This is a feasibility study taking place at The Ottawa Hospital (TOH), Hôpital Montfort, and Queensway Carleton Hospital that seeks to evaluate the impact of the COVID-19 pandemic on family member bereavement and study the effect of virtual support groups on reducing risk of developing Severe Grief Reaction (SGR). This project is inviting family members of deceased patients at either of the three before mentioned sites to enroll in this study.
Background:
Severe grief reactions (SGR), or complicated grief (CG), are experienced by 2-3% of the
population after the loss of a loved one, and can be associated with declining health, social
distress, increased use of healthcare resources and higher mortality. SGR can be related to
the circumstances of the patient at the end of life, particularly in deaths that were
unexpected or traumatic, when the family member was unprepared or unsupported. The COVID-19
pandemic has affected many aspects of end-of-life care. For example, infection control
measures may reduce interactions between long-term care residents and family members, and
have often limited in-person family visiting to the final hours of life, or no visiting at
all for patients with COVID-19. Anecdotally, this disruption of normal interactions has been
difficult for patients and families alike, and it is known that isolation and lack of closure
with a loved one can contribute to the risk of SGR. The prevalence of SGR is expected to rise
amid increased challenges in supporting a surge of people with SGR due to physical distancing
and limited bereavement resources.
Methods:
The proposed mixed methods explanatory study includes both retrospective and prospective data
collection. The quantitative components will principally consist of natural experiments to
identify patient/FM characteristics indicating a high risk of SGR during the COVID-19
pandemic. The qualitative components will deepen an understanding of the impact of COVID-19
on bereavement, while providing a formative evaluation for the virtual support groups. Study
subjects will include all patients who died in an acute care facility in Ottawa (The Ottawa
Hospital, Queensway-Carleton Hospital, and Hôpital Montfort) from January 1, 2020 until June
30, 2020, and their primary contact (as indicated in their medical record).
Significance:
Early identification of FMs at risk of SGR provides an opportunity for early intervention
with the hope of preventing or reducing the severity of the SGR, but it also enables
prioritization of those in greatest need, should demand exceed resources. Moreover, because
it is still early in the pandemic, the study will be able to collect clinical data about the
circumstances of the death, and consistently collect bereavement data for family members of
people who died before and after the pandemic struck, and before and after the availability
of virtual support groups. Therefore have a unique opportunity to conduct two natural
experiments- studying the impact of the COVID pandemic on bereavement, and studying the
effect of virtual support groups on symptoms.
Other: Bereavement Virtual Support Group
Family members who experience loss will be invited to attend a virtual support group (VSG) led by Bereaved Families of Ontario- Ottawa (BFO). In pre-COVID-19 times, BFO presented monthly "Support and Share" nights with guest speakers, followed by breakout peer support groups for all different types of losses: loss of child, spouse, parent, loss by suicide, etc. These groups are facilitated by trained volunteers with a shared loss and include between 75 and 150 participants. These Support and Share Nights serve as intake sessions- interested participants from the breakout groups can attend "Closed Groups" where a smaller group of participants (up to 12) explore their grief more deeply. These run over 8-10 consecutive weeks with the same group of participants. They are led by trained facilitators who have experienced similar losses. Each week has a different theme, based on evidence-based components of bereavement support (e.g. writing a letter to the deceased).
Inclusion Criteria:
- Family Members of deceased patients from The Ottawa Hospital, Queensway-Carleton
Hospital, and Hôpital Montfort
Exclusion Criteria:
- Anyone who is unable to participate in a virtual intervention
Ottawa Hospital
Ottawa, Ontario, Canada