How relatives adjust after the death of a patient with cancer in hospice

Measuring the quality of end-of-life care: Development, testing, and cultural validation of the Danish version of Views of Informal Carers' Evaluation of Services-Short Form

BACKGROUND

The perspectives of patients and relatives are important in the improvement of the quality of health care. However, the quality of end-of-life care has not been systematically evaluated in Scandinavia.

AIM

To develop or adapt and subsequently validate a questionnaire assessing the quality of end-of-life care in Denmark. The questionnaire was intended for bereaved relatives in order to assess the quality of care in the last 3 months of the patient's life and the circumstances surrounding death.

DESIGN AND DATA SOURCES

Based on the literature and interviews with 15 bereaved relatives and 17 healthcare professionals, relevant topics to include in a questionnaire were identified. The topics were prioritized by 100 bereaved relatives and subsequently compared to existing questionnaires. The chosen questionnaire was tested by cognitive interviews with 36 bereaved relatives.

RESULTS

Most of the important topics were covered by the Views of Informal Carers' Evaluation of Services-Short Form, but not all Danish settings (e.g. home care by a palliative team) were covered. These settings were added to the Views of Informal Carers' Evaluation of Services-Short Form, and a few adaptations were made before a Danish version of the Views of Informal Carers' Evaluation of Services-Short Form was tested by cognitive interviews. This cultural validation showed that the slightly adapted Danish version was perceived as relevant, understandable, and acceptable. Furthermore, the cognitive interviews gave insight in the comprehension and interpretation of Views of Informal Carers' Evaluation of Services-Short Form items.

CONCLUSION

With a few adaptations, the British Views of Informal Carers' Evaluation of Services-Short Form was relevant in a Danish setting.

Family members' perceived needs for bereavement follow-up

Palliative care does not end with the death of the patient, and many palliative care services offer specific follow-up services for the bereaved. The aims of this study were to quantitate perceived bereavement needs and to qualitatively describe these needs. The study design was cross-sectional and targeted family members three to nine months after the patient's death. Two hundred and forty-eight family members responded (response rate 66%) to a postal questionnaire with Likert-type and open-ended questions. The responses to the open-ended items were analyzed with manifest content analysis, and the quantitative part was analyzed with descriptive statistics. The analysis showed that about half of the family members expressed a need for bereavement follow-up. A majority favored a personal meeting, preferably in their own home, with the staff member who had had the most contact with the patient and the family. The family members wanted to talk about what had happened during the palliative phase (e.g., if the patient had suffered or not), and also about their present situation, their feelings of loneliness, and the future. The follow-up procedure made the family member experience a feeling of being recognized as a person with their own needs and was also valuable with regard to the family members' feelings of guilt. The findings are discussed in relation to narrative theory, meaning-based coping, and the dual process model of coping with bereavement, and designing follow-up procedures.

Bereaved spouses' adjustment after the patients' death in palliative care

Objectives:

To improve the support to bereaved spouses during the year after the patient's death, a project was started consisting of three visits by a nurse (after 1, 3, and 13 months) with conversations about the patient's death and the spouse's life situation. The aim of this study was to describe the bereaved spouse's situation and adaptation during the first year after the loss.

Methods:

Spouses of patients cared for by The Advanced Home Care Team (APHCT) in Uppsala, Sweden, were invited to participate in the project. Each participant was encouraged to talk freely about his or her situation, but enough direction was given to ensure that all items listed on a standardized questionnaire were covered.

Results:

Fifty-one spouses met the inclusion criteria and were invited to participate and 45 accepted. The subjects felt quite healthy but were tired and suffered from sleep disturbance. The grief reactions had initially been high but showed a significant decline from 1 to 13 months (p < .01). Forty-nine percent had experienced postbereavement hallucinations.

Significance of results:

This study showed that the bereaved spouses felt quite healthy and adjusted quite well to their new life situation, after the patient's death in a palliative care setting. The grief reactions had initially been high but showed a significant decline during the year.

Caring for the terminally ill: experiences of Latvian family caregivers

AIM

To increase understanding of the experiences and needs of family caregivers of terminally ill persons in Latvia.

BACKGROUND

Latvia has high death rates from cardiovascular disease and cancer, and families care for the terminally ill with little preparation and support. Health professionals also have little preparation in supporting these patients and families at the end of life.

METHODS

A qualitative study was carried out in the summer of 2004 in Latvia. Data collection was by semi-structured interviews with caregivers (n=18) whose care recipients died at least 1 year previously.

FINDINGS

The caregiver narratives addressed experiences that paralleled the trajectory of the patient's illness: the disruption of normal life patterns; taking on the caregiver role; establishing new patterns and learning role competencies; engaging in preparation for dying; and the gains and losses of the caregiving experience as seen in retrospect.

CONCLUSIONS

The caregiver narratives suggested a need for more education in practical caregiving; access to patient care equipment and supplies; and a need for ongoing support and guidance by knowledgeable medical personnel during caregiving.

Find a way out: bereavement support in Taiwan hospice

GOALS OF WORK

The aim of the study was to explore one of the possibilities to enhance bereavement care in Taiwan hospice due to insufficient attention and resources. Meanwhile, a theoretical assumption about the relationship between anticipatory grief and postdeath grief was made and examined.

PATIENTS AND METHODS

Through convenience sampling, 109 most bereaved families of terminally ill cancer patients were included. Data were collected by the Anticipatory Grief Scale (Theut SK et al (1991) Caregiver's anticipatory grief in dementia: a pilot study. Int J Aging Hum Dev 32:113-118), Perinatal Grief Scale (Potvin L, Lasker J, Toediter T (1989) Measuring grief: a short version of the Perinatal grief scale. J Psychopathol Behav Assess 11:29-45), and a background information sheet.

MAIN RESULTS

Anticipatory grief was correlated with postdeath grief significantly but mildly. Age was associated with anticipatory grief, not with postdeath grief. However, relationship and gender did not statistically relate to anticipatory grief and postdeath grief.

CONCLUSIONS

Although anticipatory grief could predict postdeath grief, the result was not encouraging enough. Prevention is still the best way not only for the bereaved in theoretical point of view but also for hospice staff in practical application. However, how to screen out high-risk bereaved family in order to provide help in advance require more effort.

Informational and emotional support received by relatives before and after the cancer patient's death

The purpose of this study is to find out what cancer patients' relatives think about the informational and emotional support they receive from health care professionals before and after the patient's death. The data were collected with a structured questionnaire administered to relatives of cancer patients who had died in one of seven health care centres and in one hospice in south-western Finland during a 2-year period before data collection. The questionnaires were sent out by staff to one family member of each adult patient (n=910). The final sample comprised 376 family members, most of whom were the deceased patient's spouses or children. Relatives felt that they had received fairly much support from health care professionals, both before and after the patient's death. Before the patient's death most of the information received by relatives concerned the patient's illness and treatment. They received less information about forms of financial support available. Communication had been honest and the information provided was easy to understand and based upon the relatives' needs. Emotional support before the patient's death consisted mainly of acceptance of the relative and listening to what relatives had to say. However, relatives had only limited opportunity to talk about their difficulties in everyday life. After the death of the patient, staff had mostly supported relatives by showing their acceptance of them and by giving them the time they wanted. Some background variables for both patients and relatives correlated with the support received by relatives before and after the patient's death.