Priority 10 & 12 Bereavement Services and Spiritual Care

Transcription

1 Delivering the Supportive and Palliative Care Improving Outcomes Guidance (IOG) across the East Midlands Priority 10 & 12 Bereavement Services and Spiritual Care Policy for the Provision of Spiritual Care and Bereavement Support East Midlands Cancer Network 2010

2 Document History Document Location This document is only valid on the day it was printed. The source of the document will be found at this location Revision History Date of this revision: June 2011 Date of next revision: Revision date Previous revision date Summary of Changes First issue Changes marked Approvals This document requires the following approval. Name Title Date of Issue Bereavement & Spiritual Care Group Version Distribution This document has been distributed to: Group Name Location Date of Issue Version Primary Care Trust East Midlands 01/07/ Acute Trust East Midlands 01/07/ General Practitioners East Midlands 01/07/ Lead Cancer Nurses East Midlands 01/07/ Allied Health Protection East Midlands 01/07/ Leads Voluntary Sector East Midlands 01/07/ Hospices East Midlands 01/07/ EMCN NSSG Boards East Midlands 01/07/ Lead Nurses in East Midlands 01/07/ Community Long Term Conditions East Midlands 01/07/ Managers Social Services East Midlands 01/07/ This list is not exhaustive as dissemination will take place by the above groups 2

3 CONTENTS Acknowledgements Context: The East Midlands Cancer Network Introduction and Background Network Policy for the Provision of Spiritual Care and Bereavement Support Network Policy for the Provision of Spiritual Care and Bereavement Support References Appendices Appendix 2 Post Bereavement Assessment Tool Appendix 3 Bereavement/Family Support Service 1:1 Evaluation Appendix 4- Bereavement Service Questionnaire Appendix 5 Bereavement Support Service Audit Tool Appendix 6 - Template for GP Condolence Letter

4 Acknowledgements This policy and documents within it, has been adapted from those of the following Cancer Networks: Merseyside & Cheshire Cancer Network Mount Vernon Cancer Network Sussex Cancer Network Acknowledgement is also given to Marie Curie Cancer Care for the care competencies referred to in this policy. With gratitude 4

5 1. Context: The East Midlands Cancer Network NHS East Midlands The National Cancer Services Analysis Team has not yet produced a map for the East Midlands Cancer Network (EMCN). The network is not fully co-terminus with NHS East Midlands. It does not cover parts of North Lincolnshire and Bassetlaw. However the map below serves to give an indication of the size and complexity of the EMCN. NB: Derby Hospitals are now known as Royal Derby Hospital (was DRI) and London Road Community Hospital (was DCGH). 5

6 The East Midlands Cancer Network (EMCN) embraces a core population of approximately 4.2 million people. Formed by the merger of the three previous local Cancer Networks, it went operational on 1 st October The network is divided into discrete localities as follows: Primary Care Trusts Total locality pop Trusts Hospitals Hospices Other Kettering Locality Northants Teaching PCT Northampton Locality Northants Teaching PCT LLR Locality NHS Leicester City Leicester County & Rutland PCT Burton Locality South Staffs PCT Derby Locality Derbyshire County PCT NHS Derby City PCT Nottinghamshire Locality Nottingham City PCT Nottinghamshire County PCT Lincs Locality Lincolnshire County PCT 284, ,294 1,017, , ,330 1,070, ,391 Kettering General Hospital NHS Foundation Trust Kettering General Hospital Cransley Hospice Lakelands Day Care Hospice Northampton General Hospital NHS Trust Northampton General Hospital Cynthia Spencer Hospice University Hospitals of Leicester NHS Trust Leicester Royal Infirmary Leicester General Hospital Glenfield Hospital LOROS Manor Croft Day Hopsice (part of LOROS) Rainbows Hospice Coping with Cancer Burton Hospital NHS Foundation Trust Queens Hospital St Giles Hospice Derby Hospitals NHS Foundation Trust Royal Derby Hospital London Road Community Hospital Nightingale Macmillan Unit Treetops Hospice Ashgate Hospice Nottingham University Hospitals NHS Trust Sherwood Forest Hospitals Foundation NHS Trust City Hospital Queens Medical Centre Newark Hospital Kings Mill Hospital Beaumond House Community Hospice Hayward House Hospice John Eastwood Hospice Treetops Hospice (no commissioned bereavement support) Dove Cottage Day Care Hospice Nottingham Hospice United Lincolnshire Hospitals NHS Trust Lincoln County Hospital Grantham Hospital Pilgrim Hospital, Boston St Barnabas Hospice Butterfly Hospice Trust Lindsay Lodge Hospice (Scunthorpe) Sue Ryder Care, Thorpe Hall Hospice, Peterborough Louth and District Hospice St Andrew s (Grimsby) Lincolnshire Centre for Grief and Loss Spiritual care and a variety of mechanisms for bereavement support are delivered at a number of the organisations within the network. This includes face to face contact and telephone support. It is recognised that some community hospitals and mental health providers also offer levels of spiritual care and bereavement support although they are not outlined in the table above. 6

