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This study implies specific guidelines for intervention. It appears that bereavement follow-up may lessen the grief response at 13 months. Therefore, hospice programs should continue this valuable service. Follow-up interventions should focus on the factors which proved significant: rumination, loss of control, and death anxiety. The study also provided the beginnings of a risk assessment tool for bereaved individuals. Increased age was proved to be a risk factor related to a greater grief response. Although most of the literature indicates women are at a higher risk early in the bereavement period, this study showed that at a later time men expressed a greater degree of grief. The implications of the study include the need for ongoing education regarding the normal grief response and the physical and emotional manifestations of grief. The results of the study support emotional care for survivors as well as provision for appropriate referral resources as needed.
In this secondary analysis of data from the National Hospice Study (NHS), a new measure, quality of death (QOD), was developed by weighting reports of cancer patients' last 3 days of life by what patients wanted their last 3 days to be like. Using analysis of covariance, the QOD scores were higher for terminally ill patients in hospices (either home-care [HC] or hospital-based [HB]) than similar patients who received conventional care (CC). The results are discussed in terms of verification of the hospice philosophy and other uses for a quality of death measure.