title: "It is the 'starting over' part that is so hard": Using an online group to support hospice bereavement.
abstract: OBJECTIVE
  Although hospice agencies are required to provide informal caregivers (family or friends of the patient) with formal bereavement support when their loved one passes, most bereavement interventions lack standardization and remain untested. We employed the Dual Processing Model of Bereavement as a theoretical framework for assessing the potential of a secret Facebook group for bereaved hospice caregivers.
  
  
  METHODS
  A mixed-methods approach was utilized to analyze online communication (posts and comments) in the secret Facebook group, and self-reported outcome measures on depression and anxiety were compared pre- and post-intervention.
  
  
  RESULTS
  Sixteen caregivers participated in the secret Facebook group over a period of nine months. The majority of online talk was oriented to restoration, revealing abrupt and anticipated triggers that evoked feelings of loss. Caregivers also shared loss orientation through storytelling, sharing and giving advice, and encouraging others to manage the challenges of coping. Caregiver anxiety and depression were lower after the intervention.
  
  
  CONCLUSIONS
  This pilot study provides insight into the use of a secret Facebook group to facilitate bereavement support to caregivers. Findings highlight the promise of Facebook for hospice bereavement support. Providers and researchers are encouraged to explore the positive outcomes associated with bereavement support.
authors.affiliation: Division of Nursing Research and Education,City of Hope National Medical Center,Duarte, California.
authors.forename: Elaine
authors.initials: E
authors.lastname: Wittenberg-Lyles
authors.affiliation: Curtis W. and Ann H. Long Department of Family and Community Medicine,University of Missouri,Columbia, Missouri.
authors.forename: Karla
authors.initials: K
authors.lastname: Washington
authors.affiliation: Curtis W. and Ann H. Long Department of Family and Community Medicine,University of Missouri,Columbia, Missouri.
authors.forename: Debra Parker
authors.initials: DP
authors.lastname: Oliver
authors.affiliation: Department of Communication,University of Kentucky,Lexington, Kentucky.
authors.forename: Sara
authors.initials: S
authors.lastname: Shaunfield
authors.affiliation: Curtis W. and Ann H. Long Department of Family and Community Medicine,University of Missouri,Columbia, Missouri.
authors.forename: L Ashley
authors.initials: LA
authors.lastname: Gage
authors.affiliation: Curtis W. and Ann H. Long Department of Family and Community Medicine,University of Missouri,Columbia, Missouri.
authors.forename: Megan
authors.initials: M
authors.lastname: Mooney
authors.affiliation: Curtis W. and Ann H. Long Department of Family and Community Medicine,University of Missouri,Columbia, Missouri.
authors.forename: Alexandria
authors.initials: A
authors.lastname: Lewis
mesh_terms: D000223:Adaptation, Psychological; D001007:Anxiety / Q000517:prevention & control; D001601:Bereavement; D017028:Caregivers / Q000523:psychology*; D003863:Depression / Q000517:prevention & control / Q000523:psychology; D005260:Female; D006738:Hospices; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D061108:Social Media; D012944:Social Support
keywords: Hospice