7 2. Introduction and Background Purpose and Scope The NICE Improving Supportive and Palliative Care for Adults with Cancer Guidance (IOG) (2004), sets out a number of recommendations in relation to spiritual and bereavement care provision. There is, at network level, a need to ensure that a range of bereavement information and support, and culturally sensitive spiritual care exists, which meets all levels of need. Further, Cancer Networks are required to develop guidance to inform the level of bereavement support provided and the need for follow up and specialist referral, particularly for those at risk of complicated grief reactions. Finally, the policy recognises that sensitive practice relating to spiritual and bereavement care is a concept that should prevail throughout the Cancer Network regardless of whether the patient has died following a cancer diagnosis. The purpose of this document is to set out the agreed approach to spiritual and bereavement care within the East Midlands Cancer Network (EMCN), and to specify the standard of care that should be achieved by organisations delivering such care. It seeks to inform commissioners who, working through cancer networks, should ensure that a range of spiritual care and bereavement services are in place to meet the spectrum of need. The policy applies to all providers of care within the network, and should be read in conjunction with the following: National Bereavement Consortium (2001) Bereavement Care Standards.UK Project NHS Chaplaincy meeting the religious and spiritual needs of patients and staff (November 2003) NICE Improving Supportive and Palliative Care for Adults with Cancer (2004) Cancer Reform Strategy (2007) National End of Life Care Strategy (2008) End of Life Care Strategy; quality markers and measures for end of life care (2009) Spiritual care matters NHS Scotland 2009 A study into implementing the Guidance for bereavement needs assessment in palliative care. Help the Hospices (2010) Spiritual Care at the End of Life A systematic review of the literature (2010) EMCN Key Worker Policy (2010) EMCN Holistic Needs Assessment (2010) Improving Outcomes: A Strategy for Cancer (2011) Guidance for staff responsible for care after death (Last Offices) (April 2011) When a Person dies Advice on developing Bereavement Services in the NHS Department of Health (expected June 2011) National Guidance on the Certification of Death (expected 2011) Spiritual Support & Bereavement care quality markers and measures for End of Life Care (expected 2011) The policy applies to adults aged 19 and above. It should be recognised that services also need to be available for children up to 18 facing bereavement. The Spiritual and 7

8 Bereavement Care needs of younger patients with cancer should be considered in accordance with the Association for Children s Palliative Care (ACT) Manifesto, 2010 Living Matters for Dying Children. Principles Underpinning Spiritual and Bereavement Care Services The following principles underpin the development of services and professional practice before, at the time of and after death. Service providers have and are encouraged to have local policies in place which support these principles. Respect for the individual Equity of provision Clear, sensitive and consistent communication with patients and their families leading up to death and afterwards Accurate, appropriate information provision for patients and their families Effort is made to conduct discussions in a private, conducive environment Health and safety of the patient, bereaved and of staff is maintained Practice is underpinned by core competencies with training and supportive programmes in place for health care professionals and unpaid staff Data is collected in order to monitor and evaluate outcomes leading to effective service improvement There are also a variety of research models which support these principles such as Neuman s model of holistic care (1995) and Holloway s fellow traveller narrative model (2010). 3. Network Policy for the Provision of Spiritual Care and Bereavement Support Spiritual Care The EMCN recognises that all people have a spiritual dimension relating to the meaning and purpose of their lives, irrespective of whether they have a structured faith or belief system. What is Spiritual Care? The EMCN Spiritual and Bereavement Care Executive Group regards spiritual care as holistic, person centred care which, through affirmation, enables a person to draw upon their personal and spiritual resources in their own way. In the health care setting, this involves helping people face and cope with the doubts, anxieties and questions which often accompany ill health, suffering and approaching death. It makes no assumptions about personal conviction or life orientation. Spiritual care is part of the work of all health care professionals, but in Hospitals and Hospices Chaplains, in particular, provide the professional lead for the spiritual dimension. Spiritual care is not necessarily religious and non religious spiritual care can also be accessed through the Chaplaincy service. The purpose of this definition is to 8

