Bereavement risk screening: A pathway to psychosocial oncology care.

OBJECTIVE: This qualitative study sought to obtain feedback from stakeholder cancer caregivers and bereaved family members on the implementation of bereavement risk screening in oncology. METHODS: Semi-structured interviews were conducted with 38 family members of patients with advanced cancer (n = 12) and bereaved family members (n = 26) on when and how to effectively implement bereavement risk screening. Data were analyzed using thematic analysis. RESULTS: Many participants indicated that they would be open to completing a self-report screening measure before and after the patient's death. Several suggested screening at multiple timepoints and the importance of follow-up. Participants viewed screening as an opportunity to connect to psychosocial support. CONCLUSIONS: The findings suggest that family members appear supportive of sensitively approached bereavement risk screening before and after a patient's death as an important component of quality psychosocial care. To optimize implementation, bereavement risk screening would involve screening at multiple timepoints and include follow-up. Findings suggest standardized risk screening using a brief, validated self-report tool would be a pragmatic approach to increasing access to bereavement care.

Examining the role of trauma, personality, and meaning in young prolonged grievers.

PURPOSE: Younger spouses or partners have been understudied in the prolonged grief literature. The purpose of this study was to determine rates of prolonged grief in young spouses or partners and the associations between prolonged grief and personality styles (specifically, narcissistic, histrionic, and obsessive), trauma history, and the perceived meaning of the loss in the young conjugally bereaved. PARTICIPANTS AND METHOD: Participants between 20 and 50 years old who lost a spouse/partner to cancer 6 months-3 years prior to the study completed the following measures during one time point (via phone or in person interviews): Prolonged Grief-13, traumatic life events questionnaire, Millon clinical multiaxial inventory-III, and grief meaning reconstruction inventory. RESULTS: Fifty-six spouses and partners (51.8% women) completed the interviews (mean age: 44.54 ± 4.20 years). The participants (49.1%) reported elevated rates of prolonged grief and 12.3% of the participants were diagnosed with prolonged grief with the recently published diagnostic algorithm. Bivariate analyses demonstrated an association between prolonged grief and negative meaning of the loss (r = 0.73; p < 0.01) and the frequency of the traumatic events (r = 0.23; p < 0.05). Multivariate analyses revealed that negative meaning of the loss was the only significant predictor of prolonged grief (Beta = 0.71; p = 0.0001). CONCLUSION: Elevated levels of prolonged grief were found in this population, suggesting a need for further research into young spousal grief. Young bereaved spouses may lack flexibility in reconstructing their view of the world as the death may invalidate their previously held world beliefs.

The organization of thanatology.

This article explores, using Wilensky's Model of Professionalization, the emergence of professional organizations within the thanatology. The authors review the history of four organizations--The Foundation of Thanatology, Ars Moriendi, The Forum for Death Education and Counseling (now the Association for Death Education and Counseling: A Thanatology Organization [ADEC]), and The International Work Group on Death, Dying, and Bereavement (IWG). The authors speculate on some of the reasons that the first two failed while IWG and ADEC remain viable-while noting challenges that these remaining thanatological organizations will experience as they seek to continue to stay relevant.

Factors of complicated grief pre-death in caregivers of cancer patients.

PURPOSE: Over the past decade, Prigerson and her colleagues have shown that symptoms of 'complicated grief'-intense yearning, difficulty accepting the death, excessive bitterness, numbness, emptiness, and feeling uneasy moving on and that the future is bleak-are distinct from depression and anxiety and are independently associated with substantial morbidity. Little is known about complicated grief experienced by family caregivers prior to the death. This study sought to examine differences in caregiver age groups and potential risk factors for complicated grief pre-death. METHOD: Two hundred and forty eight caregivers from multiple sites nationwide (20-86 years of age) identified themselves as primary caregivers to a terminally ill cancer patient. Each caregiver was interviewed using the following measures: the Pre-Death Inventory of Complicated Grief-Caregiver Version; the Brief Interpersonal Support Evaluation List; the Structured Clinical Interview for the DSM-IV Axis I; the Life Orientation Test-Revised; the SEPRATE Measure of Stressful Life Events; the Covinsky Family Impact Survey; and mental health access questions. RESULTS: The study found that those under 60 years old had higher levels of complicated grief pre-death than caregivers 60 and older (t(246) = 2.30, p < 0.05). Significant correlations were also found between levels of complicated grief pre-loss and the following psychosocial factors: perceived social support (r = -0.415, p < 0.001); history of depression (r = -0.169, p < 0.05); current depression (r = -0.158, p < 0.05); current annual income (Spearman rho = -0.210, p < 0.01); annual income at time of patient's diagnosis (Spearman rho = -0.155, p = 0.05); pessimistic thinking (r = 0.320, p < 0.001); and number of moderate to severe stressful life events (Spearman rho = 0.218, p = 0.001). In a multi-variate analysis (R(2) = 0.368), pessimistic thinking (Beta = 0.208, p < 0.05) and severity of stressful life events (Beta = 0.222, p < 0.05) remained as important factors to developing complicated grief pre-death. CONCLUSIONS: These results suggest that mental health professionals who work with caregivers should pay particular attention to pessimistic thinking and stressful life events, beyond the stress of the loved one's illness, that caretakers experience. Additionally, although not reaching significance, mental health professionals should also consider younger caregivers at greater risk for complicated grief pre-loss.

Bereavement summer camp for children and teens: a reflection of nine years.

The need to facilitate healthy bereavement, resulting from both deaths from life-threatening illnesses as well as violent, sudden deaths, is great. For the past 9 summers, Bereavement Services at Calvary Hospital, Bronx, New York, has sponsored a week-long day camp for bereaved children and adolescents. Each year the program expands by adding new activities to meet the needs of grieving children in therapeutic ways congruent with current research and timely clinical interventions. This article reflects on our experience, which has evolved and become stronger over the past 9 years. It is believed that this program is replicable and can be initiated and developed by other hospitals and organizations interested in developing similar programs.