Exploration of clinicians’ perspectives of using a bereavement risk screening tool in a palliative care setting: a qualitative study
Keywords:
bereavement risk, prolonged complex bereavement, risk screening, bereavement risk indexAbstract
AbstractTo minimise the adverse outcomes of prolonged complex bereavement, health professionals need effective risk screening tools to identify those at risk. However, existing tools can be challenging to implement in the clinical setting. This qualitative study aimed to explore clinicians’ perspectives and experiences of using the Bereavement Risk Index (BRI) screening tool, including identifying barriers and enablers regarding its use and what they perceived as important domains in bereavement risk screening. Data was collected through semi-structured group and individual interviews and deductively analysed using the Theoretical Domains Framework. Eleven participants employed in one regional palliative care service were interviewed. The results revealed three key implications: 1) a risk screening tool is highly beneficial, however contextual factors can limit its implementation; 2) clinician confidence in the tool and perception of the tool’s comprehensiveness are significant factors in its use; 3) feedback is needed as to whether clinicians’ assessment of bereavement risk remains accurate and valid in the longer term.
References
Agnew, A., Manktelow, R., Haynes, T., & Jones, L. (2010). Bereavement assessment practice in hospice settings: Challenges for palliative care social workers. The British Journal of Social Work, 41, 111–130. doi: 10.1093/bjsw/bcq055
Aoun, S., Ewing, G., Grande, G., Toye, C., & Bear, N. (2018). The impact of supporting family caregivers before bereavement on outcomes after bereavement: Adequacy of end of life support and acheivement of preferred place of death. Journal of Pain and Symptom Management, 55(2), 368–378. doi: 10.1016/j.jpainsymman.2017.09.023
Aranda, S. M., & Milne, D. (2000). Guidelines for the assessment of complicated bereavement risk in family members of people receiving palliative care. Centre for Palliative Care (Australia).
Atkins, L., Francis, J., Islam, R., O’Connor, D., Patey, A., Ivers, R., … Michie, S. (2017). A guide to using the Theoretical Domains Framework of behaviour change to investigate implementation problems. Implementation Science, 12(1), 1–18. doi: 10.1186/s13012-017-0605-9
Barratt, M., Ferris, J., & Lenton, S. (2014). Hidden populations, online purposive sampling, and external validity: Taking off the blindfold. Field Methods, 27(1), 3–21. doi: 10.1177/1525822X14526838
Benner, P. (1984). From novice to expert: Excellence and power in clinical nursing practice. Addison-Wesley Publishing Company.
Blackburn, P., & Dwyer, K. (2017). A bereavement common assessment framework in palliative care: Informing practice, transforming care. American Journal of Hospice and Palliative Mediine, 34(7), 677–684. doi: 10.1177/1049909116647403
Bosma, H., Johnston, M., Cadell, S., Wainwright, W., Abernethy, N., Feron, A., … Nelson, F. (2010). Creating social work competencies for practice in hospice palliative care. Palliative Medicine, 24(1), 79–87. doi: 10.1177/0269216309346596
Breen, L., Aoun, S., O’Connor, M., & Rumbold, B. (2014). Bridging the gaps in palliative pare bereavement support: An international perspective. Death Studies, 38(1), 54–61. doi: 10.1080/07481187.2012.725451
Cane, J., O’Connor, D., & Michie, S. (2012). Validation of the theoretical domain’s framework for use in behaviour change and implementation research. Implementation Science, 7, 37. doi-org.libraryproxy.griffith.edu.au/10.1177/1525822X14526838.
Creswell, J. W. (2009). Research design: Qualitative, quantitative, and mixed methods approaches (3rd ed.). SAGE Publications.
Debono, D., Taylor, N., Lipworth, W., Greenfield, D., Travalgia, J., Black, D., & Braithwaite, J. (2017). Applying the Theoretical Domains Framework to identify barriers and targeted interventions to enhance nurses‘ use of electronoic medication management systems in two Australian hospitals. Implementation Science, 12(1), doi: 10.1186/s13012-017-0572-1
Gobet, F., & Chassy, P. (2008). Towards an alternative to Benner’s theory of expert intuition in Nursing: A discussion paper. International Journal of Nursing Studies, 45, 129–139. doi: 10.1016/j.ijnurstu.2007.01.005
Hudson, P. L., Trauer, T., Graham, S., Grande, G., Ewing, G., Payne, S., … Thomas, K. (2010). A systematic review of instruments related to family caregivers of palliative care patients. Palliative Medicine, 24(7), 656–688. doi: 10.1177/0269216310373167
Kirk, J. W., Sivertsen, D., Petersen, J., Nilsen, P., & Petersen, H. (2016). Barriers and facilitators for implementing a new screening tool in an emergency department: A qualitative study applying the Theoretical Domains Framework. Journal of Clinical Nursing, 25, 2786–2797. doi: 10.1111/jocn.13275
Kristjanson, L., Cousins, K., Smith, J., & Lewin, G. (2005). Evaluation of the Bereavement Risk Index (BRI): A community hospice care protocol. Journal of Palliative Nursing, 11(12), 610–618. doi: 10.12968/ijpn.2005.11.12.20226
Levy, L., Derby, J., & Martinkowski, K. (1992). The question of who participates in bereavement research and the bereavement risk index. Omega, 25(3), 225–238. doi: 10.2190/HVGD-2NXV315R-X9FT
Lincoln, Y., & Guba, E. (1985). Naturalistic Inquiry. Sage Publications.
