Hospice Services for Complicated Grief and Depression: Results from a National Survey

Abstract

OBJECTIVES To describe the prevalence of screening for complicated grief (CG) and depression in hospice and access to bereavement therapy and to examine whether screening and access to therapy varied according to hospice organizational characteristics or staff training and involvement. DESIGN Cross-sectional national survey conducted from 2008 to 2009. SETTING United States. PARTICIPANTS Hospices (N = 591). MEASUREMENTS Whether hospices screened for depression or CG at the time of death or provided access to bereavement therapy (individual or group). Organizational characteristics included region, chain status, ownership, and patient volume. Staffing-related variables included training length and meeting attendance requirements. RESULTS Fifty-five percent of hospices provided screening for CG and depression and access to bereavement therapy, 13% provided screening but not access to bereavement therapy, 24% provided access to bereavement therapy but not screening, and 8% neither screened nor provided access to bereavement therapy. Hospices with 100 patients per day or more were significantly more likely to provide screening and access to bereavement therapy. CONCLUSION Hospices appear to have high capacity to provide screening for CG and depression and to deliver group and individual therapy, but data are needed on whether screeners are evidence based and whether therapy addresses CG or depression specifically. Future work could build upon existing infrastructure to ensure use of well-validated screeners and evidence-based therapies.

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

“…These findings are consistent with previous hospicebased studies, which found that about one-third of all bereaved family members or friends utilize hospice bereavement services 24,33 and that less than half of those with symptoms of CG or depression do so. 17,24 These findings are also consistent with broader trends in mental health care, which indicate that the majority of Americans with any type of mental health symptoms do not utilize support from mental health professionals. 34,35 Although reasons for low interest in bereavement services remain unknown and could not be explored in the current analyses, some factors that have been identified in previous research include not thinking participation would be helpful, and not wanting to seek support outside family members or friends.…”

“…National survey data indicate that 92% of hospices screen family members/friends for depression or CG at some point after the hospice patient is admitted and 69% screen at the time of the patient’s death, and that 79% provide group or individual therapy. 17…”

“…National survey data indicate that 92% of hospices screen family members/friends for depression or CG at some point after the hospice patient is admitted and 69% screen at the time of the patient's death, and that 79% provide group or individual therapy. 17 Yet though there are some data on services offered to family members/friends with depression, anxiety, or CG symptoms, more research on how many people in this subgroup are offered services, what types of services are offered, and which services are used is needed. Medicare does not specify which services should be provided by hospice.…”

Informal Caregivers’ Perceptions of Needs From Hospice Providers: An Integrative Review

“…While little research has been done regarding this transition, ICs in this review suggested initiating bereavement visits performed by members of their current interdisciplinary team. As bereavement services are only used by a fraction of ICs, 67 encouraging the IC's team of hospice providers to aid in the transition to bereavement services after the death of the patient could improve the delivery of this important aspect of care.…”

“We Take Care of People; What Happens to Us Afterwards?”: Home Health Aides and Bereavement Care in Hospice

“…CG and depression are both associated with a number of negative outcomes, including hypertension, sleep impairment, and suicidal ideation (Stroebe, Schut, & Stroebe, 2007). Data from a recent national survey found that 92% of U.S. hospice provide screening for depression, 97% provide screening for CG, and 79% provide either group or individual psychotherapy (Ghesquiere et al., 2015), but little data exist on the details of hospice practices in this arena.…”