Loss, grief haunt patients, healthcare providers during pandemic

Patients, family members, and healthcare professionals experience multifaceted losses and grief during this COVID-19 pandemic, according to a Singapore study. Moreover, the impact of COVID-19 and current societal restrictions causes those afflicted to fear for their future, further worsening their emotional and psychological well-being.

“Loss and grief identification and management among patients, family members, and healthcare professionals are critically important during this COVID-19 pandemic,” the researchers said.

“Current operating guidelines have proven insufficient in managing loss and grief. Innovative strategies are essential to tackle the many dimensions of loss and grief,” they added.

A scoping review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement extension for Scoping Reviews (PRISMA-ScR) and the Joanna Briggs Institute framework. Quantitative studies on loss and grief and their management were eligible for inclusion.

A total of 166 studies were identified, of which 69 met the eligibility criteria. The researchers then conducted qualitative analysis and data coding of each record using qualitative data analysis software.

Losses brought about by the COVID-19 pandemic included deaths of patients, family members, colleagues, and many others, as well as the loss of usual routines, lifestyle, and physical health. [Ann Acad Med Singap 2022;51:619-628]

These individuals suffered multidimensional grief, primarily affecting their emotional, physical, social, and existential realms. Their anger, guilt, and fear surfaced from unsatisfactory farewells, issues with funerals, social isolation, financial strain, and stigmatization.

In response, strategies to manage loss and grief were categorized into five themes, namely communication, finance, counselling, education, and spiritual care.

“[W]e propose collaborative efforts between the government, welfare organizations, and healthcare systems to raise public awareness and establish guidelines to ensure the physical and psychological well-being of society,” the researchers said.

“Healthcare officials and government policy-makers can use the findings of the present study to provide comprehensive and holistic support (physical and financial-social) and minimize psychological and spiritual distress to those suffering grief during this pandemic,” they added.

One form of support that policy-makers can utilize is psychological intervention through cognitive behavioural therapy (CBT) and mindfulness-based cognitive therapy (MBCT), which can help prepare individuals for acute grief.

CBT can improve poor coping behaviours such as avoidance and antagonistic confrontation, while challenging cognitive bias. It also improves stress management, leading to better psychological outcomes by preventing the prolongation of grief.

On the other hand, MBCT employs mindfulness meditation practices to promote nonjudgmental awareness. This approach can be hosted on virtual platforms, which can be beneficial to individuals in isolation with no access to mental health professionals.

“The COVID-19 pandemic has brought about multiple losses to various groups, namely patients, families, and healthcare professionals,” the researchers said. “Grief, which is the reaction to these losses, could cause strain on these individuals’ physical and mental health if not identified and managed early.”