The researchers make a clarion call for greater investment in bereavement care

The public health damage 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 an article 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 investments in bereavement support services are woefully inadequate to address this growing public health crisis, said researchers at the Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine and collaborating organizations.

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 the founding director of the new center and an associate professor of public health sciences at the Miller School, noted, “We need a paradigm shift in how health care professionals, institutions, and systems look at bereavement Sylvester is leading the way by investing in the creation of this center, 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. Yet bereavement care is often under-resourced and inequitable in access.”

Wendy G. Lichtenthal, PhD, FT, FAPOS, Corresponding Author

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, emphasizing 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 bereavement care – healthcare teams engage in loss-aware practices, and compassionate communities consider the emotional and practical needs of the families of dying patients.
• Bereavement Care Ownership – Institutions provide bereavement staff training, family risk assessments, outreach, and grief counseling or support. Communities create bereavement centers and ‘champions’ to provide bereavement care in workplaces, schools, places of worship or care facilities.
• Allocation of Bereavement Care Resources – Specialist staff offer universal coverage and bereaved stakeholders provide input to identify community barriers and needed resources.
• Upskilling of support providers – Bereavement training is integrated into health professional training programs and institutions offer specialist bereavement 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 grief-aware and informed workforce, as well as grief-literate, compassionate communities and health systems that prioritize loss as a vital part of ethical health care.”

“This paper calls on health care 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.