Bereavement care provision in palliative care – a European descriptive and consensus-building exercise

Bereavement care is an explicit aspect of holistic palliative care which extends to caring for those who are important to the patient (WHO, 2002). Bereavement care ensures that families and significant others are supported from the time of diagnosis and in the time after the patient’s death. It may involve information, practical support, social support and for some, counselling and psychological support. US, Canadian, Australian, British and European models of bereavement care have developed since the beginning of the modern hospice movement in the 1960s.

These models involve a range of approaches to, assessments for and provision of bereavement care which include individual, family and group interventions and volunteer supports. (Field et al 2004; O’Connor et al 2009; Aranda and Milne, 2000; Relf, Machin and Archer, 2010) In addition, bereavement supports vary in the extent to which they interact with community models of bereavement support and primary care (Field et al 2007), the constituency they serve (i.e. only hospice-bereaved families or open to whole community) and in the extent to which they can be described as targetted at those in need, those already experiencing difficulty or universally open to all (NICE, 2004, Currier et al, 2008; Schut and Stroebe 2005, Aoun et al, 2012).

In pracitice bereavement care may also be offered in an ad-hoc manner, relative to the resources and skills of the service. Informal and broad community support intiatives can provide responsive care, which fits with tradition and a community’s natural way of doing things.

group chairs bereavement Orla Keegan and Irene Murphy

The Task Force is chaired by Orla Keegan, Irish Hospice Foundation, Ireland and Irene Murphy, Marymount University Hospice, Ireland.

Moreover, while bereavement care is properly of the remit of all care professionals in palliative care, there is variation in the disciplines which lead the development of bereavement services internationally – including social work, psychology, nursing, counselling, chaplaincy, and volunteer coordinators.

While some literature is available on how bereavement services have evolved and developed in the West, there is little available as yet on Eastern Europe and further afield. In addition, there is some concern that what we know about bereavement is biased in favour of the white, western female experience and is based primarily on clinical populations (Wortman and Silver, 2001).

Current thinking links bereavement care to a public health approach. Only small proportions of bereaved people require psychotherapeutic intervention (circa 10 to 15%), a somewhat larger proportion may benefit from trained volunteer and/or professional listening & support service and all could utilise enhanced information, assurance and communication (NICE, 2004; Aroun, 2012). A public health approach seeks to make sure people get the help that is matched to their need.