in age heterogamous unions, have worse mental health than married persons, but they do not seem to be more disadvantaged in terms of physical health. Differential selection, marital quality, and health behaviors partly account for some of the health disparities by marital status and spousal age gap. DISCUSSION Our findings suggest that marrying a spouse who is very dissimilar in age may enhance one's vulnerability to the adverse consequences of widowhood for health.
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Affiliation(s)
- Kate H Choi
- Correspondence should be addressed to Kate H. Choi, Department of Sociology, Social Science Centre Room 5306, University of Western Ontario, London, Ontario N6A5C2, Canada. E-mail:
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Rochman D. Death-related versus fond memories of a deceased attachment figure: examining emotional arousal. DEATH STUDIES 2013; 37:704-724. [PMID: 24521029 DOI: 10.1080/07481187.2012.692455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Grieving is infused by memories and emotions. In this study, bereaved participants recalled either death-related or fond memories of their loved ones. Their emotional arousal was examined via physiologic and voice analytic measures. Both death-related and fond memories generated an acoustic profile indicative of sadness (reflected by voice quality related parameters). Death-related memories, moreover, lead to bodily tension reflected by increased diastolic blood pressure levels and mean fundamental frequency of the voice signal. Consistent with the continuing bond and attachment perspectives, "death," a reminder of the irrevocability of the loss, induced distress/anxiety. In contrast, fond memories lead to more moderate, melancholic sadness, presumably because of their association with the soothing qualities of the attachment figure.
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Affiliation(s)
- Daniel Rochman
- Department of Psychiatry, University of Alberta, Edmonton, Canada.
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44
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Breen LJ, Fernandez M, O'Connor M, Pember AJ. The preparation of graduate health professionals for working with bereaved clients: an Australian perspective. OMEGA-JOURNAL OF DEATH AND DYING 2013; 66:313-32. [PMID: 23785983 DOI: 10.2190/om.66.4.c] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Students enrolled in health profession courses require grief education so that, upon graduation, they are able to meet the needs of clients living with loss and grief. We investigated grief and loss education in six Australian university programs--medicine, nursing, counseling, psychology, social work, and occupational therapy--drawing from course documents and face-to-face interviews with key staff and final-year students. Only the counseling course included a dedicated grief and loss unit. The nursing, medicine, and occupational therapy courses emphasized end-of-life issues rather than a breadth of bereavement experiences. The social work course taught grief as a socially-constructed practice and the psychology course focused on grief and loss in addiction. Several factors influenced the delivery of grief education, including staffing, time, placement opportunities, student feedback, and needs of each profession. The study provides an indication as to how future health professionals are prepared for grief and loss issues in their practice.
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Affiliation(s)
- Lauren J Breen
- School of Psychology and Speech Pathology, Curtin University, Perth, Western Australia, Australia.
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45
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Pfefferbaum B, Tucker P, Jeon-Slaughter H, Allen JR, Hammond DR, Whittlesey SW, Vinekar SS, Feng Y. A pilot study of physiological reactivity in children and maternal figures who lost relatives in a terrorist attack. DEATH STUDIES 2013; 37:395-412. [PMID: 24517563 DOI: 10.1080/07481187.2011.649938] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Trauma is thought to interfere with normal grief by superimposing symptoms of posttraumatic stress disorder. This exploratory pilot study examined the association between traumatic grief and objectively measured physiological reactivity to a trauma interview in 73 children who lost relatives in the Oklahoma City bombing as well as a potential link between children and their maternal figures in physiological reactivity. Although the authors found no association between posttraumatic stress and objectively measured physiological reactivity among children, they found significant differences in objectively measured reactivity associated with loss and grief. Children who lost "close" relatives evidenced greater objectively measured reactivity than those who lost "distant" relatives. For the most part, children with higher levels of grief evidenced greater objectively measured reactivity than those with lower levels of grief. The most interesting of the findings was the parallel pattern in objectively measured physiological reactivity between children and their maternal figures along with a positive association between children's objectively measured physiological reactivity and maternal figures' self-reported physiological reactivity. Research using larger representative samples studied early and over time is indicated to determine the potential significance of these findings.
