Reflections on a journey, doing unfinished business, and homage to Balfour Mount

As a medical student at McGill in 1972, I was honored to meet Dr. Balfour Mount. He made it possible for me to accompany him to St. Christopher’s Hospice. We were 8 students from all over the world. Dr. Cicely Saunders felt the best way to learn to be with dying patients was to work as a nurse. So, in that summer of my third year of medical school, I did. My career has gone on, first at Mc Gill and since 1987 at UC San Diego. I have been privileged to teach generations of students and faculty a humanistic empowering model of healthcare, seeing the patient as teacher. Our role is to create environments where people take charge of their lives and achieve wellbeing. My first teacher in doing unfinished business was my father. I was 17. He was 72. He had a MI, called me and my mother into the CCU and said, “The last 25 years with you and Ellen have been the best years of my life. If I should die, I want to say thank you and goodbye.” Then he lived for 20 years and we got to know each other. Present at these moments in people’s lives, we can facilitate unfinished business, whether a mother with cancer, who wrote letters for the next 20 years of her daughter’s life, knowing she wouldn’t be there, a Somali family saying goodbye in the ICU to a loved one or my Dad, opening doors to the future.

use of digital tablets eases the way to compassionate care during the COVID-19 pandemic

Objective: A patient communication program was implemented as a response to hospitals visiting restrictive policies during the COVID-19 pandemic. The aim of the program was to facilitate communication between patients and families, mainly through the use of digital tablets; thus program performance was evaluated by selecting the number of calls performed, the average call time, and the percentage of patients that used the program more than once. Methods: A communication service for hospitalized patients who did not have access to a personal electronic device or were unable to use their electronic device was launched at different MUHC hospitals. A dedicated team of re-deployed employees was available to help patients connect with their loved ones using a hospital tablet or telephone. Results: A total of 806 calls were performed between April and November 2020. Eighty one percent of the calls were performed during the non-visitors policy implementation, being video calls preferred over phone calls. The average call time was 15 min, 34% of the patients had a video call with their loved one more than once and 40% of the calls were performed in the intensive care unit. Conclusion: The patient communication program can be described as a new delivery model of compassionate care. It was effective, helped reduce patients’ isolation and met the needs of family members and caregivers during the hospital non-visitors policy directed by the Ministère de la Santé et des Services Sociaux de Québec during the Covid-19 pandemic.

Bereavement Adaptation as Deflection Reduction: Bereaved Caregivers Define the Event of Dying

Affect control theory (ACT) has the potential to extend dominant understandings of adaptation to bereavement. Using narratives from bereaved caregivers, we assessed attributions they made about the death of a loved one from cancer. We transformed these attributions into actor-behavior-object events along the evaluation, potency, and activity dimensions of ACT. After creating hypothetical baseline deflections for events, we simulated the attributions as events in INTERACT. We found eight emergent categories of resolutions that caregivers used to make sense of the death: caregivers redefined the event to align with their sentiments about the deceased or the death. We also found racial differences in the attributions. White caregivers were more likely to blame themselves or others for the death of their loved one, while black caregivers were more willing to admit their deceased loved one’s faults. These findings demonstrate how caregivers make sense of their grief in a framework of cultural sentiments and underscore the utility of affect control theory in qualitative and theory-generating research.

Bereavement among Adolescents with Intellectual Disability: A Qualitative Study

The current study was conducted to explore the bereavement (experienced loss of a loved one through death within time frame of 0–3 years span). Seven adolescents (10–19 years old) with intellectual disability were included in the study. Semi-structured interviews were conducted through interview guide which was prepared with the help of Piaget’s theory of cognitive development concept related to death. Data was analyzed with content analysis and six major themes were derived, that is, meaning of death, death rituals, religious concepts related to death, reasons of death, grieving perception, and coping with grief. Mostly, concepts were explained under the light of religious preaching and their introjection in the lives of adolescents with intellectual disability. Current study helped in exploration of experiential phenomenon of loss in adolescents with intellectual disability.

Bereavement Experiences of Families in the Cardiac Intensive Care Unit

Background Losing a loved one in the intensive care unit is associated with complicated grief and increased psychologic distress for families. Providing bereavement support may help families during this time. However, little is known about the bereavement experiences of families of patients in the cardiac intensive care unit. Objective To describe the bereavement experiences of families of patients in the cardiac intensive care unit. Methods In this secondary analysis, an exploratory, descriptive design was used to understand the families’ bereavement experiences. Families from 1 cardiac intensive care unit in a tertiary medical center in the western United States participated. Audiotaped telephone interviews were conducted by using a semistructured interview guide 13 to 15 months after the patient’s death. A qualitative, descriptive technique was used for data analysis. Two independent researchers coded the interview transcripts and identified themes. Results Twelve family members were interviewed. The majority were female (n = 8, 67%), spouses (n = 10, 83%), and White (n = 10, 83%); the mean age (SD) was 58.4 (16.7) years. Five main themes emerged: (1) families’ bereavement work included both practical tasks and emotional processing; (2) families’ bereavement experiences were individual; (3) these families were resilient and found their own resources and coping mechanisms; (4) the suddenness of a patient’s death influenced families’ bereavement experiences; and (5) families’ experiences in the intensive care unit affected their bereavement. Conclusions This study provided insight into the bereavement experiences of families of patients in the cardiac intensive care unit. These findings may be useful for professionals working with bereaved families and for cardiac intensive care units considering adding bereavement support.

Uses of Facebook and grief: emotional expression and seeking support in social media

This article discusses the use of Facebook in relation to grief by women who have lost a loved one. Qualitative research was carried out using a phenomenological-hermeneutic method, in which 29 bereaved women were interviewed. The results indicate that Facebook is a platform for emotional expression and for seeking support. This research contributes to the understanding of communicative practices in digital media, which blur the boundaries between what is private and public during moments of crisis.

Prevalence of grief disorders in bereaved families of cancer patients: A meta-analysis

Background: Cancer caregiving is a distressing experience and loss of a loved one can lead to intense grief and other adverse effects. However, the prevalence of grief disorders among families associated with cancer-related deaths remains unknown. Aim: This study aimed to determine the prevalence of grief disorders among families of patients with cancer to better inform clinicians, researchers, and policymakers. Design: Meta-analysis, PROSPERO number CRD42020209392. Data sources: The databases of CINAHL, Embase, MEDLINE, PubMed, Scopus, PsycINFO, and Web of Science were comprehensively searched with no language restrictions. The quality of included studies was assessed with Hoy’s criteria. Results: Among the 3046 records screened, 19 studies were eligible for meta-analysis, with a total of 14,971 participants. The pooled prevalence rate of grief disorders was estimated at 14.2% (95% CI, 11.7%–16.7%), ranging from 7% to 39%. The prevalence was higher in females (10%; 95% CI, 8.2%–12.1%), those who are religious (9.55%; 95% CI, 8.97%–10.16%), spouses of the deceased (7.78%; 95% CI, 6.08%–9.69%), and families of patients with neurological cancers (6.4%; 95% CI, 0.10%–19.9%). Educational levels, study locations, diagnosis tools, time post-after loss, and study methods seemed not to affect the prevalence of grief disorders in families of patients with cancer. Conclusions: As the prevalence of grief disorders in cancer-related bereavement is substantial, therefore, support including palliative care is important to reduce the burden of caregiving. In addition, future studies are needed to identify and explore effective strategies that can help reduce the burden caused by grief disorders after the death of the patient.