Matching response to need: What makes social networks fit for providing bereavement support?

Experience of loss and grief among people from Germany who have lost their relatives during the pandemic: the impact of healthcare professionals' support

Background

Due to public restrictions during the early stages of the COVID-19 pandemic, many people were unable to visit and bid a proper farewell to their dying loved ones. This study aimed to address the loss-oriented aspects of grief and bereavement of relatives and relate these to the support they may have received from their dying relative's caring professionals.

Materials and methods

People from Germany who experienced bereavement during the COVID-19 pandemic were enrolled in a cross-sectional study between July 2021 and May 2022, using standardized questionnaires (i.e., ICG, Inventory of Complicated Grief; BGL, Burdened by Grief and Loss scale; WHO-5, WHO-Five Wellbeing Index; and 5NRS, perception of burden related to the pandemic).

Results

Most participants (n = 196) had the opportunity to visit their relatives before death (59%). When this was not possible, being burdened by grief and loss was significantly higher (Eta2 = 0.153), while this had no significant influence on complicated grief or psychological wellbeing. Furthermore, 34% of participants felt well-supported by the treatment/care team. Their own support was moderately correlated with BGL scores (r = -0.38) and marginally with ICG scores (r = -15). Regression analyses showed that complicated grief symptoms as the dependent variable were predicted by (low) psychological wellbeing, relational status, and the perception of COVID-19-related burden (R2 = 0.70). In contrast, BGL as the dependent variable can be best explained by the perception of emotional affections because of restricted visits shortly before their death, by the (short) duration of visits before death, and by the relational status (R2 = 0.53). Although both were interconnected (r = 0.44), their predictor pattern was different.

Conclusion

Being able to visit dying relatives was important for the mourning and bereavement processes. This emotional aspect was more relevant to the normal, non-pathological grief and loss processes than to complicated grief processes. Support from their dying relatives' treatment/care team was highly relevant to the mourning process, but the visiting relatives often lacked information about additional resources such as psychologists or pastoral care professionals or had limited access to them.

Supporting bereaved people: a qualitative study on the experience of informal support providers, before and during the pandemic scenario

The COVID-19 outbreak has further highlighted the need to strengthen support networks to sustain grieving people. However, we know very little about the experience of those who, because of their emotional connection with the bereaved person or of their social function, find themselves supporting people in grief. The current study aimed to analyze the experience of grievers' informal support providers (relatives and friends, teachers, religious leaders, funeral providers, pharmacists, volunteers, and social service workers). 162 in-depth interviews were collected (meanage = 42.3, SD = 14.9; women = 63.6%). Findings highlight two different ways of talking about one's experience and two different ways of offering support. Such dissimilarities do not relate to the period in which support was offered (before or during the pandemic). The results will be discussed in order to highlight emerging training needs to support bereaved people in their difficult transition.

Psychosocial Care Needs, Personality Styles, and Coping Strategies of Mourners in a Rural Municipality in Spain: An Observational Study

Grieving is a natural, self-limiting process of adaptation to a new reality following a significant loss, either real or perceived, with a wide range of manifestations that have an impact on the health of the grieving individual. This study aims to analyse the relationships between interpersonal styles, coping strategies, and psychosocial care needs in a sample of mourners in a rural municipality. Initial hypothesis: there are associations between types of grief and psychosocial needs, as well as between types of grief and interpersonal styles or coping strategies. An observational, descriptive, analytical, cross-sectional study was carried out with a sample of 123 people. Female participants represented 64.2% of all participants. The mean age was 42.7 (±13.2) years, and 86.2% of participants reported continuing to suffer from the loss, with a 10.5% prevalence of maladaptive grieving. Regarding the associations identified between coping strategies and the interpersonal characteristics of the mourners, we found that those with the best coping scores described themselves as self-confident, boastful, jovial, forceful, gentle-hearted, self-assured, outgoing, and/or neighbourly. By contrast, mourners who obtained poorer coping scores self-identified as shy, unsparkling, timid, unsociable, unbold, and/or bashful. This provides a clinical profile linked to maladaptive grieving in which emotional, self-perception, and social problems are prevalent.

