Standard 7: Care after death - Example GP Practice Team EOLC group exercise

Record: Those attended, apologies, and date of meeting.

The aim

  • For each staff member to tap into their own experiences of handling patients and carers affected by anticipatory grief (patient and carer) and bereavement (carer).
  • For staff to have a shared understanding of how best to support anticipatory grief and bereavement – considering medical and de-medicalised (non-health) support.
  • To consider how the practice can robustly identify the minority of people who may require intervention. (this starts at having a concise, accessible, timely record of deceased patients and their bereaved).

Principles

  • Recognise and acknowledge anticipatory grief and bereavement needs of patients and carers.
  • Assess and advise on 'normal grief' and more complex grief.

Discussion

Due to the family medicine nature, general practice regularly comes into contact with people who have anticipatory grief (whilst living) and also the bereaved at some point in their experience of grieving. This can be an extremely satisfying aspect of general practice and an important part of building the continuity of care within the GP-patient relationship. Most bereavement reactions are not complicated and the necessary support is provided by family, friends, and various societal resources. It is important not to 'medicalise' normal grief. Therefore, it is helpful to understand the normal process of grief and what can be expected in order to then understand more complicated grief and the associated risks. Loss is completely personal and many events can result in grief, for example, death of a spouse, family member or friend; child loss; miscarriage and stillbirth; loss of an ability (such as hearing, sight, physical ability) and even pet death. Loss can be recognised by all members of the practice team and everyone in the practice can have/develop a role to support people in some way. Typically, GPs and District Nurses use home visits, telephone consultations, and condolence letters to support bereaved people1.

Task

Each person to think about a specific patient or carer you have handled who was/is affected by anticipatory grief or bereavement:

  • Patient 1 with 'normal grief'.
  • Patient 2 'requiring more medicalised intervention(s)'.
  1. Go round the group and ask people to say which patient they are thinking of. Depending on time, agree one or two patients to discuss in more detail.
  2. Ask if people are willing to volunteer A FEW WORDS ONLY what was most rewarding about being involved in their care.
  3. Ask what people found challenging? Are staff left with effects of professional grief?
  4. Discuss the following questions as a group (and someone take notes on the key points):
  • How do practice staff think they should care for patients who are bereaved?
  • Is there a system in place to for all staff to access a timely record of deceased patients and their bereaved?
  • How does the practice acknowledge a person has had a bereavement?
  • Does the practice routinely offer any signposting support?
  • Using examples, how did the patient experiencing anticipatory grief or bereavement present/ get noticed by different staff? First for patient 1, then repeat for patient 2.
  • Who had contact (any form) with the patient?
  • Were there other opportunities for identifying their grief needs?
  • What were their needs – health, psychosocial, cultural, spiritual, practical and other?
    • Explore different people's attitudes, beliefs and experiences.
  • What worked well /made a difference? – for the patient, for staff, for the practice?
  • Is there learning for i) staff, ii) the practice, iii) external to the practice.
  • What will people do differently in the future.
  • How will lessons learned improve future practice? Is there an action plan?
  • How will lessons learned be shared with you GP networks and wider system?
  •  Set a review date.

6. Informing part of the evidence on Standard 7

  • Identify people with anticipatory grief and bereavement needs.
  • Practice protocol of support offer, agreed by practice team.
  • Audit criteria shared and agreed.

Next: Standard 8: General Practice hubs within Compassionate Communities >


References

  1. Nagraj, S. & Barclay, S. (2011) Bereavement care in primary care: a systematic literature review and narrative synthesis. BJGP

 

QI 7: Continuous Improvement

Regular audit of support offered to the bereaved. For example, documented contact with the bereaved, support information given.

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