Contextual determinants of guideline-based family support during end-of-life cancer care and subsequent bereavement care: A cross-sectional survey of registered nurses

Marco Riguzzi; Qëndresa Thaqi; Anja Lorch; David Blum; Simon Peng-Keller; Rahel Naef

doi:10.1016/j.ejon.2024.102555

Contextual determinants of guideline-based family support during end-of-life cancer care and subsequent bereavement care: A cross-sectional survey of registered nurses

Eur J Oncol Nurs. 2024 Mar 27:70:102555. doi: 10.1016/j.ejon.2024.102555. Online ahead of print.

Authors

Marco Riguzzi¹, Qëndresa Thaqi², Anja Lorch³, David Blum⁴, Simon Peng-Keller⁵, Rahel Naef²

Affiliations

¹ Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Universitaetstrasse 84, 8006 Zurich, Switzerland; Centre of Clinical Nursing Science, University Hospital Zurich, Sonnentalstrasse 25, 8600 Dübendorf, Switzerland. Electronic address: marco.riguzzi@uzh.ch.
² Institute for Implementation Science in Health Care, Faculty of Medicine, University of Zurich, Universitaetstrasse 84, 8006 Zurich, Switzerland; Centre of Clinical Nursing Science, University Hospital Zurich, Sonnentalstrasse 25, 8600 Dübendorf, Switzerland.
³ Department of Medical Oncology and Haematology Clinic, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.
⁴ Competence Centre for Palliative Care, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091 Zurich, Switzerland; Centre for Palliative Care, City Hospital Zurich, Tièchestrasse 99, 8037 Zurich, Switzerland.
⁵ Spiritual Care, Faculty of Theology, University of Zurich, Kirchgasse 9, 8001 Zurich, Switzerland.

PMID: 38626610
DOI: 10.1016/j.ejon.2024.102555

Abstract

Purpose: In end-of-life cancer care, 10-20% of bereaved family members experience adverse mental health effects, including prolonged grief disorder. Despite great efforts, evidence-based recommendations to support their grieving process and well-being are often not successfully adopted into routine clinical care. This study identified facilitators and barriers using implementation science methodology.

Methods: 81 registered nurses working in cancer care from four hospitals and three home care services in Switzerland assessed their current family support practices in end-of-life care and bereavement care. They then assessed organisational attributes of their institution and their own individual characteristics and skills regarding literature-based factors of potential relevance. Facilitators and barriers to guideline-based family support were determined using fractional logistic regression.

Results: Service specialisation in palliative care, a culture that supports change, the availability of family support guidelines, billing/reimbursement of bereavement support services, and individual knowledge of family support and skill were systematically associated with higher adoption of guideline-based family support practices. Lack of privacy with families and insufficient training acted as significant barriers.

Conclusions: While several potentially relevant factors have emerged in the literature, certain organisational and individual determinants actually empirically predict guideline-based family support according to nurses in end-of-life cancer care, with some determinants having much stronger implications than others. This provides crucial guidance for focussing quality improvement and implementation efforts through tailored strategies, especially with scarce resources. Furthermore, adoption is lower in bereavement care than in end-of-life care, suggesting a particular need for supportive organisational cultures including specific training and billing/reimbursement options.

Keywords: Bereavement; Cancer care; Community care; Contextual determinants; End-of-life care; Family support; Guideline-based practices; Hospitals; Implementation research; Nurses.