9 positively acknowledge and define the existence of the area of human spirituality including spiritual need and practice. The EMCN has identified the following as minimum standards for the delivery of effective spiritual care: 1. The nature of spiritual care may be ascertained from the patient/client themselves or as a result of the assessment process, for example, during the Holistic Needs Assessment (EMCN HNA Guidelines 2010). 2. An equitable approach which ensures people are treated with respect, dignity and compassion. 3. Access to written and/or internet based information e.g. Information Prescription about spiritual care service provision and how to access it, which is available in different formats and languages as needed. 4. A system in place that allows patients and carers a choice of spiritual care, be that formal or informal. 5. All staff and spiritual care givers should be supported by appropriate training, education and supervision. Resources are available for staff across the network on the My Learning Space website ( 6. Spiritual, religious and cultural core competencies are developed and in place. These are also available on the My Learning Space website. 7. Each provider, possibly in collaboration with partner healthcare organisations, should develop and implement a local spiritual care plan which outlines the necessary provision for the local community and which reflects the spiritual and religious needs of that community. 8. Health care Chaplaincy services take the ethnic and religious diversity of the local population into account, along with the spiritual needs of those with no religious conviction or affiliation. Chaplaincy services may increasingly need to interface with local communities but this will require additional resources to meet the proposed national quality markers. 9. Health and social care professionals have a responsibility to be aware of the spiritual care services available in their own area and how to access them. The EMCN endorses the following from the End of Life Care Strategy: It is important to consider the support, care and information that is required by the person s family and caregivers during illness and into bereavement. Similarly, spiritual care and support for both the person and their carers is integral to the end of life care pathway An assessment of spiritual needs, which is reviewed regularly, should be part of all patient and carer assessments Spiritual, religious and cultural core competencies should be adopted within all core training 9

10 Spiritual and religious care competencies EMCN also endorses the spiritual and religious care competencies for Supportive and Palliative Care competencies developed by Marie Curie Cancer Care and outlined in the NICE IOG (see Figure 1). Ideally these should be incorporated into organisations training and appraisal processes. The Spiritual Care Pathway There is no clearly defined pathway for spiritual care as it is recognised that patients and their families and carers may need this care at any point, from the diagnosis of their illness onwards, during survivorship and around the time of disease progression and death. Assessment and care planning are essential in ensuring access to responsive spiritual care. An example of a spiritual assessment tool is attached as Appendix 1. It should be carried out initially on admission, and then reviewed at appropriate intervals throughout their care pathway. The Liverpool Care Pathway (LCP) also offers an opportunity for reviewing spiritual care provision in the last days of life. 10

11 Fig 1: NICE Improving Supportive and Palliative Care for Adults with Cancer Spiritual and religious care competencies for Specialist Palliative Care Level 1 All staff and volunteers who have casual contact with patients and their families/carers This level seeks to ensure that staff and volunteers understand that all people have spiritual needs, and distinguishes between spiritual and religious needs. It seeks to encourage basic skills of awareness, relationships and communication, and an ability to refer concerns to members of the multidisciplinary team. Level 2 All staff and volunteers whose duties require contact with patients and their families/carers This level seeks to enhance the competencies developed at Level 1 with an increased awareness of spiritual and religious needs and how they may be identified and responded to. In addition to increased communication skills, identification and referral of difficult needs should be achievable, along with an ability to identify personal training needs. Level 3 Staff and volunteers who are members of the multidisciplinary team This level seeks to further enhance the skills of Levels 1 and 2. It moves into the area of assessment of spiritual and religious need, developing a plan for care and recognising complex spiritual, religious and ethical issues. This level also introduces confidentiality and the recording of sensitive and personal patient information. Level 4 Staff or volunteers whose primary responsibility is for the spiritual and religious care of patients, visitors and staff Staff working at Level 4 are expected to be able to manage and facilitate complex spiritual and religious needs in patients, families/carers, staff and volunteers. In particular, they will deal with the existential and practical needs arising from the impact on individuals and families of illness, life, dying and death. In addition, they should have a clear understanding of their own personal beliefs and be able to journey with others, focused on people s needs and agendas. They should liaise with external resources as required. They should also act as a resource for the support, training and education of health care professionals and volunteers, and seek to be involved in professional and national initiatives. 11

