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Roberts KE, Jankauskaite G, Slivjak E, Rubin L, Schachter S, Stabler S, Wiener L, Prigerson HG, Lichtenthal WG. Bereavement risk screening: A pathway to psychosocial oncology care. Psychooncology 2020; 29:2041-2047. [PMID: 32840939 DOI: 10.1002/pon.5526] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/10/2020] [Accepted: 08/13/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This qualitative study sought to obtain feedback from stakeholder cancer caregivers and bereaved family members on the implementation of bereavement risk screening in oncology. METHODS Semi-structured interviews were conducted with 38 family members of patients with advanced cancer (n = 12) and bereaved family members (n = 26) on when and how to effectively implement bereavement risk screening. Data were analyzed using thematic analysis. RESULTS Many participants indicated that they would be open to completing a self-report screening measure before and after the patient's death. Several suggested screening at multiple timepoints and the importance of follow-up. Participants viewed screening as an opportunity to connect to psychosocial support. CONCLUSIONS The findings suggest that family members appear supportive of sensitively approached bereavement risk screening before and after a patient's death as an important component of quality psychosocial care. To optimize implementation, bereavement risk screening would involve screening at multiple timepoints and include follow-up. Findings suggest standardized risk screening using a brief, validated self-report tool would be a pragmatic approach to increasing access to bereavement care.
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Affiliation(s)
- Kailey E Roberts
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York, USA
| | - Greta Jankauskaite
- Department of Psychology, University of Maryland, College Park, Maryland, USA
| | - Elizabeth Slivjak
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, Colorado, USA
| | - Lisa Rubin
- Department of Clinical Psychology, The New School for Social Research, New York, New York, USA
| | | | - Stacy Stabler
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Lori Wiener
- National Cancer Institute, Pediatric Oncology Branch, Bethesda, Maryland, USA
| | - Holly G Prigerson
- Cornell Center for Research on End-of-life Care, Weill Cornell Medicine, New York, New York, USA
| | - Wendy G Lichtenthal
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA.,Department of Psychiatry, Weill Cornell Medicine, New York, New York, USA
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Yin Q, Zhang H, Shang Z, Wu L, Sun Z, Zhang F, Zhou Y, Song X, Liu W. Risk factors for PTSD of Shidu parents who lost the only child in a rapid aging process: a cross-sectional study. BMC Psychiatry 2020; 20:37. [PMID: 32000723 PMCID: PMC6993428 DOI: 10.1186/s12888-020-2446-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 01/21/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The elderly population is rising globally, especially in China where a large population base causes the largest number of older adults in the world. Notably, Shidu people who are over the age of 60 and have lost their only child have drawn great public attentions as they become more elderly, medically unstable and worse mentally unhealthy. Posttraumatic stress disorder (PTSD) is one of the most common consequences resulted from the loss of the only child. However, few previous studies have examined PTSD in Shidu older aldults, and the risk factors are a relatively understudied area. Our study aims to estimate the prevalence and potential risk factors of PTSD and improve the possibility of early identifying the high-risk Shidu parents with PTSD, and successively provide timely and effective interventions. METHOD Based on the register of population statistic information provided by the health family planning commission, 149 participants were enrolled randomly. Data was collected by interviews and questionnaires. Socio-demographic and bereavement-related information and physical health outcomes were obtained. PTSD Checklist-Civilian Version was used to screen for bereavement-related PTSD. RESULT The morbidity of PTSD reached 30.9%, while in the group of age over 60 the morbidity reached 31.6%. Stratified by potential demographic risk factors, SDPs have significant between-group differences of PTSD. Specially, being women, higher income, losing the single child at older age, more serious medical conditions and being Shidu for a shorter period indicated higher severity of PTSD in SDPs. The single child dying at a older age and from accidence were also significant indicators. Regression analysis showed the gender of SDPs, hospital visits, and the cause of child death significantly predicted the severity of PTSD. CONCLUSION With the accelerate process of aging, especially in China, Shidu older adults become a group deserved more attentions. PTSD is clearly a possible reaction to the loss of the only child. The gender and hospital visits of the Shidu older adults and the causes of their child's death significantly related to the prevalence of PTSD, which could help to improve the possibility of early intervening.
