The impacts and effectiveness of support for people bereaved through advanced illness: A systematic review and thematic synthesis

Harrop, Emily; Morgan, Fiona; Longo, Mirella; Semedo, Lenira; Fitzgibbon, Jim; Pickett, Sara; Scott, Hannah; Seddon, Kathy; Sivell, Stephanie; Nelson, Annmarie; Byrne, Anthony

doi:10.1177/0269216320920533

Cited by 35 publications

(40 citation statements)

References 86 publications

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“…14,15,21–25 Likewise, accessing peer support from those with shared experiences was also found to be helpful, in terms of understanding grief responses 21–23,25 and developing supportive relationships. 25 This is consistent with the evidence for bereavement support relating to deaths from advanced disease 26,27 and Dual Process Models of grief adaptation, which describe a process of oscillation between loss-orientated and restoration-orientated coping. 28 It is also consistent with other disaster-specific evidence on the importance of social support and connectedness for the psycho-social recovery and mental health of trauma victims 29,30 and international guidelines 31 which recommend the promotion of connectedness and self/community efficacy when responding to collective trauma events.…”

Section: Discussionsupporting

confidence: 83%

“…While the evidence considered in this review was based on forms of in-person support, current COVID-19 infection control requirements means that alternative, remote modes of delivery such as telephone/virtual counselling, virtual groups, online forums or even outdoor activities, are required. Due to the dearth of evidence on these methods in disaster and regular bereavement contexts, 26 it is important that rapid evidence is sought on their acceptability, feasibility and effectiveness.…”

Section: Discussionmentioning

confidence: 99%

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What elements of a systems’ approach to bereavement are most effective in times of mass bereavement? A narrative systematic review with lessons for COVID-19

et al. 2020

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Background: The global COVID-19 pandemic has left health and social care systems facing the challenge of supporting large numbers of bereaved people in difficult and unprecedented social conditions. Previous reviews have not comprehensively synthesised the evidence on the response of health and social care systems to mass bereavement events. Aim: To synthesise the evidence regarding system-level responses to mass bereavement events, including natural and human-made disasters as well as pandemics, to inform service provision and policy during the COVID-19 pandemic and beyond. Design: A rapid systematic review was conducted, with narrative synthesis. The review protocol was registered prospectively ( www.crd.york.ac.uk/prospero , CRD 42020180723). Data sources: MEDLINE, Global Health, PsycINFO and Scopus databases were searched for studies published between 2000 and 2020. Reference lists were screened for further relevant publications, and citation tracking was performed. Results: Six studies were included reporting on system responses to mass bereavement following human-made and natural disasters, involving a range of individual and group-based support initiatives. Positive impacts were reported, but study quality was generally low and reliant on data from retrospective evaluation designs. Key features of service delivery were identified: a proactive outreach approach, centrally organised but locally delivered interventions, event-specific professional competencies and an emphasis on psycho-educational content. Conclusion: Despite the limitations in the quantity and quality of the evidence base, consistent messages are identified for bereavement support provision during the pandemic. High quality primary studies are needed to ensure service improvement in the current crisis and to guide future disaster response efforts.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

What elements of a systems’ approach to bereavement are most effective in times of mass bereavement? A narrative systematic review with lessons for COVID-19

et al. 2020

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“…Targeted interventions for those experiencing CG is most effective, 82 , 83 yet at present evidence on what, how, and for whom such treatments work is limited. 15 , 82 Interventions such as condolence letters and death registers have been subject to little empirical evaluation. 84 The efficacy of education recommendations also remains largely unknown.…”

Section: Discussionmentioning

confidence: 99%

“…Significant knowledge gaps remain that have implications for practice and warrant further research. Targeted interventions for those experiencing complicated grief is most effective (83, 84) yet at present evidence on what, how, and for whom such treatments work is limited (15,83). Interventions such as condolence letters and death registers have been subject to little empirical evaluation (85).…”

Section: Implications For Research and Practicementioning

confidence: 99%

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Supporting bereavement and complicated grief in primary care: a realist review

et al. 2021

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BackgroundBereavement can have significant impacts on physical and mental health, and a minority of people experience complicated and prolonged grief responses. Primary care is ideally situated to offer bereavement care, yet UK provision remains variable and practitioners feel uncertain how best to support bereaved patients.AimTo identify what works, how, and for whom, in the management of complicated grief in primary care.Design & settingA review of evidence on the management of complicated grief and bereavement in UK primary care settings.MethodA realist approach was taken which aims to provide causal explanations through the generation and articulation of contexts, mechanisms, and outcomes.ResultsForty-two articles were included. Evidence on the primary care management of complicated or prolonged grief was limited. GPs and nurses view bereavement support as part of their role, yet experience uncertainty over the appropriate extent of their involvement. Patients and clinicians often have differing views on the role of primary care in bereavement. Training in bereavement, local systems for reporting deaths, practitioner time and resources can assist or hinder bereavement care provision. Practitioners find bereavement care can be emotionally challenging. Understanding patients’ needs can encourage a proactive response and help identify appropriate support.ConclusionBereavement care in primary care remains variable and practitioners feel unprepared to provide appropriate bereavement care. Patients at higher risk of complicated or prolonged grief may fail to receive the support they need from primary care. Further research is required to address the potential unmet needs of bereaved patients.

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Caregiver bereavement outcomes in advanced cancer: associations with quality of death and patient age

Mah

Swami

Pope

et al. 2021

Support Care Cancer

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Purpose We investigated relationships between domains of quality of dying and death in patients with advanced cancer and their caregivers’ bereavement outcomes and the moderating effect of patient age at death. Methods Bereaved caregivers of deceased patients with advanced cancer who had participated in an early palliative care trial completed measures of grief (Texas Revised Inventory of Grief [TRIG]), complicated grief (Prolonged Grief Inventory [PG-13]), and depression (Center for Epidemiologic Studies-Depression [CESD-10]). They also completed the Quality of Dying and Death measure (QODD), which assesses patients’ symptom control, preparation for death, connectedness with loved ones, and sense of peace with death. Results A total of 157 bereaved caregivers completed the study. When patient age × QODD subscale interactions were included, greater death preparation was related to less grief at patient death (past TRIG: β = − .25, p = .04), less current grief (present TRIG: β = − .26, p = .03), less complicated grief (PG-13: β = − .37, p = .001), and less depression (CESD-10: β = − .35, p = .005). Greater symptom control was related to less current grief (present TRIG: β = − .27, p = .02), less complicated grief (PG-13: β = − .24, p = .03), and less depression (CESD-10: β = − .29, p = .01). Significant patient age × connectedness interaction effects for current grief (present TRIG: β = .30, p = .02) and complicated grief (PG-13: β = .29, p = .007) indicated that, with less connectedness, younger patient age at death was associated with greater caregiver grief. Conclusion Better end-of-life death preparation and symptom control for patients with cancer may attenuate later caregiver grief and depression. Less connectedness between younger patients and their families may adversely affect caregiver grief.

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The impacts and effectiveness of support for people bereaved through advanced illness: A systematic review and thematic synthesis

Cited by 35 publications

References 86 publications

What elements of a systems’ approach to bereavement are most effective in times of mass bereavement? A narrative systematic review with lessons for COVID-19

What elements of a systems’ approach to bereavement are most effective in times of mass bereavement? A narrative systematic review with lessons for COVID-19

Supporting bereavement and complicated grief in primary care: a realist review

Caregiver bereavement outcomes in advanced cancer: associations with quality of death and patient age

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