Fig 1 - uploaded by G Michael Downing
Content may be subject to copyright.
Source publication
Objective:
The Bereavement Risk Assessment Tool (BRAT) was designed to consistently communicate information affecting bereavement outcomes; to predict the risk for difficult or complicated bereavement based on information obtained before the death; to consider resiliency as well as risk; and to assist in the efficacy and consistency of bereavement...
Context in source publication
Context 1
... call for reliable and valid assessment tools is frequently cited in the literature as integral to a larger commitment to standards of bereavement care and hospice palliative care overall (Bromberg & Higginson, 1996;Keegan, 2002). To this end, the Bereavement Risk Assessment Tool, or BRAT, (Figure 1) was developed 1) to improve our ability to predict difficulties and complications for bereaved persons through timely and comprehensive assessment; 2) to standardize language and enhance communication among team members, and; 3) to improve the efficiency and consistency in the allocation of bereavement services. ...
Citations
... Therefore, bereavement is a subjective experience, and the tools currently available to health practitioners for early risk assessment and action may be helpful. According to Sealey et al. (2015), a total of 19 tools are available, and the most recent are: Bereavement Risk Assessment Tool (Rose et al., 2011), Bereavement Risk Index (Kristjanson et al., 2005); and Brief Grief Questionnaire (Ito et al., 2012). ...
Abstract
Aim
To describe a synthesis of the experience related to the spirituality of those living a bereavement journey in primary qualitative studies.
Design
A systematic review of qualitative studies.
Data Source
A systematic review was carried out in March 2019 and was updated in January 2023. Searching was accomplished by an online database, such as CINAHL, MEDLINE, PsycINFO, MedicLatina, LILACS, SciELO and Academic Search Complete. The search strategy did not consider a timeline as an eligibility criterion. The quality of the studies was assessed, and a thematic synthesis was performed in this review.
Methods
A systematic review of qualitative studies was conducted according to Saini and Shlonsky's methodology.
Reporting Method
PRISMA checklist.
Results
The review included 33 articles. Most of the studies were phenomenological and focused on parents' and family experiences of bereavement. Seven significant categories emerged, which match unmet spiritual needs during the grieving process. Two major categories were identified regarding the role of spirituality in bereavement: Spirituality as a process and spirituality as an outcome.
Conclusion
In clinical practice, attention to spirituality and providing spiritual care is critical to guarantee a holistic approach for those experiencing bereavement.
Implications
The findings of our study could foster awareness that healthcare professionals should include the spiritual dimension in their clinical practice to provide holistic care to individuals, enhancing the healing process in bereavement.
... Wenn Angehörige oder nahestehende Menschen sterben, kann sich die psychische Belastung bei den Hinterbliebenen in Bezug auf Qualität, Intensität und Dauer sehr unterschiedlich gestalten. Während "normale" Trauerverläufe durchaus mit hohen Belastungen einhergehen können, die jedoch innerhalb von ein bis 2 Jahren nach dem Tod deutlich abnehmen [1], entwickeln andere Betroffene schwierige bis hin zu klinisch bedeutsamen Trauerverläufen [2][3][4][5][6]. Für letztgenannte Verlaufsformen hat sich im deutschen Sprachraum der Begriff der "komplizierten Trauer" durchgesetzt [7]. ...
... Deshalb ist es von besonderer Bedeutung, in den Einrichtungen und Kliniken, in denen sterbende Menschen betreut werden, eine Trauerkultur zu entwickeln, die die Betroffenen im Trauerprozess unterstützt.Aufgabe der Trauerberatung und Trauerbegleitung ist es, allen Betroffenen einen sicheren Raum für die schmerzlichen Trauerprozesse zu geben, sie in ihrer Trauer zu begleiten, den Trauerprozess zu erleichtern, eventuell auftretende komplizierte Unterstützungsangebote und ggfs. therapeutische Maßnahmen zu verweisen[202]. "Zur Identifikation möglicher komplizierter Trauer hat sich der Multiprofessionelle Fragebogen zur Trauerbewältigung (MFT, engl. BRAT) als hilfreich erwiesen (Lit. ...
