Bereaved Family Members Need More than Support

When a loved one dies unexpectedly while in the hospital, bereaved family members often have many questions about what happened and why. Even if the person’s overall health and long-term prognosis were poor, sudden death from an unexpected or even expected complication can leave grieving family members feeling angry and betrayed. These feelings are often exacerbated by perceived or actual failures in patient care: Nurses didn’t answer the patient’s call light promptly. The attending physician was rarely around. On-call doctors were unable to answer the family’s questions appropriately. Specialists weren’t consulted in a timely manner. The list goes on and on.

Credit: neptunesociety.com

Many hospitals offer bereavement services to family members who have lost a loved one. But these usually focus on providing comfort, spiritual counseling and/or emotional support. Few hospitals offer a path through which grieving families can voice their concerns and complaints and get answers to their questions about the care the patient received. The result: Bereaved families turn to legal action and official complaints to get these things addressed.

A New Approach to Bereavement Services

Recently, researchers in the UK conducted a small pilot study to learn if a hospital bereavement program led by senior physicians, nurses and the hospital’s quality and safety team could lessen the incidence of survivors’ complaints and help family members cope more effectively with a difficult death. Using a model developed by Medway Clinical Commission Group, the hospital implemented a system whereby bereaved family members were contacted by the hospital one working day after a patient had died. The family was invited to attend a one-hour meeting with the specialist in charge of the patient’s care and the matron (head nurse) on the ward where the person’s death occurred. The head of the hospital’s quality and safety team attended the meeting as well. Detailed minutes were compiled, which were later forwarded to the grieving families along with the results of any inquiries or investigation that occurred after the meeting took place.  

The study looked only at deaths that occurred following surgical procedures between May 2017 and January 2018. Of the 121 families contacted about the meetings, 18, or about 15 percent, agreed to attend.

During the semi-structured meetings, family members were encouraged to describe their version of the events surrounding the patient’s death and voice their questions and concerns. Not surprisingly, most of the families who attended the meetings (about 83 percent) had unanswered questions about their loved one’s medical or nursing care. Over 75 percent had questions or concerns about the quality of care provided, and a little over 10 percent had concerns about both.

Doctors meet with bereaved family members to discuss concerns
Credit: sph.nhs.uk

The most common concerns identified related to the medical management of the patient’s condition; the quality of nursing care they received; and communication with and between the health care team. Many families also wanted to know whether anything more could have been done to save the patient’s life, and some wanted reassurance that other patients and families would not go through the ordeals they had experienced.

Grieving Families Feelings Defused

The results of the pilot program were largely positive. Of the bereaved families who attended, a little less than half (44 percent) had been thinking about filing a formal complaint before the meeting took place. After the meeting, over three-quarters of those families said they had obtained “closure” and that their concerns had been adequately addressed. Additionally, two families who had already sought legal advice decided to forgo legal action after speaking with hospital staff. The remaining families were awaiting the results of a further investigation before submitting their feedback.

These results echo those from several “disclose and compensate” programs in the United States. For example, since 2001 the University of Michigan Health System has been disclosing serious medical errors to patients and/or their grieving families and offering a formal apology and financial compensation for harms done. Despite dire predictions that such transparency would cause the number of malpractice claims and financial settlements to skyrocket, the rate of both has actually decreased.