Objectives
The COVID-19 pandemic and its containment measures disrupted end-of-life and grief experiences worldwide. This Canadian mixed-methods study evaluated quality of death (QOD) outcomes for individuals who died in hospital during the pandemic, bereavement outcomes of their family members, and the impact of hospital visitor restrictions on these outcomes.
Sample, Setting and Procedures
Retrospective lists of adult patient deaths (all causes) from two large urban hospitals in Toronto, Canada, between March 2020 and May 2022 were used to identify next-of-kin. At least six months post-death, next-of-kin were contacted and invited to participate. Consenting participants completed questionnaires assessing satisfaction with care, symptoms of depression, post-traumatic stress, complicated grief, and perceived hospital restrictions. QOD was assessed via a structured questionnaire administered by phone or video. A purposive sub-sample participated in semi-structured interviews exploring their experiences of patient death and bereavement. Interview transcripts were analyzed using thematic analysis.
Results
A total of 286 bereaved family members completed study measures (mean age 62.3 years; 66% women; 59% spouses). A sub-sample of 87 family members participated in qualitative interviews. Higher levels of pre-death hospital visitor restrictions were significantly associated with lower QOD and satisfaction with care (p < 0.001). Both pre- and post-death restrictions correlated positively with symptoms of depression, post-traumatic stress, and complicated grief (all p < 0.001). Qualitative findings will be presented to provide deeper insight into participants’ experiences of pandemic restrictions during hospitalization, the patient’s last day and death, and bereavement.
Conclusion and Clinical Implications
These findings highlight the profound effects of the pandemic and its containment measures on end-of-life and bereavement outcomes. They provide evidence to inform interventions, research, and policy development to better support families, particularly during public health crises.