The Physician and Medical Staff Home Condolence Visit

Dear Editor:

The process of the consoling visit in the first week after a patient's death enables a new perspective and recognition that professional work goes beyond the treatment of the patient and includes the family. This process is not only natural, but desirable, and becomes part of the comprehensive management for the family and patient, particularly in long-term care. ¹

The medical team of the Geriatric Skilled Nursing Department of the Herzog Hospital of Jerusalem, Israel, makes home visits to the families of recently deceased patients. We believe that these visits constitute an integral part of caring for the patient's family, and conclude the responsibility of the staff to the patient and his or her family. The staff utilizes this occasion as a means for closure, gives medical information, and provides direction for additional support. ²

A few years ago, the departmental policy was for the social worker of the department to communicate empathy by telephone to the family of the deceased. It was recognized that the relationship with the family was abruptly disconnected and that change was needed. After the patient's death it is often overlooked that the family still relies on the medical team for comfort and guidance. A face-to-face visit with the family facilitates the following actions:

Conveying nonverbal expressions of empathy impossible to communicate by any other means.

Allowing the family to speak more easily and in more detail in a nonthreatening environment.

Providing guidance for bereavement support program.

A condolence visit on the part of the department staff, including the physician, nurse, and social worker to the family's home has greater impact than a visit by a single staff member. It is important to recognize that the condolence visit to the homes of bereaved families is part of the staff's professional responsibility despite the possibility of personal feelings about the patient and his or her family. ³

While it is unrealistic to expect staff to make condolence visits for all deceased patients, certain criteria have been established:

If a significant and close-knit relationship has developed between the family and the staff, including open expression of feelings, frequent and lengthy conversation, and when the dying process has extended over a long period.

The home visit can be utilized to clarify the cause of death, deal with a complaint, and respond to feelings of anger or dissatisfaction if the patient died suddenly and quite unexpectedly. In this case, the family may not have been prepared and may want to know the cause of death. The visit can give the family confidence that all the needs and treatment required by the patient's illness were fulfilled.

Following the condolence visit a summary review of recommendations and guidance for future procedures for family and departmental polices is conducted at the weekly departmental multidisciplinary meetings.

A new hospital-wide policy statement regarding condolence visits is advisable, and emphasis should be placed on developing written departmental protocols for this procedure. ⁴