Table 1.
Tools for Caring for Families Before the Patient's Death to Facilitate Postloss Adjustment
| Category | Tool | Rationale/Factors to Consider |
|---|---|---|
| Communication skills | Acknowledge the effect of the pandemic: These are unprecedented times | Helps to externalize the problem, set realistic expectations within a CBT model, especially about social distancing and hospital visitor policies3 |
| Facilitate conversations with the patient and family or with provider, patient, and family | Use virtual platforms as needed and include children as appropriate9,17 | |
| Care processes | Assign a clinician or other team member to check in with the family regularly | Provides guidance and reassurance and helps to lessen feelings of anxiety15,22 |
| Screen family members for distress and risk factors for poor bereavement outcomes, provide support | Helps mitigate a difficult bereavement reaction, especially important during the pandemic17,23 | |
| Provide family members with up-to-date information, especially in the end-of-life period | Helps to align expectations with reality and prepare for their loved one's death15,17 | |
| If the family is not present at the time of death, have the physician call immediately to inform them, answer questions, and offer condolences | Initial bereavement outreach considered an essential component of quality end-of-life care, especially important during the pandemic17,24 | |
| Tools to promote connection | Look in the chart for hints about the patient before falling ill (occupation, family, and hobbies) and refer to them in conversations with the family | Promotes connection and personalizes care17 |
| For ICU patients, ask families for photos so teams can see who they were before becoming ill | Promotes connection and personalizes care17 | |
| Ask families if the patient has a favorite type of music and play it in their hospital room | Helps the family feel involved in their loved one's care17 | |
| Place a Getting to know you poster on the patient's door, created by a staff member with a family member over the telephone | Promotes connection and personalizes care, especially because families do not want to think their loved one was just another number15 | |
| Take a team photo alongside the Getting to know you poster to send to the family | Promotes connection and personalizes care and can be an important memento during bereavement within the continuing bonds framework3,17 | |
| Take a photo of the patient speaking to a family member if they are unable to visit | Helps the family member feel connected and can be an important memento during bereavement within the continuing bonds framework3 | |
| Suggest families make an audio recording that can be played by staff for the patient, telling them the things they would tell them in person | Helps alleviate guilt or regret in bereavement, especially if they were not able to be present at the time of death17,21 | |
| Depending on infection status, consider tracing handprints or making hand molds of the patient | Legacy-making activity that helps families, including children, maintain a connection with their loved one after their death17,21,25 | |
| Obtain a cardiac tracing from the patient's last days to send to the family | Legacy-making activity that helps families, including children, maintain a connection with their loved one after their death17,21,25 |
CBT = cognitive behavior therapy; ICU = intensive care unit.