Bereavement outcomes in family members of those who died in acute care hospitals before and during the first wave of COVID-19: A cohort study.

BACKGROUND: The COVID-19 pandemic has caused millions of deaths worldwide, leading to symptoms of grief among the bereaved. Neither the burden of severe grief nor its predictors are fully known within the context of the pandemic. AIM: To determine the prevalence and predictors of severe grief in family members who were bereaved early in the COVID-19 pandemic. DESIGN: Prospective, matched cohort study. SETTING/PARTICIPANTS: Family members of people who died in an acute hospital in Ottawa, Canada between November 1, 2019 and August 31, 2020. We matched relatives of patients who died of COVID (COVID +ve) with those who died of non-COVID illness either during wave 1 of the pandemic (COVID -ve) or immediately prior to its onset (pre-COVID). We abstracted decedents' medical records, contacted family members >6 months post loss, and assessed grief symptoms using the Inventory of Complicated Grief-revised. RESULTS: We abstracted data for 425 decedents (85 COVID +ve, 170 COVID -ve, and 170 pre-COVID), and 110 of 165 contacted family members (67%) consented to participate. Pre-COVID family members were physically present more in the last 48 h of life; the COVID +ve cohort were more present virtually. Overall, 35 family members (28.9%) had severe grief symptoms, and the prevalence was similar among the cohorts (p = 0.91). Grief severity was not correlated with demographic factors, physical presence in the final 48 h of life, intubation, or relationship with the deceased. CONCLUSION: Severe grief is common among family members bereaved during the COVID-19 pandemic, regardless of the cause or circumstances of death, and even if their loss took place before the onset of the pandemic. This suggests that aspects of the pandemic itself contribute to severe grief, and factors that normally mitigate grief may not be as effective.

Comparative end-of-life communication and support in hospitalised decedents before and during the COVID-19 pandemic: a retrospective regional cohort study in Ottawa, Canada.

OBJECTIVE: To compare end-of-life in-person family presence, patient-family communication and healthcare team-family communication encounters in hospitalised decedents before and during the COVID-19 pandemic. DESIGN: In a regional multicentre retrospective cohort study, electronic health record data were abstracted for a prepandemic group (pre-COVID) and two intrapandemic (March-August 2020, wave 1) groups, one COVID-19 free (COVID-ve) and one with COVID-19 infection (COVID+ve). Pre-COVID and COVID-ve groups were matched 2:1 (age, sex and care service) with the COVID+ve group. SETTING: One quaternary and two tertiary adult, acute care hospitals in Ottawa, Canada. PARTICIPANTS: Decedents (n=425): COVID+ve (n=85), COVID-ve (n=170) and pre-COVID (n=170). MAIN OUTCOME MEASURES: End-of-life (last 48 hours) in-person family presence and virtual (video) patient-family communication, and end-of-life (last 5 days) virtual team-family communication encounter occurrences were examined using logistic regression with ORs and 95% CIs. End-of-life (last 5 days) rates of in-person and telephone team-family communication encounters were examined using mixed-effects negative binomial models with incidence rate ratios (IRRs) and 95% CIs. RESULTS: End-of-life in-person family presence decreased progressively across pre-COVID (90.6%), COVID-ve (79.4%) and COVID+ve (47.1%) groups: adjusted ORs=0.38 (0.2-0.73) and 0.09 (0.04-0.17) for COVID-ve and COVID+ve groups, respectively. COVID-ve and COVID+ve groups had reduced in-person but increased telephone team-family communication encounters: IRRs=0.76 (0.64-0.9) and 0.61 (0.47-0.79) for in-person, and IRRs=2.6 (2.1-3.3) and 4.8 (3.7-6.1) for telephone communications, respectively. Virtual team-family communication encounters occurred in 17/85 (20%) and 10/170 (5.9%) of the COVID+ve and COVID-ve groups, respectively: adjusted OR=3.68 (1.51-8.95). CONCLUSIONS: In hospitalised COVID-19 pandemic wave 1 decedents, in-person family presence and in-person team-family communication encounters decreased at end of life, particularly in the COVID+ve group; virtual modalities were adopted for communication, and telephone use increased in team-family communication encounters. The implications of these communication changes for the patient, family and healthcare team warrant further study.