'Sadly I think we are sort of still quite white, middle-class really' - Inequities in access to bereavement support: Findings from a mixed methods study

BACKGROUND

Voluntary and community sector bereavement services are central to bereavement support in the UK.

AIM

To determine service providers' perspectives on access to their support before and during the COVID-19 pandemic.

DESIGN

Mixed methods study using an explanatory sequential design: (1) Cross-sectional online survey of UK bereavement services; (2) Qualitative interviews with staff and volunteers at selected services.

SETTINGS/PARTICIPANTS

147 services participated in the survey; 24 interviews were conducted across 14 services.

RESULTS

67.3% of services reported there were groups with unmet needs not accessing their services before the pandemic; most frequently people from minoritised ethnic communities (49%), sexual minority groups (26.5%), deprived areas (24.5%) and men (23.8%). Compared with before the pandemic, 3.4% of services were seeing more people from minoritised ethnic groups, while 6.1% were seeing fewer. 25.2% of services did not collect ethnicity data. Qualitative findings demonstrated the disproportionate impact of the pandemic on minoritised ethnic communities, including disruption to care/mourning practices, and the need for culturally appropriate support. During the pandemic outreach activities were sometimes deprioritised; however, increased collaboration was also reported. Online provision improved access but excluded some. Positive interventions to increase equity included collecting client demographic data; improving outreach, language accessibility and staff representation; supporting other professionals to provide bereavement support; local collaboration and co-production.

CONCLUSIONS

Service providers report inequities in access to bereavement support. Attention needs to be paid to identifying, assessing and meeting unmet needs for appropriate bereavement support. Identified positive interventions can inform service provision and research.

Does 'Time Heal all Wounds?' The Prevalence and Predictors of Prolonged Grief Among Drug-Death Bereaved Family Members: A Cross-Sectional Study

Despite rising rates of drug-related deaths (DRDs), the consequences of DRDs for bereaved family members are scarcely investigated. This study aimed to estimate the prevalence of prolonged grief (PG) symptoms in bereaved family members after DRDs, identify predictors of PG and examine whether symptom levels decrease with time. A cross-sectional design based on survey data from parents (n = 93), siblings (n = 78), children (n = 24) and other family members (n = 39) was conducted (n = 234). Descriptive analyses, a multivariate linear regression, and ANOVA were performed. 60 family members (26%) suffered from high levels of PG symptoms after DRDs (parents 31.2%, siblings 21.8%, children 20.9%). The strongest associations were found between a high level of symptoms and 'months since the loss', 'suicidal thoughts' and 'withdrawal from others'. The ANOVA analyses showed that time does not always 'heal all wounds', and the bereaved who lost one to 2 years ago had the highest level of PG symptoms.

Using the Delphi technique to achieve consensus on bereavement care in palliative care in Europe: An EAPC White Paper

BACKGROUND

The WHO definition of palliative care includes bereavement support as integral to palliative care, yet a previous survey of bereavement support in palliative care in Europe has shown a range of service responses to loss. A rigorous approach to agreeing and implementing a palliative care bereavement framework was required.

AIM

The aim of this study was to develop consensus on best-practice recommendations for bereavement care principles, structures, processes and delivery based on current practice and evidence.

DESIGN

In accordance with Guidance on Conducting and Reporting Delphi Studies, a consensus-building five-round Delphi technique was performed. A scoping review of research literature informed drafting of 54 statements by the EAPC Bereavement Task Force. Evaluation of the statements was performed by an expert panel using a 5-point Likert scale. ⩾80% agreement were defined as essential items and 75%-79% agreement were defined as desirable items. Items with a consensus rating <75% were revised during the process.

SETTING/PARTICIPANTS

The Delphi study was carried out by an expert panel among membership organisations of the European Association for Palliative Care.

