A standardized approach to bereavement risk-screening: a quality improvement project

Abstract

Objectives: Identifying family members at-risk of poor bereavement outcomes poses a challenge for clinicians, resulting in inconsistent bereavement follow-up. The current quality improvement study tests a method for identification of at-risk family members, and describes follow-up they received from the bereavement service at Dana-Farber Cancer Institute.

Design: A standardized bereavement risk assessment, referral and follow-up process was piloted as part of a quality improvement project using a plan-do-study-act approach (PDSA).

Methods: A convenience sample of eleven clinical social workers completed paper and pencil bereavement risk-screening assessments using the Bereavement Risk-Screening Tool (BRST) on a sample of bereaved family members known to them. The results of the BRST were passed onto the bereavement program for follow-up.

Findings: Eleven out of a total of 17 social workers participated in the study. Social workers screened 100% (52/52) of identified bereaved family members, corresponding to 52 patient deaths. Approximately half (28/52) were identified as being ‘at-risk’ of a poor bereavement outcome based on the social worker’s consideration of the presence of potential risk-factors and their response to a prediction-type question about the bereaved individual’s future coping. ‘Lack of preparation for the death’, ‘unexpected death within the context of an illness’ and ‘witnessing a difficult death’ were the most commonly identified risk factors. Of those individuals who were identified to be ‘at-risk’, 89% received an outreach attempt by telephone from the director of bereavement services, surpassing our project target of 80%.

Conclusions: The BRST has the potential to help clinicians in health care settings identify those family members who might be considered at heightened risk of a poor bereavement outcome, facilitating early outreach and recommendations for support. The tool was easy to complete and helped streamline the referral process to the bereavement program.

Keywords:

• Bereavement
• Palliative care
• risk-screening
• quality improvement
• prevention
• bereavement programs

Acknowledgements

We would very much like to thank the social workers who participated in this project, and Amanda Moment LICSW who provided valuable feedback about an earlier version of the BRST. We would also like to thank our Project sponsors from DFCI and the CPIP team, including Drs. Jacobson and Cummings for their helpful comments throughout the project.