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Affiliation(s)
- Betty Pfefferbaum
- Department of Psychiatry and Behavioral Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73126-0901, USA.
| | - Phebe Tucker
- Department of Psychiatry and Behavioral Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73126-0901, USA
| | - Haekyung Jeon-Slaughter
- Department of Psychiatry and Behavioral Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73126-0901, USA
| | - James R Allen
- Department of Psychiatry and Behavioral Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73126-0901, USA
| | - Donna R Hammond
- Department of Psychiatry and Behavioral Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73126-0901, USA
| | - Suzanne W Whittlesey
- Department of Psychiatry and Behavioral Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73126-0901, USA
| | - Shreekumar S Vinekar
- Department of Psychiatry and Behavioral Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73126-0901, USA
| | - Yan Feng
- Department of Psychiatry and Behavioral Sciences, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73126-0901, USA
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46
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Comprendre le deuil pour mieux accompagner les proches de patients décédés en réanimation. ACTA ACUST UNITED AC 2012. [DOI: 10.1007/s13546-012-0621-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Rodríguez Villar S, Sánchez Casado M, Prigerson HG, Mesa García S, Rodríguez Villar M, Hortigüela Martín VA, Marco Schulke CM, Barrientos Vega R, Quintana M, Leóz Abellanas G. [Incidence of prolonged grief disorder in relatives of patients who die during or after admission in Intensive Care Unit]. ACTA ACUST UNITED AC 2012; 59:535-41. [PMID: 22818955 DOI: 10.1016/j.redar.2012.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 05/23/2012] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To determine the incidence of «Prolonged Grief Disorder» from one year after the death of a relative admitted to the Intensive Care Unit. MATERIAL AND METHODS A cross-sectional, longitudinal follow-up study was conducted in a general ICU of a reference hospital. The relatives were evaluated approximately one year after the death using the «Consensus Criteria for Prolonged Grief Disorder» as a tool. The prevalence between the first and second years was determined. RESULTS A total of 151 relatives of patients who died in ICU were included. The follow-up was carried out 22.1±5.3 months after the death. Eleven relatives (10.3%) fulfilled the «Consensus Criteria for Prolonged Grief Disorder». Of all the grieving relatives, those identified with prolonged grief disorder are the ones who most often require psychological/psychiatric support. CONCLUSIONS In a sample of close relatives of patients who died in ICU, a significant minority fulfilled the criteria for «Prolonged Grief Disorder» 1-2 years after the death. This condition, which is often overlooked, and could require some kind of psychological treatment, should be taken into consideration.
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Affiliation(s)
- S Rodríguez Villar
- Servicio de Medicina Intensiva, Hospital General Ntra. Sra. del Prado, Toledo, España.
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Psychological Consequences of Indirect Exposure to Disaster Due to the Haiti Earthquake. Prehosp Disaster Med 2012; 27:359-68. [DOI: 10.1017/s1049023x12001008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
AbstractIntroductionFew studies have focused on the mental health consequences of indirect exposure to disasters caused by naturally occurring hazards. The present study assessed indirect exposure to the 2010 earthquake in Haiti among Haitian-Americans now living in Miami; these subjects had no direct exposure to the earthquake, but retained their cultural identity, language, and connection to family and friends in Haiti.MethodsTwo months following the earthquake a sample of Haitian-Americans was surveyed inquiring about: (1) their psychological reactions to the quake; (2) types of exposures experienced by their family members and friends in Haiti; and (3) symptom levels of (a) major depression, (b) generalized anxiety disorder, (c) complicated grief, (d) mental health status, and (e) physical health status.ResultsHaitian-Americans living in Miami experienced a broad spectrum of indirect exposures to the 2010 earthquake in Haiti. These exposures were strongly associated with psychological distress, trauma-related mental health consequences, and diminished health status. Most notable was the multiplicity of indirect exposures to the on-scene experiences of multiple family members and friends in Haiti.ConclusionsConsideration should be given to the psychological impact and needs for support among indirectly-exposed populations with strong affiliation to directly-impacted victims.Shultz JM, Besser A, Kelly F, Allen A, Schmitz S, Hausmann V, Marcelin LH, Neria Y. Psychological consequences of indirect exposure to disaster due to the Haiti earthquake.Prehosp Disaster Med.2012;27(4):1-10.
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Kusano AS, Kenworthy-Heinige T, Thomas CR. Survey of bereavement practices of cancer care and palliative care physicians in the Pacific Northwest United States. J Oncol Pract 2012; 8:275-81. [PMID: 23277763 DOI: 10.1200/jop.2011.000512] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2012] [Indexed: 11/20/2022] Open
Abstract
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.
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Affiliation(s)
- Aaron S Kusano
- University of Washington School of Medicine, Seattle, WA 98195, USA.
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