12 4. Network Policy for the Provision of Spiritual Care and Bereavement Support Bereavement Care What is Bereavement? Murray-Parkes (2001) defined bereavement as a state of loss resulting from death, and identified grief as the psychological and emotional reaction to bereavement. It is acknowledged that grief is a normal and expected response to loss, and that most people are able to adapt to their loss with no or minimal support or intervention. Mourning is also a normal part of the grieving process and is a component of the psychological adaptation process, often involving a degree of ritual and custom. According to Murray-Parkes, the majority of people will have an unproblematic mourning period, while some will need additional psychological support other than just information. A small minority, however, will require specific psychiatric/psychological therapy to cope with a major, destabilising crisis or serious mental health problem related to complex loss and bereavement issues. What is Bereavement Support? The EMCN Spiritual Care and Bereavement Support Executive Group regards Bereavement Support as the care and guidance offered to people, which helps them through common and more complicated mourning and grief. Depending on the assessed complexity of the bereavement, support might be offered through unplanned conversations with healthcare staff, the sensitive provision of written information, phone call contacts, home visits, group and/or one to one counselling. Bereavement care and support should ideally be pre-emptive, before the death of a patient. However, bereaved people may access services at any time after the death, and clear signposting to enable timely access to services is paramount. Delivering Bereavement Support The NICE Improving Supportive and Palliative Care for Adults with Cancer Guidance (2004) describes a three component model of bereavement support that should be implemented within each Cancer Network. This model will enable provider organisations to meet individual needs through a variety of mechanisms. Provider organisations should be able to offer Component 1 care, and should have access to Components 2 and 3 care when required. The model is underpinned by the provision of competency based training and education for the providers of care, and is demonstrated in Figure 2. 12

13 Fig 2: NICE Improving Supportive and Palliative Care for Adults with Cancer Three Component Model of Bereavement Support (2004) Component 1 Grief is normal after bereavement and most people manage without professional intervention. Many people, however, lack understanding of grief after immediate bereavement. All bereaved people should be offered information about the experience of bereavement and how to access other forms of support. Family and friends will provide much of this support, with information being supplied by health and social care professionals providing day-to-day care to families. Component 2 Some people may require a more formal opportunity to review and reflect on their bereavement experience, but this does not necessarily have to involve professionals. Volunteer bereavement support workers/befrienders, self help groups, faith groups, and community groups will provide much of the support at this level. Those working in Component 2 must establish a process to ensure that when cases involving more complex needs emerge, referral is made to appropriate health and social care professionals with the ability to deliver Component 3 interventions. Component 3 A minority of people will require specialist interventions. This will involve mental health services, psychological support services, specialist counselling/psychotherapy services, specialist palliative care services and general bereavement services, and will include provision for meeting the specialist needs of bereaved children and young people. It is recognised that bereavement support in the acute hospital setting offers practical support and signposting (Component 1). In other care settings the support tends to be longer term fulfilling all components of the model as required. Referral processes vary across the East Midlands. Health and social care professionals working within Component 1 have a responsibility to be aware of the Component 2 and 3 bereavement support services available in their own area and how to access them. The Bereavement Support Pathway The Pathway for bereavement support consists of: Assessment Bereavement care should ideally begin prior to the death of a patient, with those who will become bereaved undergoing assessment regarding their risks and the need for onward referral. The GSF and LCP are tools to help health and social care professionals undertake this process. The EMCN Holistic Needs Assessment (2010) may also support this. At this point, or as deemed appropriate, written information about bereavement and grief, and ways to access support should be provided. Various bereavement assessment tools are available from Help the Hospices and 13