RESULTS

In total, 376 email requests to complete Delphi questionnaire were distributed with a response rate of 23% (n = 87) and a follow-up response-rate of 79% (n = 69). Of the initial 54 statements in six dimensions, 52 statements were endorsed with 26 essential statements and 26 desirable statements.

CONCLUSIONS

The six dimensions and 52 statements agreed through this Delphi study clarify a coherent direction for development of bereavement services in palliative care in Europe.

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.

Exploring the Social Networks of Women Bereaved by Stillbirth: A Descriptive Qualitative Study

The loss of a baby to stillbirth is a traumatic experience and can lead to secondary losses, such as the loss of social relationships. In Nigeria, stillbirths are a common public health problem. However, limited attention has been given to the social ramifications of stillbirths. This study describes the social networks of women who have experienced a stillbirth and the factors influencing their social networks. Interviews and social network diagrams were used to collect data from 20 women about their social networks before and after stillbirth. Findings suggest that the experience of shame, unmet expectation of support, and a lack of trust led to relationship changes after stillbirth. Most participants met bereavement needs with their existing social networks before stillbirth, but many participants also experienced relationship losses (even among family networks). Information from social network analysis can reveal the risks and strengths inherent in social networks, which can be helpful for the provision of tailored/personalized bereavement care.

Why and how the work of Motor Neurone Disease Associations matters before and during bereavement: a consumer perspective

Background:

Studies on the experiences of consumers with Motor Neurone Disease Associations at end of life and bereavement are lacking, and their role and capability within the broader sectors of health and disability are unknown.

Objectives:

To ascertain the experiences and views of bereaved motor neurone disease caregivers with Motor Neurone Disease Associations about service gaps and needed improvements before and during bereavement and to propose a model of care that fits with consumer preferences and where Motor Neurone Disease Associations are effective enablers of care.

Methods:

A national bereavement survey was facilitated in 2019 by all Motor Neurone Disease Associations in Australia. A total of 363 respondents completed the section on support provided by Motor Neurone Disease Associations. A mixed-method design was used.

Results:

Respondents were generally positive about support received before bereavement (73-76%), except for emotional support (55%). Positive experiences related to the following: information, equipment advice/provision, advocacy/linking to services, showing empathy/understanding, personal contact and peer social support. Negative experiences included lack of continuity in case management and contact, perceived lack of competence or training, lack of emotional support and a lack of access to motor neurone disease services in rural areas. Suggested improvements were as follows: more contact and compassion at end of life and postdeath; better preparation for end of life; option of discussing euthanasia; providing referrals and links for counseling; access to caregiver support groups and peer interaction; provision of a genuine continuum of care rather than postdeath abandonment; guidance regarding postdeath practicalities; and more access to bereavement support in rural areas.

Conclusion:

This study provides consumer perspectives on driving new or improved initiatives by Motor Neurone Disease Associations and the need for a national standardised approach to training and service delivery, based on research evidence. A public health approach to motor neurone disease end-of-life care, of international applicability, is proposed to address the needs and preferences of motor neurone disease consumers, while supporting the capability of Motor Neurone Disease Associations within a multidisciplinary workforce to deliver that care.

A Compassionate Communities Approach in a Grief and Bereavement Support Program: Bridging the Gap in Palliative Care

Grief and bereavement support is a fundamental component of palliative care, yet there is a gap in practice as not all palliative care services offer it. The compassionate communities (CC) approach aims to build community capacity to address grief as grief support is considered everyone's responsibility. This study describes the characteristics, development, growth and attendees of a grief support program that uses a CC approach to bridge the gap of grief support in palliative care.

The prevalence of childhood bereavement in Scotland and its relationship with disadvantage: the significance of a public health approach to death, dying and bereavement

BACKGROUND AND METHOD

There is an absence of research on the prevalence of bereavement during early childhood and the relationship between childhood bereavement and socioeconomic status (SES) and this poses a challenge in both understanding and supporting children's bereavement experiences. Using longitudinal data from the Growing Up in Scotland study, which tracks the lives of three nationally representative cohorts of children, this paper aimed to address these gaps in research. It specifically drew on data from Birth Cohort 1 to document the recorded bereavements of 2,815 children who completed all 8 sweeps of data collection, from age 10 months to 10 years.

