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| Professor David Kissane |
Supporting families of patients with advanced cancer and
assisting them in bereavement is an important clinical goal for oncology and mental
health professionals.
For the first time, research at Monash University shows that
Prolonged Grief Disorder, a common form of complicated grief that brings
substantial burden and distress to the bereaved, can be prevented with early
introduction of high quality, family supportive therapy.
Published last week in the prestigious Journal of
Clinical Oncology, the randomised controlled trial shows that
family-focused therapy delivered to high-risk families during palliative care
and continued into bereavement reduced the severity of complicated grief and
the development of prolonged grief, a disorder affecting up to 20% of the
bereaved.
“Rather than clinical services responding to family distress
using a crisis model—which commonly happens today—this new model of care
provides continuity of care by the psycho-oncologist, a social worker,
psychologist or family counsellor, as the cancer is treated,” said lead author
Professor David Kissane, Head of Department of Psychiatry at Monash University.
Professor Kissane said that bereavement care is not the
'Cinderella' add-on after death, but rather integrated into a comprehensive
care paradigm during the treatment of advanced cancer.
Through the use of a simple screening tool, at-risk families
can be identified in this cost-effective model of care.
“In our study, the rate of prolonged grief disorder at 13
months post death was 15.5% for family members who received standard care,
whereas this rate significantly reduced to 3.3% among families who received
family-supported care in the form of 10 family therapy sessions,” said
Professor Kissane.
“We know that families who communicate poorly, display
unbridled conflict or have low levels of involvement with each other, prove
predictive of the development of prolonged grief disorder or depression in
bereavement.”
“These same characteristics of family relationships prove
challenging to clinical teams striving to care for the patient with cancer, and
clinicians are often at a loss as to how best to help these families.”
According to eminent British
psychiatrist Dr Colin Murray Parkes OBE, Prolonged Grief Disorder (PGD) is the
most frequent and challenging form of complicated grief.
“PGD is clinically distinct from
major depression and resistant to traditional therapies,” said Dr Parkes.
“This important new study provides
evidence supporting the use of Family-Focussed Grief Therapy for PGD, it
extends our understanding of the care needed by families at risk,
before as well as after bereavement.”
The model of care reported in this study delivers family
support via a series of six to ten family meetings across 12-18 months.
Cornell University’s Irving
Sherwood Wright Professor of Geriatrics Holly Prigerson has spent decades studying families
struggling to care for a dying loved one.
“The data
highlight how family conflict influences the plight, care and bereavement
adjustment of all involved, and the need for a family-focused intervention is
serious,” said Professor Prigerson, Director, Centre for Research on End of
Life Care.
“Professor
Kissane’s Family-Focused Grief Therapy is a novel and very welcome addition to
clinical care of terminally ill patients and the family members who survive
them into bereavement.”
“Not only is it likely to ease the
mental anguish of bereaved survivors, but also the pain and suffering of the
patient and his or her care providers,” said Dr Prigerson.
Facing
advanced cancer and bereavement is very stressful for all families, with 20% of
families struggling long term.
“This study
explores the value of social workers offering family therapy interventions for
at-risk families who have high conflict and low communication and found that
the intervention resulted in real gains for this group,” said Ms Glenda Bawden,
Head of Social Work at Monash Health.
“Such evidence allows social workers to confidently initiate family
therapy as a helpful intervention to those most at risk of complicated grief.”
CEO of
Palliative Care Victoria Ms Odette Waanders said this seminal research
highlights important policy and practice opportunities to improve the way we
support ‘difficult families’ during end of life care and how we can reduce the
longer-term negative (personal, social and economic) impacts of complex grief.
