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

Article excerpt

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 a joint effort between the staff and volunteers of the Victoria Hospice Society, Victoria, BC, in operation since 1980, and three talented clinicians with a background in counseling, palliative care, and bereavement. The staff at the Victoria Hospice has been actively involved, provincially and nationally, in the development of a number of initiatives for palliative care training, advocacy and research, the latter being the 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 the psychosocial needs and care of individuals who are dying or bereaved, with the ultimate goal being the improvement of the 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 the human context behind these issues. "My own voice" presents personal stories and insights of individuals other than the authors regarding the care for dying patients. "Perspective" sections address important and overarching topics relevant to most transitions. The book starts with principles of palliative hospice care, a description of the Victoria Hospice's program and team, key concepts, and the framework and a model used to organize the book (Chapter 1). Bates's (1993) definition of psychosocial domain is used to set the scope of the 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 the field by the authors or others to develop standardized psychosocial assessment instruments to be used during palliative care and bereavement.

The framework for palliative care is provided by the Palliative Performance Scale (PPSv2), and the model of grief is based on Rando's (1984) phases of grief and Worden's (1992) grief's tasks. A metaphor of the last journey through life is used along with the PPSv2 to discuss transitions in palliative care and the metaphor of walking through a labyrinth is used to represent the bereavement journey toward healing after the loss. The PPSv2 is recommended as the tool to assess patients who are dying.

PPSv2 is an unpublished version of the 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 the book (or in its web site reference) about whether this or the original version is reliable and valid. The original PPS (Anderson et al., 1996) and the PPSv2 only assess general physical functioning, mobility, intake, and conscious level. Based on their extensive clinical experience, in Chapter 2 the authors describe psychosocial issues arising during the dying journey, discuss the importance of psychosocial assessment, and suggest assessment questions to ask. For a psychosocial guide on palliative care, it is unfortunate that the issues related to standardized psychosocial assessments are not discussed, as it would be useful to reflect on the stage of scientific validity of the palliative care field in general.

The chronicity of the disease and its recurrence, which is appropriately called "the path not chosen," along with the worst fears facing families are described in Chapter 3. …