Evaluation of Bereavement Assessment Within Inpatient Palliative Care Consultation

Abstract

It is crucial for palliative care teams to evaluate practices in assessing the risk of developing complicated grief among family members and caregivers of patients. A retrospective chart review of 99 patients seen by an inpatient palliative care team at an academic medical center was conducted to assess for documentation and prevalence of complicated grief risk factors. Factors included patients whose family are their primary caregiver, involvement of young children, mental health or substance use diagnoses in patients or their family members, a history of multiple losses, traumatic or sudden death. 64% of charts did not formally document bereavement assessment while 45% of families exhibited at least one risk factor for prolonged grief. This work suggests the need for increased education for PC providers on grief risk factors as well as the implementation of a formal screening assessment in order to best utilize limited psychosocial support resources to address needs.

Low Rates of Grief and Bereavement Support Pre- and Post-Death for Those Who Died Within 72 hours of Admission to a Quaternary Teaching Hospital

“…In a recent retrospective chart review of 99 inpatients, LaTourette et al described whether risk factors for complicated grief were noted in consult palliative care reviews. 16 They found that only 36% of patients’ notes included some sort of grief assessment, such as a mention of complicated grief or family dynamics. Although not routinely assessed, risk factors for complicated grief were present in 45% of patients’ notes, the most common of which included young children (32%) and circumstances relating to a traumatic death (22%).…”

Effects of different palliative care models on decedents with kidney failure receiving maintenance dialysis: a nationwide population-based retrospective observational study in Taiwan

“…Moreover, the mortality rate is particularly high among patients with kidney failure14 and sudden death often occurs 15. The possibility of sudden death is a risk factor for complicated grief being experienced by caretakers, and therefore palliative care staff are trained to help provide psychosocial support for caretakers who are coping with grief 16 17. Patients with kidney failure often require invasive treatment during the end of life (EOL), including the use of an endotracheal tube (ETT), ventilator support, cardiopulmonary resuscitation (CPR) and even admission to the intensive care unit (ICU) prior to death,18 resulting in poor experiences for patients and their caregivers during the EOL period 19 20.…”

“… 15 The possibility of sudden death is a risk factor for complicated grief being experienced by caretakers, and therefore palliative care staff are trained to help provide psychosocial support for caretakers who are coping with grief. 16 17 Patients with kidney failure often require invasive treatment during the end of life (EOL), including the use of an endotracheal tube (ETT), ventilator support, cardiopulmonary resuscitation (CPR) and even admission to the intensive care unit (ICU) prior to death, 18 resulting in poor experiences for patients and their caregivers during the EOL period. 19 20 Such aggressive treatments, along with admission to the ICU, are associated with higher medical costs, lower psychological health in caregivers and lower self-esteem for patients.…”