14 other sources. An example of a post death bereavement tool is attached as Appendix 2 which can be used by health and social care practitioners from all Components as required, at an appropriate time to suit the bereaved. It is recommended that this type of tool is only used as a guide and that practitioners use their professional judgement when assessing the needs of the bereaved. This style of assessment should only be undertaken by an experienced practitioner who has experience of providing bereavement support and appreciates the sensitive nature of the situation. Referral The decision to refer on to a bereavement support service should be based on a Holistic Needs Assessment or a bereavement assessment. Those considered to be vulnerable or at risk of complicated grief should be referred to appropriate local services within 10 days following the assessment. Component 1 Requirements All provider organisations are equipped to offer Component 1 bereavement support, and have access to the other care components within their locality. 1. Each organisation will offer written information on bereavement and local bereavement support services around the time of the patient s death, which will be given as appropriate. Such information should ideally be delivered through an Information Prescription, in line with national policy ( A record of information given should be retained to facilitate regular audit, for example in the patient s notes, or Liverpool Care Pathway documentation. Wherever possible a copy of the Information Prescription should be kept in the patient s notes, and will be evidence of the offer and provision of such information. 2. Each organisation should undertake at least bi-annual surveys of the experience of bereaved relatives and carers. 3. A named lead within each locality should ensure that the Locality Bereavement Directory remains contemporary and is accessible to all the health and social care professions who may need it. 4. Appropriate support and supervision should be available to heath and social care staff affected by loss and bereavement issues encountered in their work. Component 2 Requirements 1. Where possible, people who are about to become bereaved will undergo an assessment for their risk of grief reactions, using a recognised tool or the Holistic Needs Assessment. The Key Worker (refer to EMCN Key Worker Policy 2010), is ideally placed to undertake this assessment. 2. Component 2 services will be proactive in contacting those identified to be vulnerable or at risk with a letter or telephone call around six to eight weeks after the death. 3. The service will be staffed by those who have undergone formalised training in the delivery of bereavement care, whether paid or unpaid. This training should also include instruction regarding local policies and procedures and meet 14

15 individual learning needs. Resources are available on the My Learning Space website ( 4. The service will be responsive to the age, cultural, disability and gender issues affecting bereavement and will have processes in place to ensure that specific cultural and religious beliefs are respected. Access to advocacy and interpreting services should be available as appropriate. 5. Each service will use their systematic assessment process with relevant documentation. 6. Client consent must be gained before further referral on to more appropriate services. 7. Clients will be discharged according to local service policies. 8. Activity data and audits of uptake and user satisfaction should be maintained and shared with commissioners and providers at least annually. Examples of Bereavement Service surveys are provided as Appendix 3 & It is recognised that each service will vary in relation to the assessment process and operational service delivery. Audit tools to assist providers to evaluate their overall service can be found on the Help the Hospice website as outlined in Appendix 5. Component 3 Requirements 1. Component 3 care is undertaken by specialist services such as psychological support and mental health services. An individual disclosing suicidal intent or behaviour must be referred to their GP or local Mental Health Service immediately with their knowledge and this will be formally documented. 2. Individuals requiring specialist intervention such as psychological support services or specialist counselling/psychotherapy services should be offered a GP referral or given information on other service providers. Again, this will be formally documented. 3. Specialist bereavement services must be sufficiently resourced to enable them to contribute to the preparation and ongoing support of health and social care professionals who encounter loss and bereavement issues in their work. Bereavement Services Provided within the East Midlands Cancer Network Information about current bereavement services provided within the East Midlands Cancer Network is available on the East Midlands Cancer Network website ( via links to the individual organisations, and NHS Choices. This approach has been taken to ensure that the information remains correct and up to date. Outside of the inpatient and hospice setting, the EMCN recommends that GPs: 1. Send a letter offering the opportunity to discuss the bereaved person s needs in relation to bereavement support within eight weeks of a death. (An example is provided as Appendix 6). 2. GPs signpost the bereaved to appropriate services utilising the website if necessary. 3. Adopt the Gold Standards Framework as a mechanism for care provision. 15