FINDINGS

The study found that 50.8% of all children are bereaved of a parent, sibling, grandparent or other close family member by age 8 and this rises to 62% by age 10. The most common death experienced was that of a grandparent or other close relative. The study also found that children born into the lowest income households are at greater risk of being bereaved of a parent or sibling than those born into the highest income households.

DISCUSSION AND CONCLUSION

Given the prevalence of childhood bereavement and its relationship with disadvantage, this paper argues that there is an important need to understand bereavement as a universal issue that is affected by the social conditions in which a child becomes bereaved, as well as an individual experience potentially requiring specialist support. This paper thus seeks to position childhood bereavement more firmly within the public health approach to palliative and bereavement care discourse and contends that doing so provides a unique and comprehensive opportunity to better understand and holistically respond to the experience of bereavement during childhood.

Experiences of Bereaved Family Members Receiving Commemorative Paintings: A Qualitative Study

IMPORTANCE

Although family members of patients who die in the intensive care unit commonly experience long-term psychological distress, end-of-life bereavement support programs for such relatives are uncommon. Whether art influences the grief experience of families is largely unexplored.

OBJECTIVE

To explore the influence of personalized paintings created to honor deceased critically ill patients on family members' bereavement experience.

DESIGN, SETTING, AND PARTICIPANTS

A qualitative descriptive analysis was conducted of semistructured interviews of grieving relatives who received a painting after the death of their loved one. The deceased patients were from a 21-bed medical-surgical intensive care unit. Eleven families were invited to receive a painting, of whom 1 family declined. A total of 22 family members of 10 patients who died in the intensive care unit were interviewed in the study between July 11, 2017, and May 19, 2019.

INTERVENTIONS

Patients were enrolled in an end-of-life care program that elicits and implements wishes of patients and their families to bring peace during the dying process. Selected families of 10 decedents were invited to receive a painting to honor their loved one 1 to 10 months after the patient's death. Using details about the patient's life story, the artist created individualized paintings to commemorate each patient.

MAIN OUTCOMES AND MEASURES

The experiences of family members receiving a personalized painting and its reported influence on their grieving experience.

RESULTS

The family members of 10 decedents (mean [SD] age, 60 [14] years; 5 women [50%]; 8 White patients [80%]) were interviewed. The central theme of art to facilitate healing was illustrated through the following domains: the cocreation process, painting narratives, postmortem connections, and legacy. The process of cocreating the paintings with the artist and family members involved reminiscing, storytelling, and creativity. Family members emphasized the role of art to facilitate healing, exemplified through connections with images portrayed that deeply resonated with memories of their loved one. Participants indicated that the paintings validated that the patient was remembered, helped families feel less alone during a time of grief, honored the loved one's life, and enhanced connections between family members and clinicians.

CONCLUSIONS AND RELEVANCE

This qualitative study's findings suggest that the creation of personalized paintings commemorating the lives of patients may help foster legacy and postmortem connections with clinicians and may help family members in their healing process.

A qualitative analysis of psychosocial needs and support impacts in families affected by young sudden cardiac death: The role of community and peer support

BACKGROUND

Young sudden cardiac death (YSCD), often occurring in previously healthy individuals, is a tragic event with devastating impact on affected families, who are at heightened risk of posttraumatic stress and prolonged grief and may themselves be at risk of YSCD. Previous research suggests that surviving family members' psychosocial support needs are often unmet.

PURPOSE

This study sought to identify how YSCD-affected families experience dedicated community and peer support in light of their psychosocial support needs.

METHODS

The study used a qualitative design, employing a thematic analysis of focus group and interview data. Three focus groups and five individual interviews were conducted with affected family members (N = 19). The sample was drawn from a UK-based charity, Cardiac Risk in the Young. Audio-recordings of the focus groups and interviews were transcribed and subjected to thematic analysis.

