This is an interesting question. I am not sure if I have ever used any tools for evaluating satisfaction for bereaved clients. This is a paradox and a mystery to figure out. It is so different for every individual. What is satisfactory for one is not for another. I am not sure if any tools could validate or be reliable. We are dealing with the human condition and trauma is different for different people. What kind of trauma, rape, murder, war, PTSD, death of a child, death of a loved one and the list goes on and on?

I imagine you could do a questionaire with some direct and open ended questions on them. Even then they are subject to intepretation. I can use my life for example. I had a brother commit suicide in 77 and I still think about it all the time. I have come to grips with it but if you asked me on some tool if I am OK, I would tell you what you probably want to hear. Reliability, I am not sure. I had a wife die in 89 and she left me with 2 little girls 5 and 11. That was very traumatic for me. Now they are grown and married, but I still think of all the guilt and hard times I had with me being a single father. I think you are doing great work but I am not sure how one measures bereavement with a follow up from a program. I hope you do well. I wish I could help you more. I probably complicated things for you.

Iive analysis agree with Vernon Boggs. Bereavement is a very personal and subjective emotion and its object analysis and quantification would be rather difficult. It is something very very abstract and is influenced by age, gender, education, economic status, social background, religious beliefs, previous experiences, inherent personality and so many other factors

This was evidenced by Bowlbys 40 thieves story and the attachment theory. Age development and gender can give one an open peek to the psychology of the mind in the grieving soul but cannot have the proper words to describe it. I do not believe they have them in any language. It is just a matter of the heart and soul. These are all subjective and open to intpretation. How anyone can dispute one's findings is beyond me. It is like saying there is no Heaven or Hell. How would one know unless they have been there. It is only an opinion of a bias to a degree. It is a strange thing this thing called life. I hope I am making sense to you.

absolutely agree with you both but the reality of working in a hospital is METRICS- and that is why I need to "ask and find out", as we need to evaluate the program goals and be able to monitor our QI initiatives- I am completely aware of the challenges but thought that starting from a place where hospices/bereavement support organizations have done evaluation would be useful.... Thanks to you both!

My wife works in Hospice and I was a Human Services Supervisor at a nursing home for my very first Human Services position. I held many a hand of those dying with no one else there. You are quite welcome but to be honest I do not know how one measures this. I am doing my dissertation on grief of young ones who had their mother die at a very early age. Now they are young adults and they tell me it was very difficult and the variables were so different but yet the phenomenon of heartache is a theme that one cannot escape. No culture or human condition can escape.

I being a paediatrician have also had my share of experience with the grief of parents in very diverse situations. I have also worked in many different places geographically. The parents in Saudi Arabia show a lot of concern and grief while the child is sick but if the child dies they would just say "It was the will of God" and move forward in their lives. In Pakistan the attendants tend to go in a form of suspended animation emotionally where they are trying to suppress their emotions but as the death is announced all the barriers break loose and the people tend to show grief by crying out loud and even beating themselves physically. Now how can same set of rules be applied to assess the bereavement responses on such diverse cultures.

So while developing the program will you be considering the religious, social, geographical and educational etc backgrounds of the subjects.

Jawad, absolutely- I work in Toronto, with 96 (minimum) different languages spoken and the needs of families are varied, as are the responses to grief support- this is both around the time of death and in the coming weeks/months/years. I have learned, however, that sometimes families go against cultural norms, especially when they have been exposed to other options, especially in their responses to grief. While many young parents (I counsel the newborn intensive care population) will look to their elders for guidance on funerals and on grief, many become disturbed by the lack of support that they may be offered by their cultural community and may turn to more formalized support for themselves and their other children. I send out a generalized newsletter to our families for the first year after the death and amazed at how many families for whom English is their second language, or a struggle to read, will find someone to share the information and use it to help them. I know this as they have called to follow up on the information they have learned in the newsletter.

I still believe that there is a way we can evaluate their perception of the value of this grief support, and maybe it is using an open-ended set of questions to allow them to tell us what they need to tell us.

Thanks to you both or your input.

Lori, I am not trying to discourage you. On the contrary I will be more than happy to help you in your study in my humble capacity. It will be a wonderful study if it can be made more objective.

I didn't see it as discouragement, but you totally know that messages can never be taken as easily as face to face conversation. Thank you.

There was an interesting study on some TV show about 2 months ago about just this very thing. I need to go back and find out the hospital that was conducting the study. I posed a question on RG about it but there were no responses. Let me see if I can figure out how to get to my dated questions. I am interested in this discussion. Please share what you find and if I can offer what I find or if it would be helpful I would be glad to share. I am too am conducting research on the barriers to Hospice care and grief "helps."

great to hear Carla- together (LOL) we can conquer the world....

Really interesting question and answers. Will be following this discussion. It is crucial that any measure should be reliable and valid for the population, setting and culture of interest. However, I'm not sure bereavement tools measure satisfaction and I am even less sure that there is a measure which truly captures satisfaction of anything!! It is so subjective, dependent of initial expectations, previous experiences and changes across time. If you need it for metrics purposes, perhaps try the one single question. Just ask your clients/patients if they feel the program has helped them in any way. An open question that you can analyse qualitatively. Still, keep in mind that they could be having a "good day" or a "not so good day" and so the answers you'll get from the same person could be different depending on how they feel. Perhaps ask them again as a follow up, i.e. 3 months after it has ended, 6m and 1 year and/or 2 years. I'd also add that just because measuring subjective experiences is hard one should not give up on it. And indeed, to show to others that your program works, and to improve it, you need these metrics.

so true Barbara- hate that metrics guide our work instead of conversation- our leaders and government need numbers, we know experiences. We only wish that the stories would be the power needed. Small steps- in deed, baby steps for the newborn intensive care population, and pediatrics in general, but we are getting acknowledgement in the process.

Lori, have you been able to find some objective way to evaluate the bereavement. Can you give some examples so that I can have some idea what wonderful job you are doing

I have found a few hospice tools that would need to be adapted, validated and used but very little response. The only way my management wants it right now is metrics based- numbers, but that does not give context which we all know is key. Currently, we keep all of the thank you cards, emails and we ask parents to send any comments to the manager but again, that doesn't get to those who have an issue with us, as much- so that we can improve.