Thanatologists examining dying and grief practices have uncovered significant trends shaping hospice and bereavement care models in recent years.

Thanatology is derived from the Greek word for death, “thanatos.” It is commonly described as the study or description of death, dying and loss and the psychological, social, cultural, biological and spiritual aspects of these processes.

Common threads gleaned from thanatology studies have helped to inform and guide hospice care delivery and innovation in several ways, according to Donalyn Gross, thanatologist and end-of-life workshop provider. Gross, a former licensed clinical social worker, has taught dying and bereavement for nearly 15 years and is also a certified music practitioner. Among the impacts has been increased public awareness around end-of-life care options and a growing movement to normalize conversations about death and goals of care, she stated.

“Hospice programs have certainly grown. More people are dying with good quality hospice support,” Gross told Hospice News. “We’re learning a lot more about hospice and what death looks like, which is different to everyone. It’s using those [perspectives] for educational purposes. Death and dying [are] more ‘out’ than they’ve ever been, and it’s getting much more attention. More people who know about advanced directives, living wills and having proxy decision makers.”

Common thanatology trends tied to hospice

The first academic program focusing on thanatology emerged in the United States in 1959, reported Edgewood College. Since then, several studies have examined aspects of the dying process, including patient preferences and experiences about end-of-life care.

Cultural and spiritual beliefs about the end of life can significantly impact hospice utilization, according to recent research published in Taylor & Francis’ Death Studies journal. Individuals’ attitudes toward death also affect how often goals-of-care and advance care planning discussions occur, the research found.

Among the consistent examinations in thanatology has been the connection between advance care planning and goal-concordant hospice care delivery, according to Rani Goldman, certified thanatologist and bereavement coordinator at New York-based Stony Brook Medicine.

Advanced directives have played an important role in patient and family engagement and ensuring continuous access to quality care, Goldman stated. Health care providers over the past several years have implemented diverse strategies to help ensure that advance care planning discussions are occurring, that patients’ decision makers are informed and that their goals can be voiced effectively. The lessons learned by a lack of goal-concordant care delivery have been imperative to improving outcomes, Goldman indicated.

Several other trends have also helped to inform end-of-life discussions. For instance, interest has mounted in discussing environmentally friendly burial options and various ways to deepen integration of technology into dying and death, she said.

“Green options in burials are a big discussion lately,” Goldman told Hospice News in an email. “Pod burials, tree cremation burials, natural burials and even body donations to university hospitals where medical students can study are popular in dialogues as well. [Also,] QR codes on grave stones that link to videos of the deceased have become more commonplace.”

Increased technology utilization in hospice has led to greater cyberthanathology examination of the impacts of digital connectedness.

Technology has reshaped patient and family interactions and become more embedded in care models to help improve timely access to hospice, recent cyberthanatology research published in Science Direct found. Digital communication technologies have impacted every aspect of social life and dying processes, according to the researchers. Providers have learned more about the connectivity of individuals’ digital identities and how they relate to death rituals, perceptions, grief education and health care professionals’ clinical practices, they stated.

Another key trend to watch in thanatology centered around the various types of therapeutic practices that can ease physical, emotional and spiritual distress for terminally ill patients, Gross stated. Music therapy, for instance, has been found to alleviate patients’ symptoms while simultaneously providing a calming environment for their loved ones, she said.

Hospice music therapists have learned a great deal about the different breathing patterns and harmonies, rhythms and tones that can help to physically relax a patient, including some methods that have been shown to reduce blood pressure, according to Gross.

Exploring bereavement innovation

Thantatology has found that a more “death positive” outlook is being embraced compared to when the Medicare Hospice Benefit was established in 1983, according to Reid Jacobs, a hospice and palliative care social worker, thanatologist and writer. Jacobs serves as volunteer and bereavement services coordinator at California-based Faith & Hope Hospice and Palliative Care.

Much more is understood about the different ways that people grieve, Jacobs said. Thanatologists have helped unveil common misconceptions about how individuals experience mourning and loss and more individualized approaches to support, he stated.

“There still remains this misunderstood and misapplied focus on Dr. Elisabeth Kübler-Ross’ stages of grief,” Jacobs said. “It’s been interpreted as a universal construct, but modern understandings are that grief is a lot more complex and there aren’t these clear stages that people go through. There’s been a shift away from that focus, and a lot of different models recognizing the unique experiences and processes of bereaved individuals experiencing a loss.”

Remorse is among the commonly experienced feelings by bereaved individuals, and hospices have gained a wider lens of how to help provide support through research, Jacobs said.

A recent study published in Death Studies found that bereavement-related regret can have lasting impacts on grieving individuals well beyond their loved one’s death. Key features of navigating bereavement-related remorse include having a complex network of connections to other individuals and a dialogical interaction of present and past self, researchers indicated in the study.

Thanatology has furthered hospices’ ability to assess and design high-quality measures in grief care, according to Kathie Supiano, licensed social worker and associate professor in the College of Nursing at the University of Utah. Supiano is a thanatology fellow and also serves as director of the university’s bereavement care program, Caring Connections.

Studies have increasingly pointed to the lasting impact that early access to bereavement support can have on outcomes, Supiano said. Research has found that the grieving process can often begin at the onset of a terminal diagnosis, and that families have better experiences with stronger bereavement support.

An important trend gaining momentum is that thanatologists have helped to advance better trauma-informed grief care models, she stated. Case in point, recent research has found that trauma death rates have been on the rise in recent years including mortalities of drug overdose, suicide, vehicular accidents and homicide. The increased prevalence is pushing more hospices to hone their bereavement services, according to Supliano.

More hospice providers are focusing on integrating trauma-informed practices into their care delivery amid rising demand for this support, she said.

“In grief care, we’ve had an increasing awareness of trauma-informed practices,” Supiano told Hospice News. “Trauma-informed approaches have given us an enormous amount of guidance in what are effective ways to help people facing the most difficult challenges of deaths [related to] suicide or drug overdoses. In hospice, we’re more attentive of those trauma features that have high risks for poor bereavement outcomes. But trauma-informed care is years ahead of where we are with grief-informed care. We underappreciate the features of death.”