Bereaved Parents' Perspectives on Informal Social Support: “What Worked for You?”

The study of psychosocial outcomes of parents bereaved by pediatric illness: a scoping review of methodology and sample composition

OBJECTIVE

Parents of children who died of a medical condition experience a range of psychosocial outcomes. The current scoping review aims to summarize the outcomes assessed, methodology, and sample characteristics of recent psychosocial research conducted with this population.

METHODS

Included studies were limited to peer-reviewed, psychosocial outcomes research published between August 2011 and August 2022, written in English, and including caregiver study participants of children who died of a medical condition. Data sources were scholarly journal articles from 9 electronic databases, including Scopus, Web of Science, Academic Search Primer, ProQuest Research Library, PubMed, Embase, PsycINFO, Psychology & Behavioral Sciences Collection, and Health Source: Nursing/Academic Edition. The Mixed Methods Appraisal Tool-2018 evaluated methodological quality.

RESULTS

The study sample included 106 studies, most of which were either qualitative (60%) or quantitative (29%). Mixed-methods studies (8%) and randomized clinical trials (2%) were also identified. Study quality was variable, but most studies met all quality criteria (73%). Studies primarily represented cancer populations (58%), White participants (71%), and mothers (66%). Risk-based psychosocial outcomes (e.g., grief) were more commonly assessed than resilience-based outcomes.

CONCLUSIONS

The current scoping review revealed that recent research assessing the psychosocial outcomes of bereaved parents is limited in the representation of diverse populations, primarily qualitative, of broadly strong methodological quality, and oriented to psychosocial risk. To enhance the state of the science and inform evidence-based psychosocial services, future research should consider varied methodologies to comprehensively assess processes of risk and resilience with demographically and medically diverse populations.

A study of grief experience interviews with family members of patients with advanced malignant tumors based on noninvasive death index monitoring

OBJECTIVE

To explore the grief experiences of family members of patients with advanced malignant tumors before and after death.

METHODS

This study used both quantitative and qualitative research methods. A total of 10 people with family members with terminal malignant tumors were chosen and assessed five times according to a specific non-invasive mortality index and the Distress Thermometer scale. Additionally, the participants attended an in-depth interview.

RESULTS

The grief experiences of the bereaved included their knowledge of and attitude towards death, the physical and mental conditions of the family members of patients in the terminal stage, the needs of family members, and the response to death and growth of those family members.

CONCLUSIONS

The grief experience interviews of family members of patients with advanced malignant tumors are universal. It is suggested that the nursing staff should pay attention to the emotional experience of the bereaved after the death of the patient throughout the whole nursing process, including the continuous follow-up during the home period. It is hoped that the implementation of grief counseling methods in the later stage can help the bereaved to successfully go through the grieving period, prevent grief disorders, and help them return to society.

Continuing bonds following stillbirth: protective and risk factors associated with parental bereavement adaptation

OBJECTIVE

To investigate any association between expressions of parents' continuing bond with their stillborn baby and bereavement adaptation.

BACKGROUND

Continuing bonds theory suggests that bereaved parents adapt to the loss of their child by sharing and transforming mental representations of the child, allowing them to be integrated into parents' everyday lives. Little is known about the mental health benefits of expressing continuing bonds following stillbirth. This study examined any association between aspects of parents' relationship with their stillborn baby, social support for the relationship, and bereavement adaptation.

METHODS

Cross-sectional questionnaire study. Parents of stillborn babies (N=170) completed an online questionnaire examining engagement in continuing bonds expressions; characteristics of parents' relationship with their stillborn baby and their experience of sharing it; social support, and meaning-making. Measures of mental health were included to quantify bereavement adaptation.

RESULTS

Regression analyses showed that time since death, meaning-making, engaging with nature, and legacy building are positively linked to bereavement adaptation. Risk factors included inadequate social support for the relationship, a greater desire to share it more freely, an increased sense of integration with baby, and societal pressure to move on.

CONCLUSION

Key aspects of parents' ongoing relationship with their stillborn baby and the social context are related to bereavement adaptation.

Social support profiles correlate with depressive symptoms among Chinese parents during the COVID-19 pandemic: A latent profile analysis

This study explored pandemic-related social support profiles and investigated their relationships with depressive symptoms among Chinese parents during the COVID-19 pandemic. The hypotheses were evaluated in an online cross-sectional survey of 1286 parents. Latent profile analysis identified two profiles of received social support (isolated and integrated support). Three convergent profiles (high, moderate, and low support) and one divergent profile were found in perceived social support. The results revealed that the distribution of age, region, income and educational level varied across these profiles. Only the "high" (β = -0.11, p < 0.01) and "divergent" (β = -0.12, p < 0.01) profiles of perceived social support were negatively associated with parents' depressive symptoms. These findings highlight the importance of developing better-targeted intervention programs aimed at optimizing the allocation and improving the quantity and quality of supportive resources for parents.

