Hospice Bereavement Service Delivery to Family Members and Friends With Bereavement-Related Mental Health Symptoms

Abstract

Objectives: A sizable minority of those who lose a loved one in hospice will experience symptoms of bereavement-related mental health disorders. Though hospices offer services to bereaved informal caregivers (family members or friends) of patients, little is known about services offered or interest in them. Therefore, we sought to assess services offered by hospice staff and interest expressed by bereaved informal caregivers with symptoms of depression, anxiety, or complicated grief (CG). Methods: De-identified electronic bereavement care charts of 3561 informal caregivers who lost someone in a large urban metropolitan hospice from October 1,2015, to June 30, 2016, were reviewed. Results: Of bereaved informal caregivers in the sample, 9.4% (n = 333) were positive for symptoms of depression, anxiety, or CG. The symptom-positive family members/friends were more likely than other family members/friends to be offered mailings, one-to-one counseling, telephone calls, and reference material. However, interest in most services by symptom-positive caregivers was low, with only 6% interested in one-to-one counseling and 7% interested in outside referral. Discussion: The findings suggest that hospices offer a range of services to family members or friends with symptoms of anxiety, depression, and CG, but that there can be a gap between what is offered and in the interest levels of the bereaved. Engagement with symptomatic family members and friends could be enhanced in future work.

“I Feel All Alone Out Here”

“…It was noted that the caregiver with the most observed emotional distress also recorded the most diaries. This finding is supported by research that suggests that individuals who are having greater difficulty with coping seek help more often than those who are less affected 29,30 . It is possible that, although it was not intended as an intervention, the automated audio diary may have provided HFCs an outlet to express their emotions in a time where other social support systems were unavailable.…”

“…This finding is supported by research that suggests that individuals who are having greater difficulty with coping seek help more often than those who are less affected. 29 , 30 It is possible that, although it was not intended as an intervention, the automated audio diary may have provided HFCs an outlet to express their emotions in a time where other social support systems were unavailable. Although hospices typically send out condolence cards or letters, follow-up calls, and educational materials to support caregivers up to a year after the death of a hospice patient as part of bereavement services, 30 future considerations for supporting caregivers may include activities that encourage constructive processing of negative feelings outside formal services, such as audio diaries or reflective journaling.…”

“…In-person connections and face-to-face interactions can be critical for many experiencing loss, particularly for those who rely on these programs and support systems to process their grief. Although HFCs in the participating hospices were able to access telehealth services soon after services were disrupted, it is important to note that the quality of bereavement services is inconsistent across hospices, 34 and services such as screening family members for depression after the patients' death and providing one-on-one or group counseling services are often only offered to those who are seen as at a greater risk for poorer mental health 30 . Thus, an area of exploration could be the concept of universal precautions of conducting depression screenings and offering counseling after bereavement.…”

Gynecologic Oncologic Surgery for the Palliation of Life-Limiting Cancer Crises—The Importance of Education and Training in Palliative Care for the Gynecologic Oncologist

“…Grief and bereavement are significant experiences for family caretakers who have been involved in the hospice and palliative care of a departed family member [19]. Hospice care must also offer support services to family members and friends who have mental health symptoms related to grief [20].…”