Do pain management apps use evidence-based psychological components? A systematic review of app content and quality.

Background: With hundreds of pain management apps on the Canadian marketplace, it can be challenging for patients and clinicians to select effective and evidence-based mobile health (mHealth) apps that address pain from a biopsychosocial perspective. Aims: The aim of this study is to identify pain management apps within the Canadian app marketplaces to aid clinicians in recommending apps. Methods: The iOS and Android marketplaces were systematically searched to identify pain management apps that included at least one core component of cognitive behavioral therapy (CBT) or mindfulness- and acceptance-based therapies. Selected apps were assessed using a researcher developed psychological components checklist, and the Mobile App Rating Scale (MARS). These two measures provided a robust assessment of the apps' technical abilities and psychological principles being implemented. Results: Five hundred eight pain management apps were identified, yet only 12 included a psychological component and were available for evaluation. On average, apps contained 8.10 out of 18 psychological components (SD = 2.77) with a MARS quality rating of 4.02 out of 5 (SD = 0.32). The most common psychological components were grounded in CBT, including psychoeducation, sleep hygiene, behavioral activation, coping skills training, and social support. Among the least commonly included components were goal setting, values, and culture/diversity. Two-thirds of the apps involved health care practitioners in their development, but independent scientific review of apps was scarce. Conclusion: The highest scoring apps (Curable, Pathways, Vivify) are highlighted for health care practitioners who may wish to recommend mHealth technologies to their patients for pain management. Future directions for research and app development are discussed.

Contexte: Le fait qu'il existe des centaines d'applications de prise en charge de la douleur sur le marché canadien peut faire en sorte qu'il soit difficile pour les patients et les cliniciens de choisir une application de santé mobile (mHealth) efficace et fondée sur des données probantes, qui aborde la douleur d'un point de vue biopsychosocial.But: Le but de cette étude est de répertorier les applications de prise en charge de la douleur disponibles sur les marchés des applications canadiens afin d'aider les cliniciens à en recommander certaines.Méthodes: Les marchés iOS et Android ont été systématiquement consultés pour répertorier les applications de prise en charge de la douleur qui comprennent au moins une composante de base de la thérapie cognitivo-comportementale (TCC) ou des thérapies fondées sur la pleine conscience et l'acceptation. Les applications sélectionnées ont été évaluées à l'aide d'une liste de vérification des composantes psychologiques élaborée par un chercheur et le Mobile App Rating Scale (MARS). Ces deux mesures ont fourni une évaluation robuste des capacités techniques et des principes psychologiques mis en œuvre.Résultats: Cinq cent huit applications de prise en charge de la douleur ont été répertoriées, mais seulement 12 d'entre elles comprenaient une composante psychologique et étaient disponibles pour l'évaluation. En moyenne, les applications contenaient 8,10 des 18 composantes psychologiques (ÉT = 2,77) et obtenaient un score de qualité MARS de 4,02 sur 5 (ÉT = 0,32. Les composantes psychologiques les plus courantes étaient ancrées dans la TCC, y compris la psychoéducation, l'hygiéne du sommeil, l'activation comportementale, la formation aux compétences d'adaptation et le soutien social. Les composantes les moins souvent incluses étaient l'établissement d'objectifs, les valeurs et la culture/diversité. Deux-tiers des applications avaient impliqué des praticiens de la santé dans leur développement, mais peu d'entre elles avaient été soumises à un examen scientifique indépendant.Conclusion: Les applications ayant obtenu les scores les plus élevés (Curable, Pathways, Vivify) sont mises en évidence à l'intention des praticiens des soins de santé qui peuvent souhaiter recommander des technologies de santé mobile à leurs patients pour la prise en charge de la douleur. Les orientations futures pour la recherche et le développement d'applications sont abordées.