Bridging the gaps in palliative care bereavement support: an international perspective

A review of palliative care policies and bereavement support practices in the United States, Canada, United Kingdom, Australia, and Japan demonstrated 4 challenges: questions over providing universal versus targeted support; a lack of clear evidence driving service delivery; informal or no risk assessment; and limited or no evaluation of services. Bridging the gaps between the policy and practice of palliative care bereavement support requires acknowledging the challenges of medical and public health models, improving bereavement need assessment processes, enhancing the role of primary care providers, and extending research to provide an evidence-base for interventions.

The preparation of graduate health professionals for working with bereaved clients: an Australian perspective

Students enrolled in health profession courses require grief education so that, upon graduation, they are able to meet the needs of clients living with loss and grief. We investigated grief and loss education in six Australian university programs--medicine, nursing, counseling, psychology, social work, and occupational therapy--drawing from course documents and face-to-face interviews with key staff and final-year students. Only the counseling course included a dedicated grief and loss unit. The nursing, medicine, and occupational therapy courses emphasized end-of-life issues rather than a breadth of bereavement experiences. The social work course taught grief as a socially-constructed practice and the psychology course focused on grief and loss in addiction. Several factors influenced the delivery of grief education, including staffing, time, placement opportunities, student feedback, and needs of each profession. The study provides an indication as to how future health professionals are prepared for grief and loss issues in their practice.

Improving a Grief and Loss Program: Caring for Patients, Families, and Staff

The University of Michigan Comprehensive Cancer Center (UMCCC) Grief and Loss Program provides supportive care services during bereavement which is considered part of the care continuum. This program received 50 death notifications per month upon project initiation and currently receives approximately 125 per month. Initial program evaluation was conducted via a pilot survey of bereaved parents as well as verbal and written evaluations from the transdisciplinary staff of Patient and Family Support Services. Grief support prior to evaluation included mailings, phone calls as indicated, poorly attended bereavement support groups, and limited staff support. Based on program evaluation, grief support continues through the use of mail/e-mail and phone calls to those at risk for complicated grief. Three to four gatherings per year are offered rather than monthly support groups, and connections to community resources are provided. The Comfort And Resources at End of Life (C-A-R-E) program was implemented to support and educate staff. Next steps include further program evaluation and potential research to examine best practices for the bereaved.

Late-life bereavement and complicated grief: a proposed comprehensive framework

OBJECTIVES

The construct of complicated grief (CG) has garnered increased empirical attention since it has been proposed as a diagnostic category for the upcoming Diagnostic and Statistical Manual of Mental Disorders-V. The aim of this article is to critically examine construct validity in light of a proposed conceptual framework, with special emphasis on understanding late-life bereavement.

METHOD

This is a review article that critically examined current bereavement and grief models. We explored discriminant and convergent validity between CG and uncomplicated grief (UG) and other psychopathological constructs in terms of symptom intensity, symptom trajectories, bereavement outcomes, and treatment response.

RESULTS

The findings from this review show mixed support for differentiating CG from other outcomes of bereavement for the following reasons: (1) a clear boundary between CG and UG has not been adequately supported, (2) symptoms of CG and bereavement-related depression and anxiety overlap, although there is some evidence of incremental validity in that CG symptoms predict global functioning above and beyond symptoms of depression, and (3) the treatment literature demonstrated that general grief interventions and treatment targeted for improving depression are ineffective at treating symptoms of CG, whereas interventions specially tailored to treating CG have been moderately effective. The findings also emphasize the importance of considering pre-bereavement circumstances, such as preexisting depression, in the conceptualization of broader bereavement outcome.

CONCLUSION

There were mixed findings supporting the construct validation of CG. A comprehensive framework that emphasizes pre-bereavement circumstances was proposed in order to better predict various grief trajectories and outcomes of late-life loss.