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Affiliation(s)
- Qianlan Yin
- Faculty of Psychology and Mental Health, Navy Medical University, 800 Xiangyin Road, Shanghai, 200433 China
| | - Huaihui Zhang
- 0000 0001 2323 5732grid.39436.3bShanghai Yangpu Mental Health Center, Shanghai University of Medicine & Health Sciences Teaching Hospital, Shanghai, 200093 China
| | - Zhilei Shang
- Faculty of Psychology and Mental Health, Navy Medical University, 800 Xiangyin Road, Shanghai, 200433 China ,Lab for Post-traumatic Stress Disorder , Faculty of Psychology and Mental Health, Navy Medical University, Shanghai, 200433 China
| | - Lili Wu
- Faculty of Psychology and Mental Health, Navy Medical University, 800 Xiangyin Road, Shanghai, 200433 China ,Lab for Post-traumatic Stress Disorder , Faculty of Psychology and Mental Health, Navy Medical University, Shanghai, 200433 China
| | - Zhuoer Sun
- Faculty of Psychology and Mental Health, Navy Medical University, 800 Xiangyin Road, Shanghai, 200433 China ,Lab for Post-traumatic Stress Disorder , Faculty of Psychology and Mental Health, Navy Medical University, Shanghai, 200433 China
| | - Fan Zhang
- Faculty of Psychology and Mental Health, Navy Medical University, 800 Xiangyin Road, Shanghai, 200433 China ,Lab for Post-traumatic Stress Disorder , Faculty of Psychology and Mental Health, Navy Medical University, Shanghai, 200433 China
| | - Yaoguang Zhou
- Faculty of Psychology and Mental Health, Navy Medical University, 800 Xiangyin Road, Shanghai, 200433 China ,Lab for Post-traumatic Stress Disorder , Faculty of Psychology and Mental Health, Navy Medical University, Shanghai, 200433 China
| | - Xiangrui Song
- Faculty of Psychology and Mental Health, Navy Medical University, 800 Xiangyin Road, Shanghai, 200433 China
| | - Weizhi Liu
- Faculty of Psychology and Mental Health, Navy Medical University, 800 Xiangyin Road, Shanghai, 200433, China. .,Lab for Post-traumatic Stress Disorder , Faculty of Psychology and Mental Health, Navy Medical University, Shanghai, 200433, China.
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Blackburn P, Bulsara C. "I am tired of having to prove that my husband was dead." Dealing with practical matters in bereavement and the impact on the bereaved. DEATH STUDIES 2018; 42:627-635. [PMID: 29364779 DOI: 10.1080/07481187.2017.1415392] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This paper reports on experiences of dealing with practical matters after death. Semi structured interviews with bereaved individuals were thematically analyzed. Within the theme of coping, dealing with practical matters was a significant stressor and was found to be extremely challenging, time consuming, and to negatively impact on mental and emotional well-being. This study adds new insights on the challenges experienced by the bereaved when attending to practical matters and may help to inform the design of bereavement support, inform standard operating procedures of businesses, and government bereavement leave legislation.
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Affiliation(s)
- Pippa Blackburn
- a Australian Health Services Research Institute (AHSRI), Palliative Care Outcomes Collaboration (PCOC) , University of Wollongong , Australia
| | - Caroline Bulsara
- a Australian Health Services Research Institute (AHSRI), Palliative Care Outcomes Collaboration (PCOC) , University of Wollongong , Australia
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Trevino KM, Litz B, Papa A, Maciejewski PK, Lichtenthal W, Healy C, Prigerson HG. Bereavement Challenges and Their Relationship to Physical and Psychological Adjustment to Loss. J Palliat Med 2017; 21:479-488. [PMID: 29182478 DOI: 10.1089/jpm.2017.0386] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE The psychosocial challenges confronted by bereaved survivors may contribute to poor bereavement adjustment. Measures of the challenges of bereavement are limited. This study is a preliminary examination of the factor structure of a new measure of bereavement challenges and their relationships to quality of life and mental illness in bereaved cancer caregivers. This measure was designed to identify intervention targets to reduce the likelihood of prolonged grief. METHODS Caregivers of advanced cancer patients were administered measures of bereavement challenges (Bereavement Challenges Scale, BCS), quality of life (Medical Outcomes Study Short Form-36), prolonged grief (PG-13), and mental disorders (Structured Clinical Interview for the DSM-IV). Principal component factor analyses identified the underlying factor structure of the BCS. We examined associations between the factors and caregiver quality of life, prolonged grief, and rates of mental disorders. RESULTS A factor analysis identified five factors: "Challenges with Connecting with Others," "Challenges with Change," "Challenges Imagining a Hopeful Future," "Challenges with Accepting the Loss," and "Challenges with Guilt." Greater endorsement of bereavement challenges was associated with worse quality of life, more severe symptoms of prolonged grief, and greater likelihood of meeting criteria for a mental disorder. CONCLUSIONS Assessing the challenges associated with bereavement is important to understanding barriers to bereaved individuals' adjustment. The five factors of the BCS point to potential targets for clinical intervention. Additional research on the BCS is needed, including validation in larger more diverse samples, and confirmation that reduction of these challenges is associated with less psychiatric morbidity and, specifically, symptoms of prolonged grief.