McLellan, J., O’Carroll, R., Cheyne, H., & Dombrowski, S. (2019). Investigating midwives’ barriers and facilitators to multiple health promotion practice behaviours: A qualitative study using the Theoretical Domains Framework. Implementation Science, 14(64), doi:10.1186/s13012–019-0913-3
Palliative Care Australia. (2018). National Palliative Care Standards (5th ed.). Palliative Care Australia.
Parkes, C. M. (1993). Bereavement. In D.Doyle, G. W.Hanks, & N.MacDonald (Eds.), Textbook of Palliative Medicine (pp. 663–678). University Press.
Parkes, C., & Weiss, R. S. (1983). Recovery from Bereavement. Basic Books.
QSR International Pty Ltd. (2015). NVivo (Version 11). Retrieved from www.qsrinternational.com/nvivo-qualitative-data-analysis-software/home [accessed 9 September 2020].
Roberts, K., Holland, J., Prigerson, H. G., Sweeney, C., Corner, G., Breitbart, W., & Lichtenthal, W. G. (2017). Development of the bereavement Risk Inventory and Screening Questionnaire (BRISQ): Item generation and expert panel feedback. Palliative and Supportive Care, 15(1), 57–66. doi: 10.1017/S1478951516000626
Robinson, L., Nuamah, I., Lev, E., & McCorkle, R. (1995). A prospective longitudinal investigation of spousal bereavement examining Parkes and Weiss’ Bereavement Risk Index. Journal of Palliative Care, 11(4), 5–13. doi: 10.1177/082585979501100402
Rose, C., Wainwright, W., Downing, M., & Lesperance, M. (2011). Inter-rater reliability of the Bereavement Risk Assessment tool. Palliative and Supportive Care, 9(2), 153–164. doi: 10.1017/S1478951511000022
Sanderson, C., Lobb, E., Mowll, J., Butow, P., McGowan, N., & Price, M. (2013). Signs of PTSD Following an expected death. Palliative Medicine, 27(7), 625–631. doi: 10.1177/0269216313483663
Sealey, M., Breen, L. J., O’Connor, M., & Aoun, S. (2015). A scoping review of bereavement risk assessment measures: Implications for palliative care. Palliative Medicine, 29(7), 577–589. doi: 10.1177/0269216315576262
Sealey, M., O’Connor, M., Aoun, S., & Breen, L. (2015). Exploring barriers to assessment of bereavement risk in palliative care: Perspectives of key stakeholders. BMC Palliative Care, 14(1), 1–12. doi: 10.1186/s12904-015-0046-7
Steinmo, S., Michie, S., Fuller, C., Stanley, S., Stapleton, C., & Stone, S. (2016). Bridging the gap pragmatic intervention design and theory: Using behavioural science tools to modify an existing quality improvement programme to implement ‘Sepsis Six’. Implementation Science, 11(1), doi: 10.1186/s13012-016-0376-8
Thomsen, K., Guldin, M., Nielsen, M. K., Ollars, C. L., & Jensen, A. B. (2017). A process evaluation of systematic risk and needs assessment for caregivers in specialised palliative care. BMC Palliative Care, 16, 23–28. doi: 10.1186/s12904-017-0196-x
Uchida, T., Satake, N., Nakaho, T., Inoue, A., & Saito, H. (2018). Bereavement risk assessment of family caregivers of patients with cancer: Japanese version of the Bereavement Risk Assessment Tool. Palliative and Support Care, 17, 444–452. doi: 10.1017/S1478951518000755
Varpio, L., Ajjawi, R., Monrouxe, L., O’Brien, B., & Rees, C. (2017). Shedding the cobra effect: Problematising thematic emergence, triangulation, saturation and member checking. Medical Education, 51(1), 40–50. doi: 10.1111medu.13124