A traumatic death support group program: applying an integrated conceptual framework

This article describes an 8-week, curriculum-based traumatic death support group program that is offered at Bo's Place, a grief and bereavement center in Houston, Texas. The program was implemented in 2006 in an effort to help family members who had experienced a death in the family by suicide, murder, accident, or sudden medical problem. The program provides the opportunity for families to come to the center and engage in selected activities as a unit, while also providing adults and children the opportunity to participate in separate support groups with curricula adapted to different age levels. The program uses an integrated conceptual framework that draws upon elements from a variety of theoretical and conceptual models related to grief. The purpose of the program is to provide multiple paths for progress in the grief journey for the bereaved. In 2008, Bo's Place incorporated a brief questionnaire into the weekly meetings, in an effort to gain a better understanding of the perceptions of adult participants of the program and their own progress in their grief. The questionnaire asked adults to provide self-ratings of their perceptions of support from the program and of their progress in their grief journey. The positive results from this pilot study have encouraged Bo's Place to develop plans for more rigorous research into the mechanisms that contribute to progress in the grief journey for bereaved adults and children.

Relationship to the bereaved and perceptions of severity of trauma differentiate elements of posttraumatic growth

The field of bereavement and grief has been expanding to recognise the potential for growth following the loss of a loved one. This study sought to examine the effect of the relationship to the deceased and perceptions of the severity of the trauma on dimensions of posttraumatic growth. Participants were 146 people who had lost either: a) a first degree relative, b) a second degree relative, or c) a non-related friend. Results demonstrated that both severity and the relationship to the bereaved differentiate posttraumatic growth outcomes. For example, participants who had lost a first degree relative reported higher levels of growth than those who had lost a second degree relative. Consistent with previous research in general trauma populations, the more severe the loss was rated, the higher the levels of growth. Implications for practice are discussed.

Professionals' experiences of grief counseling: implications for bridging the gap between research and practice

Despite the escalating interest in grief interventions, there is a clear misalignment between contemporary grief research and grief counseling practices, and this disparity may limit intervention effectiveness. Semi-structured interviews with 19 grief counselors revealed their current practices of grief counseling. The counselors' descriptions of grief and their grief counseling practices were diverse and many were influenced by classic grief theories and the grief work hypothesis. The grief counselors described negotiating several issues and dilemmas in their work and provided recommendations for achieving greater exchange between research and practice. The findings have the potential to inform the delivery, efficacy, and relevance of grief counseling in Western Australia.

Experiences and early coping of bereaved spouses/partners in an intervention based on the dual process model (dpm)

This study was designed to test the effectiveness of the Dual Process Model (DPM) of coping with bereavement. The sample consisted of 298 recently widowed women (61%) and men age 50+ who participated in 14 weekly intervention sessions and also completed before (O1) and after (O2) self-administered questionnaires. While the study also includes two additional follow-up assessments (O3 and O4) that cover up to 14-16 months bereaved, this article examines only O1 and O2 assessments. Based on random assignment, 128 persons attended traditional grief groups that focused on loss-orientation (LO) in the model and 170 persons participated in groups receiving both the LO and restoration-orientation (RO) coping (learning daily life skills). As expected, participants in DPM groups showed slightly higher use of RO coping initially, but compared with LO group participants they improved at similar levels and reported similar high degrees of satisfaction with their participation (i.e., having their needs met and 98-100% indicating they were glad they participated. Even though DPM participants had six fewer LO sessions, they showed similar levels of LO improvement. Qualitative data indicate that the RO component of the DPM might be more effective if it is tailored and delivered individually.

Acts of resistance: breaking the silence of grief following traffic crash fatalities

Theoretical arguments and empirical evidence demonstrate the limited utility of a narrow construction of "normal" grief. Sudden and violent death, the young age of the deceased, and perceptions of death preventability are associated with grief reactions that extend beyond an expected grief response. Interviews were conducted with 21 adults bereaved through the death of a family member in a traffic crash. We present their attempts to resist notions of "working through" grief and "recovery" from it and consider how the participants' constructions of an alternative discourse, or normative narrative, possess the potential to challenge a prevailing grief discourse.

Embodied Grief: Bereaved Parents' Narratives of Their Suffering Body

Experiences and symptoms emanating from the bereaved person's body are commonly considered to be psychosomatic reactions to loss. The lingering of such experiences is thought to reflect a maladaptive coping style that needs to be addressed to access the psychological pain underlying the symptoms. In this interpretive, phenomenological study of 15 family members in seven families who lost a child to sudden, unexpected death, stories of embodied grief are explored to further understand the grieving body. The findings of this study illuminate the many ways parents experience their grieving body and they underscore the importance of witnessing and acknowledging stories of the body in clinical work with bereaved parents who are learning to live in a world without their beloved child.