When the Patient Dies: A Survey of Medical Housestaff about Care after Death

A whole-hospital approach? Some staff views of a hospital bereavement care service

A qualitative study was conducted to address staff's views of bereavement care in a large hospital setting. Two focus-groups and 1 interview were attended by 21 self-selected staff. The qualitative analysis yielded the following: (a) a staff training program within a structured bereavement care service may give staff a sense of confidence and pride in this aspect of their work; (b) a whole-hospital approach to bereavement care may offer an alternative model to individual clinical services; (c) the question is raised as to whether the presence of a bereavement co-ordinator helps contain staff anxiety and other painful emotions generated by contact with the dying and bereaved; and (d) the potential role of ancillary staff in bereavement care warrants more study.

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSION

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

Last hours of living

The last hours of living can be one of the most important times in the life of any patient and his/her family. With appropriate preparation and careful management of the process by skilled clinicians, dying and death can be a comfortable and even rewarding experience for everyone involved. After death, careful attention to the grief of survivors can help them cope with their loss and rebuild their lives.

Interns Learning to Care for Dying Patients

OBJECTIVE

To examine interns' perceptions of the emotional support they were able to provide to dying patients and their families, as well as their evaluation of attending physicians as role models caring for dying patients and their families.

METHODS

A semistructured, face-to-face interview of a convenience sample of 38 internal medicine interns in two New York City teaching hospitals who were the primary house officers of patients dying between January 2000 and April 2000.

RESULTS

Fifty-eight percent of interns rated their comfort level in talking to their patient and family about end-of-life issues as good to excellent. Sixty percent of interns estimated that their impact on their patient's emotional experiences as they approached death as none to minimal. Seventy-four percent of interns rated their patient's physical comfort level good to excellent. Interns rated attending physicians as effective role models in 66% of cases; 34% percent were rated as poor to mediocre. Observation of attending physicians with patients and families was rated as the most effective method to learn how to care for dying patients.

CONCLUSIONS

While most interns felt comfortable speaking to their patients and their families about end-of-life issues, they also believed that they provided only minimal emotional support. Interns believe that direct observation of attending physicians is the most effective way to improve their skills caring for dying patients and their families; however, they report wide variability in attending physician performance as role models.

Competency in End-of-Life Care: Last Hours of Life

Clinical competence, willingness to educate, and calm and empathic reassurance are critical to helping patients and families in the last hours of living. This review adapted from the Education for Physicians on End-of-Life Care (EPEC) Curriculum describes the predictable course that occurs as well as approaches to management. Management principles are the same at home or in a health care institution. However, death in an institution requires accommodations to assure privacy, cultural observances, and communication that may not be customary. In anticipation of the event, it helps to inform the family and other professionals about what to do and what to expect. Care does not end until the family has been supported with their grief reactions and those with complicated grief helped to get care. Care at the end of life is a core competency.

Physician interactions with families and caregivers after a patient's death: current practices and proposed changes

There are little objective data concerning physician bereavement or other supportive interactions with the families and caregivers of deceased patients. We surveyed the physician staff of a large tertiary rural referral center in central Pennsylvania. We asked about current practices in attending former patients' funerals, family condolence visits, letter or phone contacts, as well as the desire of physicians to participate in these activities. The database consisted of 143 questionnaires that were returned from 286 physicians initially mailed the survey. Only 119 of the 143 had experienced patient deaths in their practices. Most of these 119 physicians did not participate in any type of planned contact with a former patient's family after the patient's death. Phone calls were used 39.6% after an inpatient death, and condolence notes were sent by about 40% of physicians. There was no correlation between these activities and number of deaths in the practice per year or if death occurred as an inpatient or outpatient. Physicians practicing at the medical center more than 10 years were more likely to contact the grieving family or caregivers. There was significant desire by the physicians to have an easy way to identify deceased patients' caregivers or loved ones, to have condolence notes available for the physicians' use, and to have bereavement service information sent to the families or caregivers.