Post-Mortem Expressions of Compassion: A Secondary Qualitative Analysis of Family and Clinician Experiences of Sympathy Cards in the 3 Wishes Project​
CCCF ePoster library. Takaoka A. Nov 7, 2018; 233388; 17
Ms. Alyson Takaoka
Ms. Alyson Takaoka
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Abstract
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Introduction

Expressions of sympathy from clinicians may be welcome for grieving family members of patients who die in the intensive care unit (ICU). However, a recent randomized controlled trial evaluating a semi-structured condolence letter in France suggested increased symptoms of depression and post-traumatic stress amongst recipients1

 

Objectives

To explore clinician and family member experiences of sending or receiving hand-written sympathy cards after death in the ICU nested within the 3 Wishes Project which seeks to honour patients at the end of life. This clinical and research program originating at St Joseph’s Healthcare Hamilton (SJH) is also operating at Vancouver General Hospital (VGH), St. Michael’s Hospital in Toronto and Ronald Reagan UCLA Medical Center in the United States.  

 

Methods

A core component of the 3 Wishes Project is an invitation for nurses, physicians, physiotherapists and respiratory therapists- both staff and trainees alike- to write a few words to bereaved family members in a sympathy card, mailed 1-2 weeks after each death. For this analysis, we searched a qualitative database of 200 clinician and family interview transcripts. Data related to sympathy cards were independently coded by 2 investigators using conventional content analysis and a list of codes was developed by consensus.  

 

Results

We identified 27 transcripts from individual interviews (n=14 family members, n=11 clinicians) and 2 focus groups (n=8 clinicians) in which sympathy cards sent by the 3 Wishes Program were discussed in 3 participating centers (SJH, VGH, UCLA). In 16 (59.3%) transcripts, participants spontaneously discussed sympathy cards. In 11 (40.7%) transcripts, participants were explicitly asked to reflect on their experiences sending or receiving sympathy cards. 

 

Family members felt deeply touched by personalized messages in the cards and saw them as a heartfelt act of compassion by the ICU team. The cards were a welcome surprise and offered an appreciated connection to clinicians with whom they had a relationship. Families reported feeling warmly remembered and they were eager to tell their relatives, friends and other hospital staff about receiving the card.

 

Clinicians viewed the cards as an opportunity to offer expressions of their shared humanity with families, reminding them that they and their loved one were not forgotten. Most staff were keen to write a few words to families of patients they cared for who they knew well enough to authentically express their sorrow. While some staff preferred to pen a message only if they directly cared for the patient, others were motivated to offer sentiments of condolence if they had a brief interaction with the patient or knew them indirectly through seeing their family in the ICU. Taking the time to discuss memories of a deceased patient in the company of a colleague offered an opportunity for reminiscing and closure.

 

A unifying concept was that both family members and clinicians experienced sympathy cards as an important continuation of care extended to family members of deceased ICU patients. Sympathy cards symbolized a special post-mortem connection for both parties. 

 

Conclusions

Family members found sympathy cards to be a meaningful, compassionate gesture by the ICU team. Inviting staff who cared for deceased patients to offer personalized condolences in a card mailed to bereaved family members may foster sincere, valued expressions of sympathy when individualized and unstructured, as contextualized in the 3 Wishes Program.

 


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