The COVID-19 pandemic: Bereavement outcomes between hospital and home deaths in palliative care
J Pain Symptom Manage. 2023 Nov 14:S0885-3924(23)00765-0. doi: 10.1016/j.jpainsymman.2023.10.025. Online ahead of print.
BACKGROUND: Australian COVID-19 public health measures reduced opportunities for people to communicate with healthcare professionals and be present at the death of family members/friends.
AIM: To understand if pandemic-specific challenges and public health measures during the COVID-19 pandemic impacted end-of-life and bereavement experiences differently if the death, supported by palliative care, occurred in a hospital or at home.
DESIGN: A cross-sectional online survey was completed by bereaved adults during 2020-2022. Analyses compared home and in-patient palliative care deaths and bereavement outcomes. Additional analyses compared health communication outcomes for those identified as persons responsible or next of kin.
SETTING/PARTICIPANTS: Of 744 bereaved people; 69% (n=514) had a death in hospital and 31% (n=220) at home.
RESULTS: The COVID-19 public health measures influenced people's decision to die at home. Compared to hospital deaths, the home death group had higher levels of grief severity and grief-related functional impairment. Only 37% of bereaved people received information about bereavement and support services. 38% of participants who were at least 12 months post-death scored at a level suggestive of possible prolonged grief disorder. Levels of depression and anxiety between the two groups were not significantly different.
CONCLUSIONS: These findings highlight the need for health services to recognise bereavement as fundamental to palliative and health care and provide pre- and post-death grief and bereavement care to ensure supports are available particularly for those managing end-of-life at home, and that such supports are in place prior to as well as at the time of the death.