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

Caroline Pearce,Isla Kuhn,Stephen Barclay,Geoff Wong

doi:10.3399/bjgpo.2021.0008

Caroline Pearce, Isla Kuhn + Show 2 more

Open Access

https://doi.org/10.3399/bjgpo.2021.0008

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Abstract

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 (CG) in primary care.Design & settingA review of evidence on the management of CG and bereavement in UK primary care settings.MethodA realist approach was taken that 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.

Highlights

Most people adapt to bereavement without formal support
Evidence from this review shows that bereavement care is considered an important part of primary care, the way in which it is provided remains inconsistent, and clinicians experience many ambiguities as to the appropriate extent of their involvement with bereaved patients
In the UK, there remains no consistent approach to general bereavement care,[4] or to managing severe grief symptoms, despite protocols for general practice proposed over 20 years ago.[8]

Summary

Introduction

Most people adapt to bereavement without formal support. a minority of bereaved people develop complicated or prolonged grief symptoms, experiencing disruption in daily functioning.[1,2] Complicated grief (CG) or Prolonged grief disorder (PGD) is a mental health condition involving a pervasive grief response that persists for more than 6 months following a loss.[3]. GPs are frequently identified as ideally placed to offer bereavement support,[8,9] yet primary care practitioners are often uncertain how to best support bereaved people[10] and awareness of CG or PGD is low.[11] In the UK, there remains no consistent approach to general bereavement care,[4] or to managing severe grief symptoms, despite protocols for general practice proposed over 20 years ago.[8] NHS policy recognises the importance of bereavement care,[12] but nationally provision is varied.[13,14,15,16]. Primary care is ideally situated to offer bereavement care, yet UK provision remains variable and practitioners feel uncertain how best to support bereaved patients. Patients at higher risk of complicated or prolonged grief may fail to receive the support they need from primary care.

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