“We need a paradigm shift in how healthcare professionals, institutions and systems view bereavement care,” said Wendy G. Lichtenthal, PhD, FT, FAPOS, associate professor of public health sciences at Sylvester Comprehensive Cancer Center and corresponding author of the article. “We must move bereavement care from an afterthought to a public health priority.” Photo courtesy of Memorial Sloan Kettering Comprehensive Cancer Center
Point of view in The Lancet Public Health Notes Current funding, resources are insufficient to address this public health problem
MIAMI, FL, March 15, 2024 – The public health toll of bereavement is well documented in the medical literature, with bereaved individuals at greater risk for many adverse outcomes, including mental health challenges, reduced quality of life, neglect of health care, cancer, heart disease, suicide and death. Now, in a paper published in The Lancet Public Healththe researchers make a clarion call for greater investment, both at the community and institutional level, in establishing support for grief-related suffering.
The authors highlight that increased global mortality caused by the COVID-19 pandemic, suicide, drug overdose, homicide, armed conflict and terrorism has accelerated the urgency of national and global frameworks to strengthen the provision of sustainable and affordable care for a heavy loss. Unfortunately, current national and global investment in bereavement support services is woefully inadequate to address this growing public health crisis, researchers from Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine and Associates.
They proposed a transitional care model that involves firmly establishing bereavement support services within health care organizations to ensure continuity of family-centered care while strengthening community support through the development of “compassionate communities” and a grief-informed workforce. The model emphasizes the responsibility of the health care system to build bridges to the community that can help the bereaved feel supported as they transition.
The Sylvester Bereavement Care Development Center advocates exactly this model of transitional care. Wendy G. Lichtenthal, PhD, FT, FAPOS, who is founding director of the new center and associate professor of public health sciences at the Miller School, noted, “We need a paradigm shift in how health care professionals, institutions, and systems view bereavement care. Sylvester is leading the way by investing in the creation of this centre, which is the first to focus on bringing the transitional model of bereavement care to life.”
What further distinguishes the Center is its roots in the science of bereavement, advancing approaches to care that are both research-based and community-engaged.
The authors focused on palliative care, which seeks to provide a holistic approach to minimize suffering for critically ill patients and their families, as one area where improvements are critically needed. They referred to ground-breaking reports by the Lancet commissions on the value of global access to palliative care and pain relief, which highlighted the “undeniable need for improved bereavement care infrastructure”. One of these reports recognizes that bereavement is neglected and calls for a re-prioritization of the social determinants of death, dying and grief.
“Palliative care should culminate in bereavement care, both in theory and in practice,” explained Lichtenthal, who is the paper’s corresponding author. “Yet bereavement care is often under-resourced and inequitable in access.”
A transitional model of bereavement care
So how do health systems and communities prioritize bereavement services to ensure no bereaved person goes without the support they need? The Transitional Bereavement Care Model offers a road map.
“We need to move bereavement care from comfort to a public health priority. Transitional bereavement care is needed to bridge the gap in offerings between health care organizations and community-based bereavement services,” Lichtenthal said. “Our model calls for health systems to improve the quality and availability of their offerings, but also recognizes that bereavement care resources within a health institution are limited, highlighting the need to help build the capacity of communities to support the bereaved.”
Key to the model, she added, is strengthening community support by developing “compassionate communities” and “up-skilling” professional services to help those with more significant bereavement support needs.
The model contains these pillars:
- Preventive care after bereavement – healthcare teams engage in loss-aware practices, and compassionate communities consider the emotional and practical needs of dying patients’ families.
- Ownership of bereavement care – institutions provide bereavement training for staff, family risk assessments, outreach and bereavement counseling or support. Communities create bereavement centers and ‘champions’ to provide bereavement care in workplaces, schools, places of worship or care facilities.
- Allocating resources for bereavement care – specialist staff offer universal outreach and bereaved stakeholders provide information to identify community barriers and needed resources.
- Upskilling of support providers – Bereavement training is integrated into health professional training programs, and institutions offer specialized grief specialists. Communities have trained, accessible bereavement professionals who provide support and are trained in how best to support bereaved people, increasing their grief literacy.
- Evidence-based care – Bereavement care is evidence-based and includes effective grief assessments, interventions, and education programs. Compassionate communities remain aware of bereavement care needs.
Lichtenthal said the new center will strive to materialize these pillars and aims to serve as a global model for other healthcare organizations. She hopes the paper’s recommendations “will cultivate a loss-aware and grief-informed workforce, as well as grief-literate, compassionate communities and health systems that prioritize bereavement as a vital part of ethical health care.”
“This paper calls on healthcare institutions to meet their duty to care for the family beyond the death of patients. By investing in the creation of the Center for Advancement in Bereavement Care, Sylvester is answering that call,” said Lichtenthal.
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Article title: Investing in bereavement care as a public health priority
DOI: 10.1016/S2468-2667(24)00030-6
authors: The full list of authors is included in the article.
Financing: The authors received funding from the National Cancer Institute (P30 CA240139 Nimer) and P30 CA008748 Vickers).
Disclosures: The authors declare no competing interests.
