By Evelyne Jhung

When Jessy Mathai, an oncology-hematology social worker, joined the Palliative Care Unit team a few years ago, she would often get referrals for families whose loved ones had just passed away. But because the Palliative Care Unit was one of three areas she was covering, she couldn’t always connect with the family in a timely manner.

“I wanted caregivers to be able to access bereavement support whenever they needed it from any member of the health-care team,” said Mathai.

Mathai and Sheila Deans-Buchan, a nurse practitioner on the Palliative Care Unit, set about creating a bereavement risk screening process in response to the lack of a formal bereavement care program.

“A couple of years ago, we realized we didn’t fully understand what the Bereavement Program, as it was called, really meant,” said Deans-Buchan. “Volunteers were mostly spearheading that type of work – for example, making followup calls and sending condolence letters to friends and family – with little staff involvement.”

Since then, accountability has transferred from the volunteers to staff, and all staff can be involved. Bereavement care doesn’t just fall on the shoulders of a social worker or spiritual care staff member. The screening tool helps staff identify in advance who would want or need followup. It is a set of 15 yes-or-no questions divided into three themes – psychological, social and circumstances of illness or death – that any member of the care team can fill out based on knowledge or observation of the patient’s family or caregiver. The result is more individualized and effective bereavement care.

“A family member or friend who would be considered at high risk and needing followup would be someone who is unaccepting of the illness; is experiencing family conflict; and where the patient is younger and with a new or sudden onset diagnosis,” said Mathai. “This is someone who needs more than a phone call; we would make a referral to a family doctor or psychologist or external bereavement-grief organizations.”

Included in the bereavement care pathway is providing support to caregivers before their loved one dies. For example, the care team holds meetings for every patient where family members are given an update, asked how they’re coping and whether they need help with funeral planning. The team also has daily interactions with family members at the bedside. For children, members of the team provide grief resources and connect with the child’s school, if necessary.

“Families were grieving but because they weren’t under our care, we had no way of providing therapeutic care for them,” said Deans-Buchan. “With our new bereavement risk screening process, any member of the care team can provide families and caregivers with appropriate and individualized support.”

Evelyne Jhung works in communications at St. Michael’s Hospital.