Table 2.
Caring for Families After the Patient's Death to Facilitate Postloss Adjustment
| Category | Tool | Rationale/Factors to Consider |
|---|---|---|
| Communication skills | Respond to emotion: Name it: This is so very hard Explore it: Can you tell me more? |
Helps bereaved individuals feel supported and allows them to process information once emotion is acknowledged26 |
| Acknowledge the effect of the pandemic: These are unprecedented times The pandemic took us all by surprise |
Helps to externalize the problem and set realistic expectations about social distancing and other restrictions. Lays the foundation for challenging unhelpful thinking within a CBT model, especially in cases where individuals might feel guilt regarding the circumstances of their loved one's death3,21 | |
| Care processes | Make a bereavement call | Helps bereaved families know the patient and family are remembered, an important component of quality end-of-life care. Ideally, performed in the first week after the patient's death15,17 |
| Send a team sympathy card | Helps bereaved families know the patient and family are remembered, an important component of quality end-of-life care. Consider including a photograph of the Getting to know me poster with the team15,17 | |
| Provide psychoeducational information about grief | Helps bereaved individuals have a roadmap of what they might expect (e.g., grief comes in waves). Include age-appropriate information about supporting grieving children as indicated16,17,21 | |
| Refer for grief counseling | Especially for individuals at high risk for poor bereavement5,17,23 | |
| Outline strategies that help recently bereaved individuals, including adapting rituals | Helps provide structure and support during bereavement. Encourage bereaved individuals to follow a routine, pay attention to their self-care, including checking in with their doctor, and maintain social connections using technology. Suggest they consider holding a virtual celebration of life with family and friends to reminisce, or writing their loved one a letter, telling them what they wish they could have said, especially if they were not able to have a proper goodbye. They can also consider planning a memorial event when able to at a later date15,17,21,25 | |
| Challenge unhelpful thinking without dismissing the emotion | Helps restructure unhelpful thinking. Within the context of a therapeutic relationship and drawing from CBT strategies, the bereaved is gently encouraged to express their thoughts and feelings and identify and challenge those thoughts that are leading to guilt, blame, or anger. A useful question to help shift perspective is What would you say to a friend in the same situation?3,21,25 | |
| Suggest support groups | Helps provide social connections and normalization of grieving process. Support groups require careful screening of participants to assess appropriateness, readiness, and timing for a group, especially given the extraordinary circumstances of the pandemic5,17 | |
| Plan for post-COVID-19 | Provides support/guidance over time. Consider offering to meet bereaved families at a later date to answer questions or holding a team memorial service where families can come together to meet the clinicians who cared for their loved ones17 |
CBT = cognitive behavior therapy; COVID-19 = coronavirus disease 2019.