Illness Doula: Adding a New Role to Healthcare Practice

Dying a 'Good' Death: The Work, Care, and Support of End-of-Life Doulas

End-of-life doulas (EOLDs) are a growing population of care providers who focus on the wishes of the dying person in order to cultivate an environment of comfort, peace, and support from the point of terminal diagnosis, during the dying process, and following death. The purpose of this study was to document the time commitment of EOLDs to dying persons and their loved ones during the dying process, as well as their experiences navigating family dynamics working towards increased acceptance of death. A mixed-methods approach was utilized to gather data on EOLDs, consisting of a quantitative survey with 618 respondents and subsequent qualitative interviews conducted with 39 participants. Results indicated that the amount of time spent with dying persons and their loved ones varies widely and often depends on when the EOLD is contracted regarding services. Factors that impede and lead to great acceptance of death are discussed as well as the role of EOLDs in navigating family dynamics.

Demystifying Death: Reflections on End-of-Life Doula Work

End-of-life doulas (EOLDs) represent a portion of a broader mobilization of end-of-life care practitioners to normalize discussions of death and assist dying persons and their caregivers in navigating the dying process. EOLDs primarily focus on creating a supportive environment for the dying and their loved ones. Research on the burgeoning care profession has documented the backgrounds and services of EOLD work; however, literature has overlooked EOLDs' personal reflections on their work. This study seeks to help fill this gap through interviews with 39 EOLDs registered with the International End-of-Life Doula Association (INELDA). Interviewees discussed the rewards, challenges, surprises, and motivations to continue their work, reinforcing previous studies' findings while expanding upon the perspectives of EOLDs in their own words. In sharing their experiences, EOLDs showcase how they facilitate death by respecting and advocating for the wishes of their clients while simultaneously navigating the hardships and joys of their profession.

End-of-Life Doulas: Documenting Their Backgrounds and Services

This is an exploratory study to document the demographic characteristics, backgrounds, and services provided by trained and certified INELDA end-of-life doulas. Like birth doulas, end-of-life doulas represent a divergent, yet complementary form of care for dying persons. The purpose of end-of-life care is to facilitate comfort of the dying person and their closest family members. Surveys were completed by 618 end-of-life doulas regarding their demographic characteristics, employment backgrounds, services, and their experiences providing end of life care to dying persons and their closest family members. Follow-up qualitative interviews were also conducted with a subset of 39 respondents who completed the original survey. Results show that trained doulas are largely white (91.4%), female (90.4%), hold a Bachelor's (32.3%) or Masters (32.4%) degree, and are employed outside of their EOLD work (70.1%). Qualitative data details services provided to dying persons and family members in addition to the benefits and challenges of working with traditional healthcare settings.

The impact of abortion doulas on women and providers' outcomes: An integrative review of the evidence

The aim of this integrative review is to map the literature on the impact of abortion doulas on women and abortion care providers. This review followed a modified Whittemore and Knafl framework and PRISMA guidelines. Electronic databases (Medline, PubMed, CINAHL, the Cochrane Library, Scopus, Proquest, EMBASE, and PsycINFO) were searched using key terms: abortion and doula. Search was limited by date (2012-2022), type (primary research only), and language (English only). Of the 99 papers found, only 4 met inclusion criteria. The four papers - drawn from 2 studies - were analysed using NICE Appraisal checklists. In total, data from 328 participants (n = 314 women, n = 5 physicians, n = 5 staff members, n = 4 abortion doulas) was analysed. Of the 314 women, 160 women received doula support and 154 did not. Two qualitative papers showed women and abortion providers reported a beneficial impact of abortion doulas, but the two quantitative (RCTs) papers showed null impact for a doula support intervention vs. usual care on women's physical and psychological outcomes. Women reported wanting support during the abortion; however, the evidence is not yet clear on whether a doula is required to address this need for women undergoing a surgical abortion in clinic. It may be that abortion support is important in ways that are difficult to measure.

Death doulas as supportive companions in end-of-life care: A scoping review

BACKGROUND

Death doulas have gained greater attention recently by offering psychosocial, spiritual and other non-clinical support for patients with time-limiting diseases, including their families, with the potential to complement existing end-of-life care services. However, their roles, scope of practice and care impact remain poorly understood.

AIM

To describe existing knowledge on death doulas regarding their roles, care impact, training and regulation.

DESIGN

This scoping review utilised Levac et al.'s framework and textual narrative synthesis to summarise the findings.

DATA SOURCES

PubMed, Scopus, CINAHL, PsycINFO, ProQuest, Google Scholar were searched for relevant articles from inception to 20 May 2021. Empirical studies, narrative reports, unpublished theses and studies in English were included.

RESULTS

Thirteen articles were included. Death doulas take on diverse roles in end-of-life care. Their roles include providing psychosocial, spiritual, practical support, companionship and resource navigation. The positive impacts of engaging a death doula include continuous presence, holistic service and flexible payment regime. The negative aspects include role inconsistencies and confusion among healthcare professionals and the public.

CONCLUSIONS

Death doulas can augment existing end-of-life care services by providing holistic and personalised care services at home or hospital settings. Their roles are still evolving and remain mostly unregulated, with little evidence about their impact. There is a need for more rigorous studies to explore healthcare professionals' views about this role and examine the clinical outcomes among dying persons and their families.