Social support in bereavement: Developing and validating a new scale

Although social support has been considered to be beneficial for the bereaved, mixed findings exist in the literature. This may be due to variations in conceptualising and measuring social support. This study aims to offer a new validated scale for research on social support in bereavement. Part 1 describes the generation of the item pool, which was derived from narratives of 28 bereaved Chinese. Part 2 includes the items selected using item analysis and explanatory factor analysis to form the preliminary version of the Scale of Social Support in Bereavement (SSB) based on data collected from 195 bereaved adults. Part 3 examined the psychometric properties of the newly developed SSB with a sample of another 196 bereaved adults. The results of confirmatory factor analysis indicated a useful structure of four factors, including "living support," "economic support," "grief processing," and "emotion restoration." The convergent validity, internal consistency reliability and test-retest reliability of the measure were shown to be strong. SSB is the first scale which measures comprehensive types of support in bereavement. It can be applied in exploration of the role of social support in bereavement, and validated in different cultural contexts.

Parental bereavement - impact of death of neonates and children under 12 years on personhood of parents: a systematic scoping review

BACKGROUND

Losing a child tragically impacts the well-being and functioning of parents. With these effects extending beyond emotional, physical morbidity and compromising self-perceptions, appropriate, longitudinal, timely and personalised support is key to effective care of bereaved parents. However, in the absence of a comprehensive understanding of parental bereavement, effective support of bereaved parents remains suboptimal. To address this gap, we scrutinise prevailing data on the effects of a child's death, aged 0-12 years, through the lens of the Ring Theory of Personhood (RToP).

METHODS

To study prevailing accounts of bereaved parents following the death of a child, we adopt Krishna's Systematic Evidence Based Approach (SEBA) to structure our Systematic Scoping Review (SSR in SEBA).

RESULTS

Three thousand seventy-four abstracts were reviewed, 160 full text articles were evaluated, and 111 articles were included and analysed using thematic and content analysis. Four themes/categories were identified relating to the four rings of the RToP. Findings reveal that static concepts of protective and risk factors for grief are misplaced and that the support of healthcare professionals is key to assisting bereaved parents.

CONCLUSION

In the absence of consistent support of bereaved parents, this study highlights the need for effective training of healthcare professionals, beginning with an appreciation that every aspect of an individual parent's personhood is impacted by the loss of their child. Acknowledging grief as a complex, evolving and personalised process subjected to parental characteristics, settings, context and available support, this SSR in SEBA calls attention to effective nurturing of the relationship between parents and healthcare professionals, and suggests use of the RToP to assess and direct personalised, timely, specific support of parents in evolving conditions. We believe the findings of this review also call for further studies to support healthcare professionals as they journey with bereaved parents.

Can social support matter? The relationship between social support and mental health among bereaved parents in an only-child society: Evidence from China

Shidu parents (parents who lost their only child) experience poor mental health, and social support is expected to alleviate mental stress and facilitate mental adaptation of bereaved parents. However, the literatures on the effects of social support on mental health of bereaved parents have yield mixed outcomes, and the relationship between social support and mental health among Shidu parents has been unexplored in China. The purpose of this study was to examine the relationship between social support and mental health among Shidu parents in China. Multistage stratified random sampling was conducted to collect data in 2017, and a total of 1,750 Shidu parents were employed as the analytical sample. The Ordinary Least Squares Model and Instrumental Variables (IV) Method were both employed. The variable of community services for the aged provided by the market was employed as the IV of the study considering death taboo inveterately rooted in philosophies and religions in Chinese culture. The results indicated that there was a positive relationship between social support and mental health among Shidu parents, specifically, objective social support and social support utilisation were significantly related to mental health of Shidu parents, while subjective social support was not. Implications of the study include the following: First, it is crucial to help spouse and friends gain appropriate social support skills. Mutual associations can be an important source of social support. Second, objective social support should be given a top priority, and suitable amount, timing, source and structure of social support should be paid more attention to strengthen the 'goodness of fit' between the needs of Shidu parents and support provided. Third, some other social services such as community care, social work services and professional consulting services can be appropriate alternatives to alleviate mental stress of Shidu parents.

Bereavement among Israeli parents who lost children in military service: Protective factors for coping with loss

This study examined parental coping with grief and identified protective factors for better coping among parents who suffered the loss of a child during military service in Israel. Coping indicators included complicated grief, functioning in life tasks, succeeding in living meaningful lives, and personal growth. Participants were 164 parents who had lost children 5-16 years previously. We found strong associations between parents' decision to continue life despite traumatic loss and several indicators of coping. Meaning-making was associated with better functioning and greater personal growth. Practitioners should explore with parents the internal struggles about deciding whether to continue in life.

Variables associated with grief and personal growth following the death of a child from cancer: A mixed method analysis

This mixed method study explored parent and child characteristics that impact grief and personal growth in parents (n = 119) after a child dies from cancer in Australia. Medical components of a child's cancer care including radiation treatment, referral to palliative care, and location of death had a significant impact on levels of grief. Parents' gender, religious affiliation, and education level had a significant impact on levels of personal growth. This study further enhances our understanding of the impact of specific parent and child characteristics throughout a child's cancer treatment and end of life that may influence their families' experience of bereavement.

