Bereavement Reactions, Consequences, and Care (1984) / Chapter Skim
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11 Conclusions and Recommendations
11 Conclusions and Recommendations
Pages 283-296
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From page 283... ...
WHAT CAN BE CONCLUDED FROM AVAILABLE RESEARCH EVIDENCE ABOUT THE HEALTH CONSEQUENCES OF BEREAVEMENT? The evidence from clinical experience and several kinds of researchepidemiologic, case follow-up, clinical, and social science leads to several important conclusions.
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From page 284... ...
But the diagnosis-specific mortality rates, symptoms, and health behaviors just discussed suggest that bereavement may exacerbate existing illnesses, precipitate depression leading to suicide, aggravate or lead to alcohol abuse that can result in cirrhosis of the liver, and leave people vulnerable to infectious diseases. Like adults, children exhibit a range of responses immediately following bereavement.
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From page 285... ...
Mental illness, especially depression, is likewise likely to be exacerbated following bereavement and to interfere with normal grieving. Perceived social support is the best replicated predictor of psychosocial adjustment.
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From page 286... ...
In fact, as discussed in Chapter 10 and in the final section of this chapter, the committee believes it is time to subject various intervention strategies to rigorous study so as to determine their benefit to particular groups of bereaved individuals. Practice Recommendations In the committee's view, the well-being of the family and others close to a dying patient is part of health professionals' responsibility in terminal illness.
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From page 287... ...
In particular, as discussed in Chapter 8, the likelihood of the distress following bereavement taking the form of physical symptoms, and the particular bodily complaints, may vary substantially by cultural group and social class. If they are unaware of this possibility, health professionals might conduct needless and costly tests or prescribe unnecessary and potentially harmful treatment.
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From page 288... ...
In the absence of such data, the committee urges clinicians to exercise caution in prescribing medications for bereaved individuals. The committee noted with interest the various efforts of health care institutions to assist the bereaved and to support health professionals in their activities in settings made stressful by frequent death.
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From page 289... ...
Regular meetings at which staff are encouraged to air their concerns, adequate back-up support from mental health professionals, and clearly delineated roles on health care teams may help alleviate the sense of isolation and overwhelming burden of individual responsibility so commonly reported. Public Education Because of the fairly recent historical changes noted in this volume, including institutional care of the dying and geographic mobility of families, most people have little direct contact with death and may not be prepared for its impact on their families.
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From page 290... ...
Inadequacies in the data base, such as the narrow scope of research, lack of good multidisciplinary studies, and some pervasive methodologic problems, have hampered the development of definitive conclusions. In this section, the committee draws together its key recommendations regarding future research directions that seem especially promising.
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From page 291... ...
Thus, it is unclear how generalizable the current knowledge base is; this makes it difficult to develop intervention strategies that are appropriate to the needs of minority groups. Indeed, as pointed out in Chapter 8, there is reason to suspect that impoverished ethnic minority group members, recent refugees, and migrants may be at especially high risk for negative health outcomes of bereavement.
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From page 292... ...
~ ~ ., ~ before the death deserves rigorous study. Furthermore, because it seems clear that for many people the grieving process continues beyond a year, studies should track bereaved individuals for a longer period of time.
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From page 293... ...
Without such studies, the interactions between risk factors will remain unclear and it will not be possible to confidently identify groups at high risk. Good cross-disciplinary longitudinal studies also will provide the foundations for intervention strategies that are appropriate to the range of needs of bereaved individuals.
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From page 294... ...
c, ~ p~IlOU. 1 U IOCUS only on lermmal care and Its costs would be to ignore an integral part of the hospice program and to pass up a rare opportunity to conduct major studies of the preventive possibilities of bereavement support and its associated savings potential.
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From page 295... ...
Finally, the committee recommends that the NIMH establish a special ad hoc research review committee to deal with bereavement studies of all kinds. A broad research initiative in this area requires a review committee that understands the nature and complexity of bereavement; the state of the art in research on the process, outcomes, and interventions; the value of different methods of studying bereavement; and the problems involved in conducting good longitudinal, multidisciplinary research in this area.
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