Seeking Therapeutic Closure: The Condolence Program

• Published in: Journal of pain and symptom management Vol. 69; no. 5; pp. e492 - e493
• Main Authors: Malik, Nasreen Bagwan, Ibanez, Laura, Zbyrko, Andrew
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01.05.2025
• Subjects: Anesthesia; Interdisciplinary Teamwork; Pain Medicine; Professionalism; Professionalism; Interdisciplinary Teamwork
• ISSN: 0885-3924
• DOI: 10.1016/j.jpainsymman.2025.02.129

1. By demonstrating lack of universal care models to address patient transitions participants will be able to self-report the importance of continuity of care for patients at the end of their life. 2. Utilizing a collaborative approach with the interdisciplinary team, in creating a care model, participants will self-report the ability to implement and integrate bereavement services as a standard operating procedure of their ambulatory palliative care programs. Hospital based bereavement programs require trained personnel, resources and offered on an ad-hoc basis. We describe an interdisciplinary team driven condolence program offered by the ambulatory palliative care team which provides patients with continuity of care, sense of nonabandonment as well as therapeutic closure to long term relationship as patients transition into hospice or die in the hospital. Outpatient palliative care team often develop long term relationships with their patients, supporting them throughout their journey of serious illness. This continuity is often disrupted during episodes of acute illness requiring hospitalization, ultimately resulting in their demise or transition to hospice. Although highly recommended, bereavement support programs are often on a ad-hoc basis and insufficiently resourced (1). Families tend to struggle with a feeling of abandonment by their palliative care team, as well as the care team struggles with lack of closure during these transitions. Intervention: We created an ambulatory condolence program, which was led by our interdisciplinary team. Patients established with the palliative care program were tracked on a biweekly basis by the nurse coordinator, as patients got hospitalized within the health system. When the patient transitions to hospice or dies in the hospital, palliative care clinician, chaplain and social work are notified. Chaplain and Social worker make phone calls within the after two weeks of this transition to acknowledge the patient's death or impending demise, assess coping, inquire about support, and provide bereavement resources. Follow up phone calls are made to patient and family if patients continue to remain on hospice. Condolence cards are sent with requested resources. Patient feedback is discussed during "The Pause" (ritual to remember those who have died), as the care team shares their individual patient experiences. Conclusions: A condolence program addresses the unmet need of continuity of care for the patients as well as the care teams as they transition to hospice or die in the hospital. It improves patient/family satisfaction and reduces their feeling of abandonment by their clinicians. It provides closure in therapeutic relationships and decreases risk of detachment and burnout amongst the care team members (2). It can be easily implemented with minimal personnel in a resource limited setting. 1. Boven C, Dillen L, Van den Block L, Piers R, Van Den Noortgate N, Van Humbeeck L. In-Hospital Bereavement Services as an Act of Care and a Challenge: An Integrative Review. J Pain Symptom Manage. 2022 Mar;63(3):e295-e316. doi: 10.1016/j.jpainsymman.2021.10.008. Epub 2021 Oct 22. PMID: 34695567. 2. Back AL, Young JP, McCown E, et al. Abandonment at the End of Life From Patient, Caregiver, Nurse, and Physician Perspectives: Loss of Continuity and Lack of Closure. Arch Intern Med. 2009;169(5):474–479. doi:10.1001/archinternmed.2008.583