Quality of Death in Hospital and Bereavement Outcomes in the COVID-19 Era

Background: The COVID-19 pandemic and its control measures have changed how people die and how their families grieve. Strict visitor policies in hospitals, restrictions on post-death ceremonies (e.g., funerals), social isolation and lack of access to professional support may have significant negative effects on the quality of death (QOD) of individuals dying during the pandemic and put their family members at risk of experiencing severe grief reactions. It is important to understand how the COVID-19 pandemic has changed the way people die and grieve because this can help improve the support services that are available to families at their most vulnerable time. Aim: This 2-year study will recruit bereaved family members of individuals who died of any cause in two hospitals in Toronto, Ontario, in order to evaluate: i) the QOD and bereavement outcomes (depression, post-traumatic stress and complicated grief) and who is at a greater risk for worse QOD and more severe grief reactions; and ii) the experience and perceived met and unmet support needs of bereaved family members. Methods: Six months after the patient death, family members of patients who died at the University Health Network or Sunnybrook Health Sciences Centre will be asked to complete surveys of the patient's QOD, their satisfaction with and access to care, depression, post-traumatic stress and grief reactions. Participants will also be interviewed about their experience of death and grief. Our research team has experience in interviewing and surveying family members after the death of a loved one in a sensitive and respectful manner. Relevance: It is urgent to address the impact of the pandemic on grieving Canadians. Our study will provide real-time evidence to inform policy and clinical guidelines to better support family members before and after patients' deaths and develop interventions to prevent and treat complicated grief and to support bereavement in general during the pandemic and beyond.