Review of Transitions in Dying and Bereavement: A Psychosocial Guide for Hospice and Palliative Care.

Abstract

THE VICTORIA HOSPICE SOCIETY MOIRA CAIRNS, MARNEY THOMPSON, and WENDY WAINWRIGHT Transitions in Dying and Bereavement: A Psychosocial Guide for Hospice and Palliative Care Baltimore, MD: Health Professions Press, 2003, 408 pages (ISBN 1-87881-292-0, US$44.95 Paperback) This psychosocial guide book for hospice and palliative care represents joint effort between staff and volunteers of Victoria Hospice Society, Victoria, BC, in operation since 1980, and three talented clinicians with background in counseling, palliative care, and The staff at Victoria Hospice has been actively involved, provincially and nationally, in development of number of initiatives for palliative care training, advocacy and research, latter being weakest of their initiatives. The main objective of this book was to describe what palliative and bereavement counselors do and how they do it. The specific goal was to examine psychosocial needs and care of individuals who are dying or bereaved, with ultimate goal being improvement of quality of palliative psychosocial care services. Each chapter addresses significant transitions, identifies psychosocial issues that patients and fami lies may face, addresses team issues, and suggests tips and interventions. case studies provide human context behind these issues. My own voice presents personal stories and insights of individuals other than authors regarding care for dying patients. Perspective sections address important and overarching topics relevant to most transitions. The book starts with principles of palliative hospice care, description of Victoria Hospice's program and team, key concepts, and framework and model used to organize book (Chapter 1). Bates's (1993) definition of psychosocial domain is used to set scope of area, encompassing emotional, intellectual, spiritual, interpersonal, social, cultural and economic dimensions of dying and bereavement. In Chapter 2, they discuss psychosocial assessment and provide questions for conducting such assessment. They state that psychosocial assessments provide a core standardized reference information regarding patients... Unfortunately, no information is provided regarding current attempts in field by authors or others to develop standardized psychosocial assessment instruments to be used during palliative care and The framework for palliative care is provided by Palliative Performance Scale (PPSv2), and model of grief is based on Rando's (1984) phases of grief and Worden's (1992) grief's tasks. A metaphor of last journey through life is used along with PPSv2 to discuss transitions in palliative care and metaphor of walking through labyrinth is used to represent bereavement journey toward healing after loss. The PPSv2 is recommended as tool to assess patients who are dying. PPSv2 is an unpublished version of Palliative Performance Scale (Anderson, Downing, Hill, et al., 1996). Although The PPSv2 is recommended to assess patients who are dying, no information is provided in book (or in its web site reference) about whether this or original version is reliable and valid. The original PPS (Anderson et al., 1996) and PPSv2 only assess general physical functioning, mobility, intake, and conscious level. Based on their extensive clinical experience, in Chapter 2 authors describe psychosocial issues arising during dying journey, discuss importance of psychosocial assessment, and suggest assessment questions to ask. For psychosocial guide on palliative care, it is unfortunate that issues related to standardized psychosocial assessments are not discussed, as it would be useful to reflect on stage of scientific validity of palliative care field in general. The chronicity of disease and its recurrence, which is appropriately called the path not chosen, along with worst fears facing families are described in Chapter 3. …