A review of bereavement care at SickKids was initiated in 2009 with the creation of the Bereavement Task Force. The aim of the review has been to conduct a thorough examination of current bereavement practices at the hospital, to undertake an external survey of best practices in bereavement care, and to make recommendations for enhancements to existing practices where appropriate.
This report details key findings of the Task Force, including existing best practices and areas where enhancements will result in improved patient and family care outcomes. Recommendations put forward in the report are informed by the findings of the review. They seek to address some of the identified gaps and to ensure that the standard of bereavement care is consistent across the hospital and with best practices.
The review undertaken by the Bereavement Care Task Force included a comprehensive examination of existing practices and resources at the hospital, as well as an external survey of best practices and a literature review. Staff from across the hospital and across disciplines were interviewed, including: doctors, nurses, social workers, psychologists, bereavement coordinators, members of the palliative and bereavement care team, chaplains, members of the protection and transport services, child life specialists, members of the division of pathology, and representatives from the Coroner’s Office. Staff were interviewed about current bereavement practices, standards, policies, and protocols.
Staff were also asked to identify families who had experienced the death of a child to be interviewed. Ten families from varying programs and clinical areas across the hospital were interviewed. Six of the interviews were conducted in person; four were conducted by telephone. All of the families interviewed had experienced the death of a child within the past three years, and the ages of the children at time of death ranged from three weeks to 16 years. The families came from diverse backgrounds, and one family required interpreter services to complete the interview. Families were asked to share their experience of bereavement care at the hospital. The interviews were guided by pre-established questions and prompts.
This report describes the work and findings of the Bereavement Care Task Force with regard to the current state of bereavement care at SickKids, as well as current thinking and evidence on bereavement care best practices. Both the strengths and gaps, with respect to the bereavement care being provided at the hospital, have been investigated and documented.
The report recognizes that families value many of the existing bereavement practices, such as legacy creation, follow-up, active support, and timely and compassionate communication. It also indicates that there are considerable and
problematic inconsistencies in the quality of bereavement care being provide to children and families. Additionally, other insights, such as the need for support for staff who are impacted when a child dies, have surfaced as a result of the work.
Based on these findings, the report offers a number of recommendations that seek to build on successes and strengths, while addressing identified gaps and inconsistencies. Where possible, the Task Force has already begun implementing
recommendations, such as building closer working relationship with the Coroner’s Office. A key recommendation of the Task Force is the creation of a hospital-wide, comprehensive bereavement program. The Task Force members are committed to continue working with stakeholders and partners within and outside of the hospital to develop and promote best practices in bereavement care at SickKids and beyond.
The interviews with staff and families, as well as the literature review, revealed both strengths and gaps in terms of existing bereavement care practices at SickKids. Based on the data gathered, the Task Force has put forward recommendations
that address a number of areas, including: enhancements to staff education and resources in the area of bereavement care; the need to challenge existing beliefs and attitudes about death as a care outcome and the potential for a dignified death to support a positive bereavement process; and the development of policies and procedures where needed to ensure consistency of bereavement care across the hospital.
1. Develop a strategy to ensure consistent bereavement care is delivered at all times, in all settings.
a. Integrate existing policies into one comprehensive guideline, while making explicit those parts of the guideline that are legislated and/or mandated aspects of care (i.e., Coroner’s cases).
b. Implement and evaluate a triage model to identify families at high risk for post-traumatic stress following the death of a child.
c. Develop a system for staff to refer families who require support following the death of their child (i.e., a bereavement clinic).
d. Develop, implement and evaluate bereavement care plans for every family whose child has died.
e. Ensure the utilization of interpreter services for families with limited English proficiency who experience the death of their child.
2. Create a hospital-wide bereavement program that integrates education, policy, research, clinical care, and evaluation. Consideration should be given to include this resource within the current Palliative Care and Bereavement Service.
a. Centralize all present and future hospital bereavement resources under the leadership of one director to ensure consistent bereavement care throughout the organization.
b. Ensure this program is responsible for the implementation and evaluation of all recommendations put forth by the Task Force.
c. This program is to assume accountability for implementing best practice guidelines throughout the hospital.
d. The Bereavement Task Force is to be reconstituted to become an advisory to the Bereavement Program.
e. Utilize TRAC-PG (Team for Research in Adolescence and Children in Palliation and Grief) as an overseeing body for
research development and implementation in the area of palliative and bereavement care.
f. Integrate bereavement work with other hospital initiatives, such as the New Immigrant Support Network (NISN) and interprofessional practice initiatives.
g. Examination of the bereavement experiences of families from diverse cultural and religious backgrounds is to be considered a priority for further research.
3. Develop new resources to promote best practices in bereavement care including bereavement care across cultures, such as:
a. A parent information package.
b. Parent-to-parent support program.
c. A bereavement website that indicates available internal and external (provincial, national and international) support
d. A mechanism through which staff may continue to stay apprised of current literature and evidence-influenced practice.
4. Link with available community resources to optimize their use, foster existing relationships, and create opportunities to develop new partnerships.
a. Work specifically with the Coroner’s Office to improve relationships and care.
b. Work to develop relationships with appropriate external agencies (e.g., hospices, Bereaved Families of Ontario).
c. Work with external agencies with which SickKids is already engaged to make bereavement care a priority in our continued work and collaboration.
5. Provide education about the principles of grief, death, dying and bereavement to all hospital personnel and, where possible, to community partners.
a. Utilize a tiered approach to education that tailors content to various roles and responsibilities.
b. Revise Mock Codes to incorporate after death care, resiliency training/education, and incident debriefing.
c. Develop a hospital-wide support program for staff who work in units/areas which experience a high number of deaths.
6. Implement a standardized follow-up process after the death of a child.
a. Create guidelines that support staff in setting boundaries around continued involvement and contact with bereaved families.
7. Adopt and implement a quality of care measurement system, for example, a tool similar to the Picker for pain (an indicator to monitor quality of care).
8. As is appropriate, continue to engage our bereaved families:
a. Through the implementation of hospital-wide memorial services.
b. Through considering the creation of a recognition wall for the children who have died.
9. Implement facility upgrades to the hospital’s morgue and quiet room.
10. Finalize and approve the draft paper: The Hospital For Sick Children Bereavement Care: An Interdisciplinary Framework for Practice.
11. Create a model of care that accurately conceptualizes the Task Force’s vision for quality paediatric bereavement care that is individualized, family-centred and evidence-based.
Bereavement Care Review Task Force Members:
Margaret Keatings (Executive Sponsor), Jackie Hubbert (Project Manager), Mayola Matthew, Maru Barrera, Marie Pinard, Chris Newman, Pam Hubley, Adam Rapoport, Trisha Sutton, Maria Rugg, Ted McNeill, Stephanie Lappan-Gracon, David Brownstone, Susan Cromwell, Michael Marshall, Karima Karmali, Catherine Fenton [parent], and Mitchel Blum [parent].
View the Report of the Bereavement Care Task Force (2.5MB PDF).