Lived experience of a child's chronic illness and death: A qualitative systematic review of the parental bereavement trajectory

To understand the lived experience of parents who have lost their child to a chronic life-limiting condition, six major databases were searched by adhering to the Preferred Reporting Items for Systematic Review and Meta-Analyses guidelines. Articles were screened for appropriateness using the Sample, Phenomenon of Interest, Design, Evaluation, Research type tool, and relevant qualitative studies were selected for full-text data analysis using Thematic Synthesis. Findings were categorized into 13 themes that were further organized into a four-phase trajectory of parental bereavement experience of child loss, namely: Liminal Margin, Holding Space, Navigating Losses, and Reconstructing Lives. The findings are discussed in the light of existing literature with practical recommendations for enhancing parental bereavement support services.

Brief report: Bereaved parents informing research design: The place of a pilot study

BACKGROUND

Risk minimization in research with bereaved parents is important. However, little is known about which research methods balance the sensitivity required for bereaved research participants and the need for generalizable results.

AIM

To explore parental experiences of participating in mixed method bereavement research via a pilot study.

DESIGN

A convergent parallel mixed method design assessing bereaved parents' experience of research participation.

SETTING/PARTICIPANTS

Eleven parents whose child was treated for cancer at The Royal Children's Hospital, Brisbane completed the questionnaire/interview being piloted (n = 8 mothers; n = 3 fathers; >6 months and <6 years bereaved). Of these, eight parents completed the pilot study evaluation questionnaire, providing feedback on their experience of participation.

RESULTS

Participants acknowledged the importance of bereaved parents being central to research design and the development of bereavement programs. Sixty-three per cent (n = 5/8) of parents described completion of the questionnaire as 'not at all/a little bit' of a burden. Seventy-five per cent (n = 6/8) of parents opting into the telephone interview described participation as 'not at all/a little bit' of a burden. When considering the latest timeframes for participation in bereavement research 63% (n = 5/8) of parents indicated 'no endpoint.' Findings from the pilot study enabled important adjustments to be made to a large-scale future study.

CONCLUSIONS

As a research method, pilot studies may be utilized to minimize harm and maximize the potential benefits for vulnerable research participants. A mixed method approach allows researchers to generalize findings to a broader population while also drawing on the depth of the lived experience.

The Impact on Mental Health of Losing an Only Child and the Influence of Social Support and Resilience

The number of parents who have lost their only child (PLOCs) has increased annually with the implementation of the birth control policy in mainland China. This study aimed to investigate the mental health status of PLOCs and the influence of social support and resilience. Study 1 recruited 100 PLOCs and 88 nonbereaved parents, and compared differences in depression, anxiety, and loneliness. Study 2 investigated the influence of social support and resilience on the mental health of PLOCs via a mediating model. Results indicate that PLOCs reported more anxiety and depression symptoms than nonbereaved counterparts. Perceived close family support, objective support, and resilience negatively predicted anxiety and depression. In addition, perceived close family support was found to influence mental health via resilience. The current findings reveal that losing an only child has long-term negative impacts on the mental health of PLOCs. However, perceived close family support and objective support can protect their mental health either directly or indirectly via resilience.

Parental experiences with a hospital-based bereavement program following the loss of a child to cancer

Objective:

The death of a child from cancer is an intense and life-changing loss for a parent. Guided by the principles of patient- and family-centered care, hospital-based caregivers developed a program to provide bereavement support for parents through phone calls and mailings. The aim of the present qualitative phenomenological study was to understand how parents experienced participating in this bereavement program.

Method:

A total of eight parents from six families participated in a focus-group evaluation of the two-year hospital-based bereavement program. Two social work clinicians/researchers independently analyzed the transcript of the focus group to define themes.

Results:

Four themes were identified: (1) lived experience of grief, (2) importance of relationships with the hospital-based team, (3) bereavement support from hospital-based providers, and (4) extending bereavement care.

Significance of Results:

Participants indicated the value of ongoing communication and connection with members of the healthcare team, who were often central to a family's life for years during their child's cancer treatment. Parents also provided suggestions for extending bereavement support through continued contact with providers and informal annual gatherings, as well as through a peer (parent-to-parent) support program.

A new model of Social Support in Bereavement (SSB): An empirical investigation with a Chinese sample

Bereavement can be an extremely stressful experience while the protective effect of social support is expected to facilitate the adjustment after loss. The ingredients or elements of social support as illustrated by a new model of Social Support in Bereavement (SSB), however, requires empirical evidence. Who might be the most effective providers of social support in bereavement has also been understudied, particularly within specific cultural contexts. The present study uses both qualitative and quantitative analyses to explore these two important issues among bereaved Chinese families and individuals. The results show that three major types of social support described by the SSB model were frequently acknowledged by the participants in this study. Aside from relevant books, family and friends were the primary sources of social support who in turn received support from their workplaces. Helping professionals turned out to be the least significant source of social support in the Chinese cultural context. Differences by gender, age, and bereavement time were also found. The findings render empirical evidence to the conceptual model of Social Support in Bereavement and also offer culturally relevant guidance for providing effective support to the bereaved.