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      Grief During the COVID-19 Pandemic: Considerations for Palliative Care Providers

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          Abstract

          The COVID-19 pandemic is anticipated to continue spreading widely across the globe throughout 2020. To mitigate the devastating impact of COVID-19, social distancing and visitor restrictions in healthcare facilities have been widely implemented. Such policies and practices, along with the direct impact of the spread of COVID-19, complicate issues of grief that are relevant to medical providers. We describe the relationship of the COVID-19 pandemic to anticipatory grief, disenfranchised grief, and complicated grief for individuals, families, and their providers. Further, we provide discussion regarding countering this grief through communication, advance care planning, and self-care practices. We provide resources for healthcare providers, in addition to calling on palliative care providers to consider their own role as a resource to other specialties during this public health emergency.

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          Place of death: correlations with quality of life of patients with cancer and predictors of bereaved caregivers' mental health.

          Alexi A Wright, Nancy L. Keating, Tracy A Balboni … (2010)
          To determine whether the place of death for patients with cancer is associated with patients' quality of life (QoL) at the end of life (EOL) and psychiatric disorders in bereaved caregivers. Prospective, longitudinal, multisite study of patients with advanced cancer and their caregivers (n = 342 dyads). Patients were followed from enrollment to death, a median of 4.5 months later. Patients' QoL at the EOL was assessed by caregiver report within 2 weeks of death. Bereaved caregivers' mental health was assessed at baseline and 6 months after loss with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, and the Prolonged Grief Disorder interview. In adjusted analyses, patients with cancer who died in an intensive care unit (ICU) or hospital experienced more physical and emotional distress and worse QoL at the EOL (all P ≤ .03), compared with patients who died at home with hospice. ICU deaths were associated with a heightened risk for posttraumatic stress disorder, compared with home hospice deaths (21.1% [four of 19] v 4.4% [six of 137]; adjusted odds ratio [AOR], 5.00; 95% CI, 1.26 to 19.91; P = .02), after adjustment for caregivers' preexisting psychiatric illnesses. Similarly, hospital deaths were associated with a heightened risk for prolonged grief disorder (21.6% [eight of 37] v 5.2% [four of 77], AOR, 8.83; 95% CI, 1.51 to 51.77; P = .02), compared with home hospice deaths. Patients with cancer who die in a hospital or ICU have worse QoL compared with those who die at home, and their bereaved caregivers are at increased risk for developing psychiatric illness. Interventions aimed at decreasing terminal hospitalizations or increasing hospice utilization may enhance patients' QoL at the EOL and minimize bereavement-related distress.
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            The Importance of Addressing Advance Care Planning and Decisions About Do-Not-Resuscitate Orders During Novel Coronavirus 2019 (COVID-19)

            J Randall Curtis, Erin K Kross, Renee D Stapleton (2020)
            Article 0 comments Cited 162 times – based on 0 reviews     Review now
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              Palliative Care Professionals' Inner Life: Exploring the Relationships Among Awareness, Self-Care, and Compassion Satisfaction and Fatigue, Burnout, and Coping With Death

              Noemí Sansó, Laura Galiana, Amparo Oliver … (2015)
              Professionals working in the landscape of death and dying frequently are exposed to existential issues, psychological challenges, and emotional distress associated with care at the end of life. Identifying factors that help professionals cope with frequent exposure to issues related to mortality could enhance palliative care providers' and patients' quality of life.
              Article 0 comments Cited 79 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Cara L. Wallace
                Journal
                Journal ID (nlm-ta): J Pain Symptom Manage
                Journal ID (iso-abbrev): J Pain Symptom Manage
                Title: Journal of Pain and Symptom Management
                Publisher: Published by Elsevier Inc. on behalf of American Academy of Hospice and Palliative Medicine
                ISSN (Print): 0885-3924
                ISSN (Electronic): 1873-6513
                Publication date PMC-release: 13 April 2020
                Publication date (Electronic): 13 April 2020
                Affiliations
                [1 ]Saint Louis University, School of Social Work
                [2 ]Eastern Michigan University, School of Social Work
                [3 ]University of Kentucky, College of Social Work
                [4 ]Washington University, Department of Medicine, Division of Palliative Medicine
                Author notes
                [∗ ]Corresponding Author: Cara L. Wallace, PhD, LMSW, APHSW-C, Assistant Professor, 3550 Lindell Blvd, Office 304, St. Louis, MO 63103, School of Social Work, College for Public Health & Social Justice, Saint Louis University, 314-977-2746 cara.wallace@ 123456slu.edu
                Article
                Publisher ID: S0885-3924(20)30207-4
                DOI: 10.1016/j.jpainsymman.2020.04.012
                PMC ID: 7153515
                PubMed ID: 32298748
                SO-VID: add661f0-f51e-44d4-8c62-46f19d7c276a
                Copyright © © 2020 Published by Elsevier Inc. on behalf of American Academy of Hospice and Palliative Medicine.
                License:

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                Date received : 29 March 2020
                Date revision received : 7 April 2020
                Date accepted : 8 April 2020
                Categories
                Subject: Article

                Keywords: grief,covid-19,end of life,loss,communication,self-care,advance care planning
                Data availability:
                Keywords: grief, covid-19, end of life, loss, communication, self-care, advance care planning

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