... BRAT) als hilfreich erwiesen (Lit. Daniel Berthold und Heidi Müller), welcher in Behandlungsteams stationär und ambulant angewendet werden kann."[202].Einrichtungen und Kliniken, die sterbende Menschen betreuen und versorgen, sollen eine hauseigene und kultursensible Abschieds-und Trauerkultur entwickeln und etablieren, die Patienten, Angehörigen und Mitarbeitern ein würdevolles Abschiednehmen ermöglicht. In der Palliativversorgung gibt es verschiedene Anbieter für Trauerbegleitung undberatung. ...
... (12)(13)(14) Although bereavement risk screening has repeatedly been highlighted as an important component of optimal care, (1,5,6) it has not been consistently implemented by palliative care or oncology services, (2,15) largely because screening by clinicians takes time and resources, (16,17) may rely on subjective impressions, and be unreliable. (18) A brief selfreport screening tool would allow screening to become a standard of care without taxing resources. Existing self-report bereavement risk assessments (19,20) have not been widely used or validated using patient-reported outcomes methods (PRO),(21) such as systematically obtaining expert and respondent feedback. ...
Objective
This qualitative study sought to obtain feedback from stakeholder cancer caregivers and bereaved family members on the implementation of bereavement risk screening in oncology.
Methods
Semi‐structured interviews were conducted with 38 family members of patients with advanced cancer (n=12) and bereaved family members (n=26) on when and how to effectively implement bereavement risk screening. Data was analyzed using thematic analysis.
Results
Many participants indicated that they would be open to completing a self‐report screening measure before and after the patient's death. Several suggested screening at multiple timepoints and the importance of follow‐up. Participants viewed screening as an opportunity to connect to psychosocial support.
Conclusions
The findings suggest that family members appear supportive of sensitively‐approached bereavement risk screening before and after a patient's death as an important component of quality psychosocial care. To optimize implementation, bereavement risk screening would involve screening at multiple timepoints and include follow‐up. Findings suggest standardized risk screening using a brief, validated self‐report tool would be a pragmatic approach to increasing access to bereavement care.
This article is protected by copyright. All rights reserved.
... The Bereavement Risk Assessment Tool (BRAT) was developed by the health professionals of Victoria Hospice Society in Canada (Rose et al., 2011). Because the BRAT is based on observation, it requires staff to be trained in its use and has several complex factors that are rated subjectively. ...
... To date, however, only a few studies have examined bereavement risk using the BRAT. Rose et al. (2011) estimated the inter-rater reliability of the BRAT using case studies, with 36 psychosocial professionals completing the BRAT on 10 caregivers of hospice palliative care patients. In that study, four of the 10 caregivers were considered to be at a high risk for bereavement (level 4 or 5). ...
... Five individuals (10%) were in a high category of risk (level 4 or 5). This prevalence is lower than that reported in previous studies (Hirooka et al. 2016;Rose et al., 2011). Participants were recruited from family psychoeducation; that is, they were already seeking psychological support, which could act as a protective factor. ...
Objectives
The Bereavement Risk Assessment Tool (BRAT) seems to be useful in identifying those who are likely to suffer from the more severe consequences of bereavement. To date, however, only a few studies have examined bereavement risk using the BRAT. This study investigated bereavement risk in family caregivers of patients with cancer using the Japanese version of the Bereavement Risk Assessment Tool (BRAT-J). We also investigated the relationship of bereavement risk with psychological distress and resilience among caregivers to determine the validity of the BRAT-J.
Methods
We conducted family psychoeducation in the palliative care unit of Tohoku University Hospital with participants who were recruited in this study. Among the participants, 50 family caregivers provided their written informed consent and were included in this study. Participants were assessed using the BRAT-J and completed the Japanese version of the Kessler Psychological Distress Scale (K6) and the Tachikawa Resilience Scale (TRS).