16 5. References Association for Children s Palliative Care (ACT) (2010). Manifesto Living Matters for Dying Children Department of Health (2003) NHS Chaplaincy: Meeting the religious and spiritual needs of patients and staff Department of Health, (2005). When a patient dies Advice on Developing Bereavement Services in the NHS. Department of Health (2007). Cancer Reform Strategy Department of Health (2008). End of Life Care Strategy Department of Health (2009). End of Life Care Strategy: quality markers and measures for end of life care Department of Health (2011). Improving Outcomes: A Strategy for Cancer Department of Health (2010) Spiritual Care at the End of Life A systematic review of the literature East Midlands Cancer Network (2010). Holistic Needs Assessment East Midlands Cancer Network (2010). Key Worker Policy Help the Hospices (2010). A study into implementing the Guidance for bereavement needs assessment in palliative care Holloway, M & Moss, B (2010), The Fellow Traveller model for spiritual care, in Spirituality and Social Work, 1 st Edition, Palgrave Macmillan Murray Parkes, C. Bereavement. Oxford Textbook on Palliative Medicine (2001) National Bereavement Consortium (2001). Bereavement Care Standards Project National End of Life Care Programme (2011) Guidance for staff responsible for care after death (last offices) National Institute for Clinical Excellence (NICE) (2004). Improving Supportive and Palliative Care for Adults with Cancer Neuman, B (1995), The Neuman Systems Model, 3 rd Edition, Norwalk: Appleton & Lange NHS Education for Scotland (2009) Spiritual Care Matters: An Introductory Resource for all NHS Scotland Staff 16

17 Appendices Appendix 1 - Spiritual Care Assessment Tool Appendix 2 - Post Bereavement Assessment Tool Appendix 3 & 4 - Bereavement Service Questionnaires Appendix 5 - Bereavement Support Service Audit Tool (Help the Hospices) Appendix 6 - GP Condolence Letter Template 17

18 Appendix 1 Spiritual Care Assessment Tool (DRAFT) Specialist Assessment and Care Pathway Spiritual Care (This template should only be used if this aspect of care is not covered in the Essence of Care Plans 1-8) Dignity Statement and Outcome Each patient is afforded the dignity of having their spiritual needs assessed and met. By addressing the patient s spiritual needs, holistic care is delivered, spiritual distress is attended to, and the patient is helped towards the goal of spiritual well-being. All patients spiritual needs will be assessed. Patient Details (affix Sticky Label) Date Active: Initial: Spiritual Care Assessment : Initial: Date Inactive: The patient is given the opportunity to discuss what is important to them at this time, e.g. their wishes, feelings, faith, beliefs, values etc. Working through these groups of questions will enable you as an Healthcare Professional to undertake an initial Spiritual Assessment: 1 Assessment of Spiritual Need: (i) Is there anything you do not understand or you would like more information about? (ii) What has changed in your life since you became unwell? (e.g. work, relationships, daily routine, leisure activities) (iii) Do you have a faith or belief? Would you like us to contact anyone for you? Do you have any special requirements for your diet, clothing or routine? Revd. Tim Couchman and Canon Jeremy Pemberton, United Lincolnshire Hospitals NHS Trust June

19 Date Active: Initial: Spiritual Care Assessment : Initial: Date Inactive: 2 Recognition of Spiritual Distress: (i) Does anything worry you e.g. about being in hospital? About what s brought you into hospital? About tests you may require? (ii) Who or what is most important to you? (iii) Is there anything concerning you about the people close to you family, friends or pets, or about your relationships? 3 Moving towards Spiritual Well-Being: (i) Are there things that you would like to be able to observe / practice while you are in hospital, that will help your sense of spiritual wellbeing? (e.g. using a quiet room, meditating, prayer, other spiritual practices) (ii) Would you like to talk to a Hospital Chaplain? (You don t have to be religious to see a Chaplain! Our Chaplains are here to listen and you can talk about anything you wish with them). Spiritual Care Pathway: The patient and/or their next of kin would like: Item Date Sig Item Date Sig Special Diet Needs relating to modesty/clothing Literature Patient pastoral support Outside faith community Family/friends pastoral support referral Access to quiet facilities Bereavement support EOL support Religious practices Other support (specify below) 19

20 If you are unable to meet the identified spiritual need, please contact one of the colleagues noted below: Item Referral point Referral date Diet (religious) Dietician/Chaplaincy Literature (all faiths) Chaplaincy Religious ritual (all faiths) Chaplaincy Referral to outside faith Chaplaincy community Access to room for Chaplaincy quiet/prayer Modesty/clothing Family/Chaplaincy End of Life Support Chaplaincy Bereavement support Chaplaincy/Bereavement Services Pastoral support (all faiths Chaplaincy and none) Pastoral support for Chaplaincy family/friends and staff If you require further professional support from the local Chaplaincy team, please contact the Switchboard in an emergency, or contact the Chaplaincy Office for less urgent matters Sig 20

