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Identifying bereavement risk, is it as simple as it sounds?


Identifying bereavement risk, is it as simple as it sounds? Liz Taylor Kate Diggory Audrey Jones Aims of this Workshop To explore the role of risk assessment in ... – PowerPoint PPT presentation

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Title: Identifying bereavement risk, is it as simple as it sounds?

Identifying bereavement risk, is it as simple as
it sounds?
  • Liz Taylor
  • Kate Diggory
  • Audrey Jones

Aims of this Workshop
  • To explore the role of risk assessment in
    providing an equitable bereavement service
  • To identify the challenges of introducing the
    risk assessment in several settings
  • To introduce and use the risk assessment in

  • Fragmented/inequitable service across Western
    Cheshire Health Economy
  • Policy shaped by NICE guidelines (2004) and End
    of Life Care strategy (2008)
  • To ensure that carers are appropriately
    supported both during a patients life and after
  • Recognising the need for resilience

Spiritual care services
Support for carers and families
Information for patients and carers
Conceptual Model to demonstrate the hierarchy of
needs in bereavement support
Overall Objective of Project
  • To pilot and develop a service model which could
    then be cascaded throughout Western Cheshire
    Health Economy and Merseyside and Cheshire Cancer

What are risk factors?
  • Risk factors are characteristics of bereaved
    individuals or features of their situation that
    increase vulnerability to the loss experience or
    slow down adjustment to bereavement.

What do we already know?
Situational factors
  • Circumstances of the death
  • -sudden
  • -untimely
  • -difficult/traumatic/violent
  • Concurrent life events
  • -multiple losses or bereavements
  • -socio-economic/financial distress

Individual factors
  • Relationship to the deceased
  • child. parent, partner
  • Pre-existing health problems
  • -physical
  • -mental, eg. history of depression
  • Personality
  • -interdependent relationships
  • -highly ambivalent relationships

Environmental factors the social and cultural
context of loss
  • -loss of main source of social support
  • -geographically isolated from family and friends
  • -lack of immediate family support
  • -family conflict
  • -cultural issues
  • -family culture of dealing with loss
  • -coping strategies
  • -disenfranchised grief

Challenges of introducing risk assessment
Assumptions and expectations
  • MCCN bereavement guidelines were developed based
    on widely accepted forms of good practice
  • The majority of bereavement work has developed in
    specialist palliative care settings
  • This builds on a background and expectation of
  • holistic assessment of patient and family
  • enhanced communication skills
  • awareness of issues of loss and grief and a
    willingness to engage with these
  • Typically deaths are due to progressive disease
    where families are grieving an anticipated death

However in a generalist setting
  • Deaths may be sudden and unexpected
  • Health care professionals may have met or engaged
    with the family briefly, if it all.
  • Patients die in the midst of busy wards with a
    pressure on bed occupancy
  • There may be no involvement of specialist
    palliative care

Challenges of educating front line staff
  • Purpose of training
  • To explore positive ways of talking with family
    members post death
  • To demonstrate giving a bereavement booklet and
    local resources
  • To raise awareness of bereavement risk factors
    and how to refer to the project
  • A 1 hour training session was developed for all
  • A 3 hour session for 1 or 2 staff from each area
  • It has been difficult for the general HCP to
    release many staff to attend even 1 hour
  • Currently providing ad hoc 15-20 minute sessions
    to provide all qualified staff with a brief
    overview of project, common risk factors, giving
    the booklet and how to refer

Meeting the project aims(To identify and
support people who may find adjustment after
bereavement difficult regardless of place or
cause of death)
  • An initial audit identified
  • a lack of awareness of bereavement risk factors
    local services
  • HCP found talking with relatives after death
  • Training was provided regarding bereavement risk
    factors to help staff identify possible
    candidates for the service
  • The HCP refers a relative to the project team and
    telephone contact is made 2-3 weeks post death to
    introduce the service and address any immediate
  • A second contact at 3 - 4 months post death aims
    to refer on as appropriate practical help,
    support or counselling
  • If people with long standing bereavement needs
    are identified during the period of the project
    they too can access the counselling or support

  • Challenging
  • Realistic Expectation of who can do risk
  • Does it work? Watch this space

  • Department of Health (2008) End of Life Care
  • Department of Health (2009) Core competencies for
    end of life care
  • Department of Health (2001) Survey on Bereavement
  • Department of Health (2001) The Report of the
    Public Inquiry into Childrens Heart Surgery at
    the Bristol Royal Infirmary 1984-1995 Learning
    from Bristol
  • Department of Health (2004) Manual Cancer
    Services Standards Quality Measures
  • Department of Health (June 2005) When a patient
    dies Advice on developing Bereavement Services
    in the NHS
  • Department of Health (2005) Chief Medical
    Officer. CMO Update Issue 41
  • Department of Health (2007) Cancer Reform
  • Department of Health (2001) The Royal Liverpool
    Childrens Inquiry Report
  • Machin L. and Archer N. (2008) Guidance for
    bereavement needs assessment in palliative
  • Machin, L. (2001) Exploring a framework for
    understanding the range of response to loss a
    study of clients receiving bereavement
    counselling. Unpublished PhD thesis Keele
    University, UK.
  • Murray- Parkes C. Coping with loss Bereavement in
    adult life BMJ. 1998 March 14 316(7134)
  • Murray- Parkes C. Bereavement Oxford Textbook on
    Palliative Medicine (2001)
  • National Bereavement Consortium (2001)
    Bereavement Care Standards.UK Project.
  • National Institute for Clinical Excellence (2004)
    Guidance on Cancer Services Improving Supportive
    and Palliative Care for Adults with Cancer.
  • NHS North West (2008)The Cancer Plan for the
    North West of England to 2012
  • Walshe C. Whom to help? An exploration of the
    assessment of grief. International Journal of
    Palliative Nursing 19973(3)132-137.