Results
According to the BRAT-J, five individuals (10%) were in the high category of bereavement risk (level 4 or 5). We also found that family caregivers of patients experienced many different pressures, such as facing the unknown; their own work; and insufficient financial, practical, or physical resources. These issues are associated with various mental problems. Additionally, the level of bereavement risk was significantly correlated with K6 scores (ρ = 0.30, p = 0.032), and the TRS score (ρ = –0.44, p = 0.001). These correlations confirmed previous findings and that the BRAT-J can be an efficient screening tool for the bereavement risk of family caregivers of patients with cancer.
Significance of results
It appears that the BRAT-J is useful in predicting the likelihood of difficulties or complications in bereavement for family caregivers and could help to provide support with these issues when needed.
... Similar findings were reported by Breen (2011) in her study of the gaps between research and practice in grief counseling. The use of other non-CG measures, such as the Beck Depression Inventory (BDI), Bereavement Risk Assessment Tool (BRAT), or the Grief and Mourning Interview and Inventory (GAMS) were also noted (Beck, Steer, & Brown, 1996;Rose, Wainwright, Downing, & Lesperance, 2011;Rando, 1993). Most of the clinicians we contacted relied almost exclusively on their preexisting, sometimes decades-old training and clinical judgement, and reviewed the literature as their time permitted. ...
Complicated Grief (CG) is one of the central themes in bereavement research and advanced clinical practice today. Using a mixed methods approach we wanted to learn: a) what tools Canadian practitioners used to identify or diagnose CG and; b) what interventions or strategies they used to address CG. Sixty three professionals responded to our survey. There were no straightforward answers to these questions: the state-of-the art of CG in Canada is, in fact, complicated. Practitioners used a wide assortment of tools and strategies with no consensus on any one approach or tool. Building a Canadian CG community of practice was recommended.
... Despite the compelling need for a brief self-report bereavement risk screening tool, measures to assess transdiagnostic psychosocial risk factors for the development of bereavement-related mental health challenges have a number of limitations, contributing to challenges in the implementation of systematic screening (Sealey, 2015a). Clinicianadministered screening tools have not proven reliable (Rose et al., 2011;Kristjanson, 2006;Sealey, 2015b) and self-report bereavement risk assessments (Jordan et al., 2005;Guldin et al., 2011) have not been widely used or validated due to their burdensome length and limited clinical utility (Agnew et al., 2010). In addition, such measures have not been developed using systematically obtained expert feedback or respondent input. ...
... The preliminary items for the BRISQ were developed based on a thorough review of the bereavement risk factor literature (as described above), using reviews by Lobb et al. (2010) and Burke and Neimeyer (2012) as guides. Additionally, items verified by the literature as prominent risk factors were selected from pre-existing bereavement screening tools, including the GEM (Jordan et al., 2005) and those developed by Rose et al. (2011) and Guldin et al. (2011). Items were identified as being within three main categories of risk described above: background factors, illness/death-related factors, and bereavement-related factors (Burke & Neimeyer, 2012;Lobb et al., 2010). ...
Objective:
Following the loss of a loved one to cancer, a significant subset of bereaved family members are at heightened risk for mental and physical health problems; however, these family members often "fall through the cracks" of the healthcare system. A brief, clinically useful self-report bereavement risk-screening tool could facilitate more effective identification of family members in need of psychosocial support before and after a cancer loss. Thus, the purpose of this study was to develop and refine the Bereavement Risk Inventory and Screening Questionnaire (BRISQ), a self-report bereavement screening tool, and to assess its utility using feedback from bereavement experts.
Method:
Quantitative and qualitative feedback from a panel of 15 clinical and research experts in bereavement was obtained through an online survey to identify the most clinically useful items and understand expert opinion on bereavement screening.
Results:
The qualitative and quantitative feedback were synthesized, resulting in a 22% reduction of the item pool. While there was a general consensus between experts on the most clinically useful risk factors for bereavement-related mental health challenges and on the utility of screening, they also offered feedback on language and formatting that guided substantial revisions to the BRISQ.
Significance of results:
These findings were utilized to refine the BRISQ in preparation for a second study to obtain family member feedback on the measure. By incorporating both expert and family member feedback, the intention is to create a screening tool that represents top clinical and research knowledge in bereavement in a way that effectively addresses barriers to care.
