DEPARTMENTS: From the Editor
Hinds, Pamela S. PhD, RN, FAAN
Traditionally in health care, bereavement interventions are anticipated to be provided in the community care setting (ie, the home, the church, or other such location) by home-based care organizations rather than in the acute care oncology setting. Belying this expectation is the confirmed documentation that, in multiple nations,1 the numbers of cancer patients who die at home and thus receive home-based professional care are in the minority (approximately one-fifth to one-third) compared with the numbers of adult and pediatric cancer patients who die in inpatient units, outpatient clinics, or nursing home settings. Further, the number of health care professionals who are formally prepared and available to provide home-based bereavement care for survivors of family members who died a cancer-related death is unknown, but in a recently released report from an organization providing nationwide statistics on bereavement care, one statistic was that only 4% of hospice paid staff are assigned to provide home or community-based bereavement care.2 Thus, the traditional expectation of bereavement care being made widely available by home-based care professionals is not supported by the statistics reported by home-based care organizations. In sum, because the majority of adult and pediatric cancer patients die in acute care settings and only a very small fraction of providers in home care organizations are officially assigned to provide bereavement care, it is likely that the most opportune setting to provide bereavement care for family members is in the acute care setting, where access to the families by health care professionals is highest. It may be that family members would find particular benefit to have bereavement care provided by the health care professionals who have consistently experienced the cancer care trajectory with them.
The potential impact of acute care-based bereavement interventions is not established at this time, but the outcomes of bereavement for family members are documented. Outcomes for bereaved parents include depression, first psychiatric hospitalizations, inability to return to employment, and a statistically higher likelihood of dying younger than parents who have not experienced the loss of a child.3-6 Outcomes for bereaved spouses and other family members related to the loss of an adult family member are similarly concerning.7,8 These outcomes have not been linked to whether the bereaved survivor (at the level of the individual family member or the family as a whole) did or did not receive bereavement care. In addition, if bereavement care had been received, the strength or dose of that care may not have been documented. According to the National Hospice and Palliative Care Organization in America, the most typical bereavement interventions provided by home-based settings include 1 or more telephone calls, a letter, or a visit to 1 to 2 family members.2 This dose of intervention seems important but minimal, given the impact of the loss of a family member. The potential benefit of bereavement care could be realized for the individual family member, the emotional and economic welfare of the family (ie, coping, lost income), to the economy of a country (lost productivity), or to costs of a health care system secondary to hospitalizations of affected family members.
In these days of health care economic duress, it is almost unthinkable for a health care setting to take on an additional domain of care responsibility or intervention with unproven benefits until concrete, empirically based findings convincingly support the merit of such an adoption for the family, the setting, and the health care system as a whole. To persuade entire health care settings and systems to take on a new domain of care and intervention such as bereavement care, the costs, the methods, and the outcomes of doing so must be documented. We as oncology nurses and nurse researchers are well placed to grasp and document the emotional and economic importance of acute care-based bereavement care. We need to begin this movement and to measure its feasibility, acceptability, and its outcomes.
My very best to you.
Pamela S. Hinds, PhD, RN, FAAN
1. Gomes B, Higginson IJ. Factors influencing death at home in terminally ill patients with cancer: systematic review. BMJ. 2006;332:515-521.
3. Lannen PK, Wolfe J, Prigerson HG, Onelov E, Kreicbergs UC. Unresolved grief in a national sample of bereaved parents: impaired mental and physical health 4 to 9 years later. J Clin Oncol. 2008;26(36):5870-5876.
4. Li J, Precht DH, Mortensen PB, Olsen J. Mortality in parents after death of a child in Denmark: a nationwide follow-up study. Lancet. 2003;361:363-367.
5. Li J, Laursen TM, Precht DH, Olsen J, Mortensen PB. Hospitalization for mental illness among parents after the death of a child. NEJM. 2005;352:1190-1196.
6. Kreichbergs U, Valdimarsdottir U, Onelov E, Henter JI, Steinbeck G. Anxiety and depression in parents 4-9 years after the loss of a child owing to a malignancy: a population-based follow-up. Psychol Med. 2004;34(8):1431-441.
7. Elklit A, Reinholt N, Nielsen LH, Blum A, Lasgaard M. Posttraumatic stress disorder among bereaved relatives of cancer patients. J Psychosoc Oncol. 2010;28(4):399-412.
8. Koop PM, Strang VR. The bereavement experience following home-based family caregiving for persons with advanced cancer. Clin Nurs Res. 2003;12(2):127-144.
© 2011 Lippincott Williams & Wilkins, Inc.