Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Purpose: This paper presents the qualitative findings of a five year study that examined the needs of secondary survivors (family, friends, caregivers, and concerned others) at the time of a loved one's death from cancer. Deaths occurred in hospitals, in the home with hospice or other home-based services, and in residential hospice facilities. Prior to taking part in this study, participants completed an eight-week structured bereavement group entitled Good Grief. This service was provided by an organization in a Mid-Atlantic state that provides education and counseling services, at no charge, to people with cancer and their families. This psychoeducational intervention was developed to help recently bereaved secondary survivors understand the grieving process and overcome the death of a loved one.

Methods: The sample for this study was drawn from secondary survivors who completed the Good Grief group from 1999 to 2004. Upon completion of the support group, each participant was invited to complete a brief survey about their needs at the time of their loved one's death. The survey consisted of thirteen items that quantitatively assessed needs and two open-ended unstructured qualitative questions that asked participants to identify what had been helpful or bothersome and for additional comments about their experiences. The focus of this study is upon the responses to the qualitative questions. The method of constant comparison was utilized in analysis of these data. To increase reliability and validity of findings, a three member research team was involved in the multiple stages of analysis to ensure that multiple viewpoints were represented

Results: Of the 100 surveys that were completed during this time, 75 contained written responses and yielded 275 units of data. From these units, four broad categories emerged: (1) need to directly express and address personal needs for support, (2) expression of personal needs through verbalized perceptions of loved one's care (3) need for consentient support via proximity with the medical team, and (4) need for anticipatory support regarding dying and end-of-life processes. Within each category, one to three subcategories emerged that capture salient dimensions of providing support to people experiencing the death of a loved one.

Implications for Practice: Results suggest that secondary survivors experience a sense of isolation and powerlessness during the end-of-life and dying processes of their loved ones that is often unrecognized by physicians, nurses, oncology counselors and other health professionals. These findings also indicate that secondary survivors have needs for support that extend well beyond activities that are traditionally associated with the physical and emotional care of loved ones. Secondary survivors may benefit from social work interventions that are directed toward helping them assert personal needs, develop greater proximity with the health care team, and prepare for the dying processes of loved ones.