... Review the risk of post-bereavement depression by allowing palliative care services the opportunity to facilitate increased support (Agnew et al, 2010;Rayner et al, 2010). One such commonly used tool is the Bereavement Risk Assessment Tool (Rose et al, 2011), which was developed to predict bereavement complications, enhance communication between family and staff members, and improve the allocation of bereavement services. However, health workers cannot rely wholly on bereavement assessment tools but rather should incorporate them into their clinical expertise (Rose et al, 2011). ...
... One such commonly used tool is the Bereavement Risk Assessment Tool (Rose et al, 2011), which was developed to predict bereavement complications, enhance communication between family and staff members, and improve the allocation of bereavement services. However, health workers cannot rely wholly on bereavement assessment tools but rather should incorporate them into their clinical expertise (Rose et al, 2011). ...
... Metzger and Gray (2008) highlight that open communication about dying with their terminally ill loved one and ultimately accepting their illness enables families to cope with loss and eases their grief during the bereavement process. Rose et al (2011) recommend that assessment and bereavement support should commence as soon as possible, as identification of concerns before the death of a loved one allows interventions to take place that may avoid difficult complicated bereavements before they begin. Protecting a loved one by not talking about death creates a false sense of happiness that protects in the short term but may cause bereavement complications, anxiety, and regret in the long term. ...
Depression is a common psychological condition among patients at the end of life, and it can also affect a patient's family both before and after their loved one's death. It is estimated that around 25% of palliative care patients are diagnosed with depression during their illness, and that a majority experience depressive symptoms. If left unrecognized and untreated this may lead to more severe illness symptoms, poor communication with family members and, ultimately, reduced quality of life and a poor prognosis. Early assessment and management using appropriate tools as a guide are essential for enabling early treatment so that patients can be comfortable and meet unfulfilled goals during their end-of-life care. Palliative care staff play an essential part in recognizing and treating depression in patients, and by focusing on those at risk they can help to reduce the number who will go on to develop the condition. This article provides an overview of the nature of the problem in palliative care patients and bereaved families, looking at how targeted monitoring and intervention can help to alleviate the burden in the former and how support can benefit the latter.
Grief and bereavement support are crucial to good palliative and end-of-life care. Support models differ between and within services. In addition, while patient and family needs vary based on risk and resilience factors, acute or unexpected death is associated with complicated grief. Our study was a retrospective review of 159 patients who died within 72 hours of hospital admission. We found a high proportion of unexpected and traumatic deaths and low grief and bereavement support rates. Further work is needed to streamline policies to optimize patient and family-centred grief and bereavement support in the acute hospital setting.
Objective
This study examined rural community-based nurses' self-reported knowledge and skills in the provision of psychosocial care to rural residing palliative and end-of-life clients and carers. We further sought to determine correlates of knowledge gaps to inform workforce education and planning.
Method
Nurses from a rural area of Victoria, Australia, were invited to complete an electronic questionnaire rating their knowledge against 6 national palliative care standards and 10 screening and assessment tools. A 5-point scale of (1) No experience to (5) Can teach others was used to rate knowledge. Results were classified into three categories: practice gaps, areas of consolidation, and strengths. Descriptive and logistical regression was used to analyze data.
Results
A total of 122 of 165 nurses (response rate = 74%) completed the survey. Of these nurses, 87% were Registered Nurses, 43% had ≥10 years' experience in palliative care, and 40% had palliative care training. The majority of practices across the standards and screening and assessment tools were rated as knowledge strengths (N = 55/67, 82%). Gaps and areas of consolidation were in the use of client and carer assessment tools, the care of specific populations such as children, supporting carers with appropriate referrals, resources, and grief, and facilitating the processes of reporting a death to the coroner. Lack of formal training and lower years of experience were found to be associated with practice gaps.
Significance of results
Our study found rural nurses were confident in their knowledge and skills in the majority of psychosocial care. As generalist nurses make up the majority of the rural nursing workforce, further research should be undertaken on what educational strategies are needed to support and upskill rural community-based nurses to undertake formal training in palliative care.
