Bereavement care provision and its associated factors among nurses in cancer care settings: a cross-sectional study

Evidence adaptation and tailored implementation of family bereavement support in specialised palliative care: A multi-method study

Background

Families experiencing the loss of their close other following advanced illness have varying degrees of needs that stretch into bereavement. Evidence-based recommendations for bereavement support are often not well implemented in palliative care services due to multiple system barriers and lack of contextual fit. To close this know-do gap, we undertook an implementation science research project.

Objective

To adapt evidence-informed recommendations for supporting bereaved families to the local context, and to develop a tailored implementation strategy for their integration in specialised palliative care services.

Settings and participants

Two specialised palliative care services located at urban teaching hospitals in German-speaking Switzerland. Participants were palliative care staff working in the service, including nurses, physicians, chaplains, psychologists, and two service users.

Methods

Multi-method implementation research project combining community engagement strategies, qualitative contextual analysis, and theory-driven implementation design processes for integrating evidence-informed interventions in new contexts: First, evidence was identified and adapted through co-design staff workshops and service user consultations, following intervention adaptation guidelines. Next, focus group interviews were held to identify barriers and facilitators to implementation, informed by the Consolidated Framework for Implementation Research and analysed using qualitative content analysis. Drawing on implementation mapping methodology, a systematic and participatory process was used to develop an implementation plan that specified activities needed to address identified barriers and support integration into palliative care services.

Results

The study resulted in an adapted bereavement support pathway with three core functions of evidence-informed practices delivered during dying, at death, three-to-six, and if necessary nine-to-twelve months post-loss: screening and assessing family needs and risks, intervention and support activities for families, and team collaboration and coordination within and across providers. Implementation was expected to be influenced by the features of the intervention itself, staff competencies, and organisational conditions, with resources required being a frequent barrier, whereas workplace culture and the project-related network acted as facilitators. A multifaceted implementation strategy with 16 distinct activities was developed to reach 70 % of bereaved families: designing a practical, implementable pathway, creating necessary team capacity and roles, optimizing workflow, offering education and clinician support, ensuring leadership and organisational commitment, and facilitating mutual exchange and learning. An implementation research logic model specified expected mechanisms of impact and outcomes.

Conclusions

The project resulted in an adapted bereavement support intervention fitted to local palliative care contexts and a tailored implementation plan. Adapting evidence to specific contexts and understanding potential barriers and facilitators is necessary to prepare implementation.

Registration

https://osf.io/qgr7y.

Contextual determinants of guideline-based family support during end-of-life cancer care and subsequent bereavement care: A cross-sectional survey of registered nurses

PURPOSE

In end-of-life cancer care, 10-20% of bereaved family members experience adverse mental health effects, including prolonged grief disorder. Despite great efforts, evidence-based recommendations to support their grieving process and well-being are often not successfully adopted into routine clinical care. This study identified facilitators and barriers using implementation science methodology.

METHODS

81 registered nurses working in cancer care from four hospitals and three home care services in Switzerland assessed their current family support practices in end-of-life care and bereavement care. They then assessed organisational attributes of their institution and their own individual characteristics and skills regarding literature-based factors of potential relevance. Facilitators and barriers to guideline-based family support were determined using fractional logistic regression.

RESULTS

Service specialisation in palliative care, a culture that supports change, the availability of family support guidelines, billing/reimbursement of bereavement support services, and individual knowledge of family support and skill were systematically associated with higher adoption of guideline-based family support practices. Lack of privacy with families and insufficient training acted as significant barriers.

CONCLUSIONS

While several potentially relevant factors have emerged in the literature, certain organisational and individual determinants actually empirically predict guideline-based family support according to nurses in end-of-life cancer care, with some determinants having much stronger implications than others. This provides crucial guidance for focussing quality improvement and implementation efforts through tailored strategies, especially with scarce resources. Furthermore, adoption is lower in bereavement care than in end-of-life care, suggesting a particular need for supportive organisational cultures including specific training and billing/reimbursement options.

The Current Status of Bereavement Care in Chinese Emergency Departments: A Multicenter Cross-Sectional Study

Understanding the current status and challenges of bereavement care will help facilitate the development of bereavement care in the emergency department. However, little is known about the status of bereavement care in Chinese emergency departments and nurses' perceptions of bereavement care. We used a self-made questionnaire to survey 124 head nurses and 870 emergency nurses in 21 hospitals in Jiangsu Province in September 2023. Among 124 emergency departments, 78 (62.90%) emergency departments provided bereavement care strategies, and the most frequent strategy was a waiting room, relevant information on funeral arrangements and the establishment of a relatively secluded environment conducive to the solace of the patient's family, or the provision of a dedicated farewell chamber. Emergency nurses believed that bereavement care is important but difficult to implement, with support resources, environment and human resources being the main challenges. In the future, further attention should be paid to the development of bereavement care in the emergency department, and the implementation of bereavement care should be supported in terms of policies, funds, resources and personnel.