RESULTS

Three super-ordinate themes were identified: 1. YSCD community support as offering a place of safety, 2. YSCD community support as fostering sense-making, 3. YSCD community support as facilitating finding new meaning.

CONCLUSIONS

YSCD-affected families can benefit from access to dedicated community and peer support that offers a safe environment, provides affiliation, understanding and normalisation and enables sense-making and the rebuilding of a sense of self. Dedicated community support can facilitate meaningful re-engagement with life through helping prevent YSCD and through memorialisation and legacy-building to maintain a continuing bond with the deceased. Clinicians need to be aware of the need to incorporate available community and peer support into patient pathways.

Who cares for the bereaved? A national survey of family caregivers of people with motor neurone disease

BACKGROUND

Although Motor Neurone Disease (MND) caregivers are most challenged physically and psychologically, there is a paucity of population-based research to investigate the impact of bereavement, unmet needs, range of supports, and their helpfulness as perceived by bereaved MND caregivers. Methods: An anonymous national population-based cross-sectional postal and online survey of bereavement experiences of family caregivers who lost a relative/friend to MND in 2016, 2017, and 2018. Recruitment was through all MND Associations in Australia. Results: 393 valid responses were received (31% response rate). Bereaved caregiver deterioration in physical (31%) and mental health (42%) were common. Approximately 40% did not feel their support needs were met. Perceived insufficiency of support was higher for caregivers at high bereavement risk (63%) and was associated with a significant worsening of their mental and physical health. The majority accessed support from family and friends followed by MND Associations, GPs, and funeral providers. Informal supports were reported to be the most helpful. Sources of professional help were the least used and they were perceived to be the least helpful. Conclusions: This study highlights the need for a new and enhanced approach to MND bereavement care involving a caregiver risk and needs assessment as a basis for a tailored "goodness of fit" support plan. This approach requires continuity of care, more resources, formal plans, and enhanced training for professionals, as well as optimizing community capacity. MND Associations are well-positioned to support affected families before and after bereavement but may require additional training and resources to fulfill this role.

Exploring the Social Networks of Bereaved Spouses: Phenomenological Case Studies

Bereavement is a significant stressor that can affect and be affected by social support, yet there is little known about the social networks of bereaved individuals. We conducted an in-depth qualitative examination of the social networks of bereaved spouses through an interpretive phenomenological analysis. Five participants were interviewed about their social networks prior to and following bereavement. Participants described considerable changes in their social networks. They reported connecting with others who had experienced similar stressors, including via online support groups for widows/widowers, as a key strategy for re-engagement with their social worlds. The death of a spouse can precipitate the dramatic reorganization of social networks to incorporate and adapt to this crisis. Findings offer guidance for service providers to support bereaved spouses to harness existing social networks to optimize received support.

The value of implementation science in bridging the evidence gap in bereavement care

There is a gap in the use of evidence in bereavement care. Implementation science is a field focused on moving evidence into practice and therefore may help close the gap. Implementation science advances the design, relevance, and dissemination of research and the adoption, implementation, and maintenance of evidence-based practices. We provide an overview of implementation science, describe five implementation frameworks (Knowledge to Action; Behavior Change Wheel; Exploration Preparation Implementation Sustainment; Interactive Systems Framework; and Reach, Adoption, Implementation, Maintenance), and illustrate their application in bereavement care. These advancements will promote high-quality bereavement care that improves the lives of bereaved people.

Grief literacy: A call to action for compassionate communities

The compassionate communities movement challenges the notion that death and dying should be housed within clinical and institutional contexts, and works to normalize conversations about death and dying by promoting death literacy and dialogue in public spaces. Community-based practices and conversations about grief remain marginal in this agenda. We aimed to theorize how grief could be better conceptualized and operationalized within the compassionate communities movement. We develop the concept of Grief Literacy and present vignettes to illustrate a grief literate society. Grief literacy augments the concept of death literacy, thereby further enhancing the potential of the compassionate communities approach.