Primary Care for the Elderly Bereaved: Recommendations for Medical Education

Overview

Journal J Clin Psychol Med Settings

Publisher Springer

Specialty Psychology

Date 2018 Mar 4

PMID 29500657

Citations 4

Authors

Sue Morris

Kristen Schaefer

Erlene Rosowsky

Affiliations

Soon will be listed here.

Abstract

The aim of this study was to explore the current practices of primary care physicians (PCPs) in providing bereavement care to elderly patients, with implications for medical education. A total of 63 PCPs answered a brief online survey about their typical practices, barriers, comfort level with bereavement, and confidence in their ability to diagnose prolonged grief disorder (PGD). They were recruited through an online newsletter and contacts of one of the authors. The results found that two-thirds of the PCPs do not routinely screen their elderly patients for recent losses, nor do they refer to mental health clinicians when loss is identified. Barriers included not learning of the deaths in patients' lives and lack of time during clinic visits. Those PCPs who had experienced their own losses were significantly more comfortable in speaking to patients about recent losses and more confident in their ability to diagnose PGD. We recommend bereavement education be incorporated into the medical school curriculum from the outset, utilizing the psychological principle of graded exposure to bereaved individuals.

Citing Articles

'A silent epidemic of grief': a survey of bereavement care provision in the UK and Ireland during the COVID-19 pandemic.

Pearce C, Honey J, Lovick R, Zapiain Creamer N, Henry C, Langford A BMJ Open. 2021; 11(3):e046872.

PMID: 33658262 PMC: 7931210. DOI: 10.1136/bmjopen-2020-046872.

Supporting bereavement and complicated grief in primary care: a realist review.

Pearce C, Wong G, Kuhn I, Barclay S BJGP Open. 2021; 5(3).

PMID: 33653707 PMC: 8278512. DOI: 10.3399/BJGPO.2021.0008.

Risk factors for a decrease in high morale in very old people over a 5-year period: data from two Nordic countries.

Nasman M, Niklasson J, Nygard M, Olofsson B, Lovheim H, Gustafson Y Eur J Ageing. 2020; 17(1):31-41.

PMID: 32158370 PMC: 7040116. DOI: 10.1007/s10433-019-00521-1.

Being there: A scoping review of grief support training in medical education.

Sikstrom L, Saikaly R, Ferguson G, Mosher P, Bonato S, Soklaridis S PLoS One. 2019; 14(11):e0224325.

PMID: 31774815 PMC: 6880967. DOI: 10.1371/journal.pone.0224325.

References

von Gunten C, Mullan P, Nelesen R, Soskins M, Savoia M, Buckholz G . Development and evaluation of a palliative medicine curriculum for third-year medical students. J Palliat Med. 2012; 15(11):1198-217. PMC: 3533838. DOI: 10.1089/jpm.2010.0502. View

Case A, Orrange S, Weissman D . Palliative medicine physician education in the United States: a historical review. J Palliat Med. 2013; 16(3):230-6. DOI: 10.1089/jpm.2012.0436. View

Cherlin E, Barry C, Prigerson H, Green D, Johnson-Hurzeler R, Kasl S . Bereavement services for family caregivers: how often used, why, and why not. J Palliat Med. 2007; 10(1):148-58. DOI: 10.1089/jpm.2006.0108. View

Billings J, Block S . Palliative care in undergraduate medical education. Status report and future directions. JAMA. 1997; 278(9):733-8. View

Nicholas J, Hall W . Screening and preventive services for older adults. Mt Sinai J Med. 2011; 78(4):498-508. PMC: 3142556. DOI: 10.1002/msj.20275. View

Schaefer K, Chittenden E, Sullivan A, Periyakoil V, Morrison L, C Carey E . Raising the bar for the care of seriously ill patients: results of a national survey to define essential palliative care competencies for medical students and residents. Acad Med. 2014; 89(7):1024-31. PMC: 4077186. DOI: 10.1097/ACM.0000000000000271. View

Prigerson H, Jacobs S . Perspectives on care at the close of life. Caring for bereaved patients: "all the doctors just suddenly go". JAMA. 2001; 286(11):1369-76. DOI: 10.1001/jama.286.11.1369. View

Shear M, Reynolds 3rd C, Simon N, Zisook S, Wang Y, Mauro C . Optimizing Treatment of Complicated Grief: A Randomized Clinical Trial. JAMA Psychiatry. 2016; 73(7):685-94. PMC: 5735848. DOI: 10.1001/jamapsychiatry.2016.0892. View

Ghesquiere A, Patel S, Kaplan D, Bruce M . Primary care providers' bereavement care practices: recommendations for research directions. Int J Geriatr Psychiatry. 2014; 29(12):1221-9. PMC: 4418789. DOI: 10.1002/gps.4157. View

10.

Bergman E, Haley W . Depressive symptoms, social network, and bereavement service utilization and preferences among spouses of former hospice patients. J Palliat Med. 2009; 12(2):170-6. DOI: 10.1089/jpm.2008.0237. View

11.

Leipzig R, Granville L, Simpson D, Anderson M, Sauvigne K, Soriano R . Keeping granny safe on July 1: a consensus on minimum geriatrics competencies for graduating medical students. Acad Med. 2009; 84(5):604-10. DOI: 10.1097/ACM.0b013e31819fab70. View

12.

Morris S, Block S . Adding Value to Palliative Care Services: The Development of an Institutional Bereavement Program. J Palliat Med. 2015; 18(11):915-22. DOI: 10.1089/jpm.2015.0080. View

13.

Shah S, Meeks S . Late-life bereavement and complicated grief: a proposed comprehensive framework. Aging Ment Health. 2011; 16(1):39-56. DOI: 10.1080/13607863.2011.605054. View

14.

Lemkau J, Mann B, Little D, Whitecar P, Hershberger P, Schumm J . A questionnaire survey of family practice physicians' perceptions of bereavement care. Arch Fam Med. 2000; 9(9):822-9. DOI: 10.1001/archfami.9.9.822. View

15.

Leung W . Competency based medical training: review. BMJ. 2002; 325(7366):693-6. PMC: 126659. View

16.

Agnew A, Manktelow R, Taylor B, Jones L . Bereavement needs assessment in specialist palliative care: a review of the literature. Palliat Med. 2009; 24(1):46-59. DOI: 10.1177/0269216309107013. View

17.

Billings J, Block S, Finn J, LeGrand S, Lupu D, Munger B . Initial voluntary program standards for fellowship training in palliative medicine. J Palliat Med. 2002; 5(1):23-33. DOI: 10.1089/10966210252784980. View

18.

Saucier D, Shaw E, Kerr J, Konkin J, Oandasan I, Organek A . Competency-based curriculum for family medicine. Can Fam Physician. 2012; 58(6):707-8, e359-61. PMC: 3374694. View

19.

Norris F, Murrell S . Social support, life events, and stress as modifiers of adjustment to bereavement by older adults. Psychol Aging. 1990; 5(3):429-36. DOI: 10.1037//0882-7974.5.3.429. View

20.

Guldin M, Jensen A, Zachariae R, Vedsted P . Healthcare utilization of bereaved relatives of patients who died from cancer. A national population-based study. Psychooncology. 2012; 22(5):1152-8. DOI: 10.1002/pon.3120. View