By Carolyn Crist

(Reuters Health) – Although hospitals and medical practitioners may follow a few bereavement practices after a patient dies, funeral attendance is uncommon, according to a review of research on the subject.

Hospitals often offer memorial services and bereavement coordinators, and clinicians may make phone calls, attend family meetings and send condolences, the study authors note in the journal Medicine.

“Bereavement practices in general, or crying, are seen as limiting the objectivity of physicians, which is seen as an important trait when doing the best for a patient,” said Sofia Zambrano of the University Center for Palliative Care in Bern, Switzerland, who wasn’t involved in the study.

“Around these practices, there is a lot of silence, and many see them as signs of weakness,” Zambrano told Reuters Health by email.

To assess how often clinicians attend patient funerals and what benefits or barriers they perceive to doing so, Dr. Laurence Weinberg of the University of Melbourne in Australia and his team analyzed 46 articles published between 1990 and 2017. The literature discussed bereavement practices and the factors that influence doctors’ involvement in funeral attendance and included 16 editorials, 12 letters and 18 studies conducted in the U.S., Canada, Australia, Israel and Ireland.

The authors did not respond to a request for comments.

They found that the likelihood of a practitioner attending a patient’s funeral was influenced by the practitioner’s age, gender, years of experience and medical specialty. One study found, for example, that female pediatric critical care specialists were more likely than others to be involved in bereavement practices.

Palliative care specialists were also more likely to take part in bereavement practices such as calling the patient’s family or sending a condolence letter, as compared with medical and radiation oncologists.

Funeral attendance ranged widely, the researchers found. Just 22% of hospital intensivists attended, compared with up to 67% of palliative care practitioners and psychiatrists. Younger doctors tended to be more skeptical about attending.

For those who did attend, the perceived benefits were to provide support to the family, extend the professional relationship, demonstrate respect to the patient and family, resolve guilt and grow personally. Barriers to attendance included lack of time, blurred professional boundaries, personal discomfort with death, deep emotions and discouragement by colleagues.

“Topics like these are seldom openly addressed, and they leave physicians wondering whether it is okay to do it or not to do it,” Zambrano said. “Or they ask themselves whether there is someone they can discuss it with and whether their bosses have engaged in these practices in the past or not.”

Forums and discussion boards online feature questions from medical students, junior physicians and nurses who ask whether it’s appropriate to attend a funeral or cry, she added. Open discussion would allow health professionals to create their own policies and better process the death of a patient.

Future studies should look at attendance across different medical specialties and specific instances where attendance is part of practice, such as policies that require at least one member of the healthcare team to attend a funeral, she added. These ideas link with ongoing research about how medical practitioners discuss end-of-life and how families perceive and experience bereavement practices.

“For families, it is important to not be disappointed if a physician or a health professional that they perceived as a close person doesn’t attend the funeral,” Zambrano said.

“Although attendance should never be forced and there should be freedom for individuals to choose according to their own preferences and expectations, signaling to physicians that it would be okay to attend the funeral may also make it easier for them to decide, as we have found that being invited to attend has facilitated attendance,” she added.

“Seeking formal and informal support from colleagues has shown to be helpful in coping with patient suicide,” said psychiatrist Dr. Shailesh Jain of the Texas Tech University Health Sciences Center in Midland, who wasn’t involved in the current study. The same principles can apply to other patient deaths.

“If possible, attend the patient’s funeral,” Jain said. “This gesture often is welcomed by the family and facilitates the grieving process.”

SOURCE: https://bit.ly/2lddz3W Medicine, online September 1, 2019.