21 Patient Details (affix Sticky Label) Date Active: Initial: History Sheet: Initial: Date Inactive: 21

22 Appendix 2 Post Bereavement Assessment Tool This style of assessment should only be undertaken by an experienced practitioner who has experience of providing bereavement support and appreciates the sensitive nature of the situation. (see page 14 above) Title of Deceased: First Name: Surname: Date of Death: Place of Death: Name of Bereaved Client: Age: GP Name: Telephone: Address of Bereaved Person: (please include postcode) Telephone: Relationship to deceased: Bereavement Information given: YES NO Has the bereaved requested no further contact? (Please tick) YES Other family members who may require support: (Please use separate risk assessment) BEREAVEMENT PROFILE 1. The Death Please circle one option for each question Did the death occur with little warning? YES NO UNSURE Was the death particularly distressing YES NO UNSURE for the bereaved? Was the death a suicide? YES NO UNSURE Has the death resulted in the loss of a YES NO UNSURE primary caregiver/provider of emotional support? Is this the death of a child/sibling? YES NO UNSURE NO Was the death preceded by a long term illness or requiring extensive support? 2. The Bereaved Person Was the bereaved reluctant to face the illness or death? YES NO UNSURE YES NO UNSURE Adapted from an assessment tool cited in Mount Vernon Cancer Network s Bereavement Policy and includes comments added to page 14 22

23 Is the bereaved the primary caregiver for YES NO UNSURE a dependent family? Does the bereaved have a history of YES NO UNSURE mental illness? Is there a history or suspicion of YES NO UNSURE alcohol/drug dependency? Is there a loss of financial provision? YES NO UNSURE Is the bereaved experiencing high levels of anxiety/stress? Are there concerns relating to self harm? Did the bereaved have an ambivalent relationship with the deceased? Was the bereaved unusually dependent or clinging to the deceased? Is the bereaved unable to self care adequately? Has the bereaved suffered any other significant losses? Are there concurrent life crises e.g. divorce or redundancy? Is there chronic illness in the bereaved person s home? Does the bereaved have a poor social support system? Is there an actual or perceived risk of loss of the bereaved person s home? Is poor familial communication a feature? Did the deceased die in a place or manner unacceptable to the bereaved? Are there any dependents in the immediate family? Scoring: YES =2 NO = 0 UNSURE = 1 YES NO UNSURE YES NO UNSURE YES NO UNSURE YES NO UNSURE YES NO UNSURE YES NO UNSURE YES NO UNSURE YES NO UNSURE YES NO UNSURE YES NO UNSURE YES NO UNSURE YES NO UNSURE YES NO UNSURE Component of support required: (See Fig 1 overleaf for details) Score of 0-10 = Component 1 Score of = Component 2 Score of 16+ = Component 3 Score Date of Scoring: Actions Taken: Signature: Date for Re-Assessment (If appropriate/necessary): Please send form to: (e.g. GP, Bereavement Service Acute Trust/Hospice): 23

24 NICE Three Component Model of Bereavement Support Fig 1: NICE Improving Supportive and Palliative Care for Adults with Cancer Three Component Model of Bereavement Support (2004) Component 1 Grief is normal after bereavement and most people manage without professional intervention. Many people, however, lack understanding of grief after immediate bereavement. All bereaved people should be offered information about the experience of bereavement and how to access other forms of support. Family and friends will provide much of this support, with information being supplied by health and social care professionals providing day-to-day care to families. Component 2 Some people may require a more formal opportunity to review and reflect on their bereavement experience, but this does not necessarily have to involve professionals. Volunteer bereavement support workers/be-frienders, self help groups, faith groups, and community groups will provide much of the support at this level. Those working in Component 2 must establish a process to ensure that when cases involving more complex needs emerge, referral is made to appropriate health and social care professionals with the ability to deliver Component 3 interventions. Component 3 A minority of people will require specialist interventions. This will involve mental health services, psychological support services, specialist counselling/psychotherapy services, specialist palliative care services and general bereavement services, and will include provision for meeting the specialist needs of bereaved children and young people. 24