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Affiliation(s)
- Kelly M Trevino
- 1 Cornell Center for Research on End-of-Life Care , Weill Cornell Medicine, New York, New York.,2 Department of Medicine, Weill Cornell Medicine , New York, New York
| | - Brett Litz
- 3 VA Boston Healthcare System , Jamaica Plain, Massachusetts.,4 Department of Psychiatry, Boston University Medical Center , Bosten, Massachusetts
| | - Anthony Papa
- 5 Department of Psychology, University of Nevada , Reno, Reno, Nevada
| | - Paul K Maciejewski
- 1 Cornell Center for Research on End-of-Life Care , Weill Cornell Medicine, New York, New York.,6 Department of Radiology, Weill Cornell Medicine , New York, New York
| | - Wendy Lichtenthal
- 7 Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center , New York, New York
| | - Charlotte Healy
- 8 Department of Professional Studies, Columbia University , New York, New York
| | - Holly G Prigerson
- 1 Cornell Center for Research on End-of-Life Care , Weill Cornell Medicine, New York, New York.,2 Department of Medicine, Weill Cornell Medicine , New York, New York
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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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Ljungman L, Hovén E, Ljungman G, Cernvall M, von Essen L. Does time heal all wounds? A longitudinal study of the development of posttraumatic stress symptoms in parents of survivors of childhood cancer and bereaved parents. Psychooncology 2015; 24:1792-8. [PMID: 26042579 PMCID: PMC5033007 DOI: 10.1002/pon.3856] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 04/23/2015] [Accepted: 04/30/2015] [Indexed: 11/20/2022]
Abstract
Background A lack of longitudinal studies has hampered the understanding of the development of posttraumatic stress symptoms (PTSS) in parents of children diagnosed with cancer. This study examines level of PTSS and prevalence of posttraumatic stress disorder (PTSD) from shortly after diagnosis up to 5 years after end of treatment or child's death, in mothers and fathers. Methods A design with seven assessments (T1–T7) was used. T1–T3 were administered during treatment and T4–T7 after end of treatment or child's death. Parents (N = 259 at T1; n = 169 at T7) completed the PTSD Checklist Civilian Version. Latent growth curve modeling was used to analyze the development of PTSS. Results A consistent decline in PTSS occurred during the first months after diagnosis; thereafter the decline abated, and from 3 months after end of treatment only minimal decline occurred. Five years after end of treatment, 19% of mothers and 8% of fathers of survivors reported partial PTSD. Among bereaved parents, corresponding figures were 20% for mothers and 35% for fathers, 5 years after the child's death. Conclusions From 3 months after end of treatment the level of PTSS is stable. Mothers and bereaved parents are at particular risk for PTSD. The results are the first to describe the development of PTSS in parents of children diagnosed with cancer, illustrate that end of treatment is a period of vulnerability, and that a subgroup reports PTSD 5 years after end of treatment or child's death. © 2015 The Authors. Psycho‐Oncology published by John Wiley & Sons Ltd.
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Affiliation(s)
- Lisa Ljungman
- Clinical Psychology in Healthcare, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Emma Hovén
- Clinical Psychology in Healthcare, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Gustaf Ljungman
- Pediatric Oncology, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Martin Cernvall
- Clinical Psychology in Healthcare, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Louise von Essen
- Clinical Psychology in Healthcare, Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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