25 Appendix 3 Bereavement/Family Support Service 1:1 Evaluation In order to ensure we offer the best possible service, we ask everyone who receives our service to complete a questionnaire. We will use the information you provide to ensure you have received the best possible care and to help us plan future services. Please be honest in your answers. Thank you for your time. 1. How did you find out about the Bereavement/Family Support Service? Referred by Health Care Professional Referred by family / friends They contacted me by phone Other (please specify) We would like to know if you received this type of support at the right time for you? Thinking back to when 1:1 support was first offered to you, was the timing of this: Too Just Too Early Right Late Please comment:

26 3. The aim of this service is to support you during this time, which we recognise is difficult for you. Has this service made this experience of bereavement more or less bearable for you? More No Less Bearable Difference Bearable Please comment: Where did you receive 1:1 support? Home In Patient Unit Hospice counselling room Other (please specify) Was the venue where you received this service appropriate? Yes No Don t Know Please comment: How do you find the length of each session? Too Just Too Short Right Long Please comment:

27 7. If you ended your 1:1 support because you did not feel it was working for you, was this because: I could not relate to my volunteer / counsellor I didn t like the venue It made me feel worse Other (please specify) Please note: If you ended your session because you could not relate to your volunteer / counsellor, we are able to provide you with another worker. Please contact if you would like to discuss this. 8. What has been most helpful? What has been least helpful? Any other comments? Many thanks for your time and input. 27

28 Appendix 4 - Bereavement Service Questionnaire To improve our service, we would really appreciate your time in completing this questionnaire. Your assistance would be invaluable in helping us to achieve a personal and caring service. The information will be treated in confidence. A stamped-addressed envelope is enclosed for your convenience. Initial Contact: How useful did you find the first contact with the service that you received? Please rate using the scale 0 8 (With 0 = Very Poor and 8 = Excellent) What improvements could be made? How useful did you find your first contact with our services? Please rate using the scale 0 8 (With 0 = Very Poor and 8 = Excellent) What improvements could be made? Counselling/Support: How helpful did you find the counselling/support? Please rate using the scale 0 8 (With 0 = Very Poor and 8 = Excellent)

29 What helped you the most? What helped you the least? Was there anything that your Counsellor/Bereavement Supporter could have done differently that would have been more helpful? When your sessions ended, please indicate which option was the reason for this: 1. By mutual consent? 2. Counsellor s decision? 3. Your decision? 4. Other? Please state: How has your life changed as a result of counselling? Any other comments? Thank you very much for taking the time to complete this questionnaire. 29

30 Appendix 5 Bereavement Support Service Audit Tool A Bereavement Support Service audit tool has been developed by Help the Hospices National Audit Tools Group (NATG) to enable hospices to provide evidence to the Care Quality Commission that the management of their service is compliant with current law and regulations and is in accordance with best practice. It can be accessed via the following link once an audit tool account has been obtained (if you are not already a member): This audit tool provides a systems audit of the bereavement support service. A separate NATG audit tool on bereavement provision and care is being developed. The Bereavement Support Service tool covers six sub-topics: Sub-topic 1: Policy and Procedures Sub-topic 2: Confidentiality and Record Keeping Sub-topic 3: Personnel Sub-topic 4: Training Sub-topic 5: Information Provision Sub-topic 6: Service Evaluation 30

31 Appendix 6 - Template for GP Condolence Letter Date Title, First Name, Last name Address line 1 Address line 2 Town County Postcode Dear (Insert Title & Last Name) On behalf of (Insert Name of Surgery) we would like to offer you our sincere condolences following the death of (relation e.g. your Husband and First Name). The death of someone close can be one of the greatest challenges you will ever have to face. This may affect you in several ways, for example emotionally, physically or socially, and possibly may affect many practical aspects of your life. Grieving is a normal process and people react differently and in their own way to this. It is important to remember to take care of yourself, and talk to family and friends if possible, although sometimes this is not easy to do. Do talk with your own GP about any health worries you might have. There are also a number of local support organisations which you may find helpful. We are able to give you information about these if you so wish. In addition, you may find the information on the Information Prescriptions website ( helpful. Nationally, Cruse Bereavement Care is the leading bereavement charity in the UK. Its website offers help, support and a list of local branches: Marie Curie Cancer Care offers a booklet on Bereavement and helping you to deal with the death of someone close, and is available at: If there are any practical information, advice and support issues that you may require, please contact (Insert Name) who will do their best to assist you. Kind regards (Insert Name of Surgery and Name of sender of letter) 31

32 unlock better care East Midlands Cancer Network 2010