Bereavement disclosure in dementia care presents ethical and cultural challenges in Japan. A cross-sectional survey was conducted with 25 family caregivers who had experience caring for a person with dementia and who had also experienced the death of a significant person, assessing attitudes toward disclosure and preferences for support. About 80% supported disclosure, citing dignity and relational closeness. Non-disclosure was most often attributed to physical condition, confusion, unpredictable reactions, or professional advice. Younger caregivers favored internet-based support, whereas older caregivers preferred booklets, lectures, and family association services. Findings highlight ethical tension between dignity and avoidance of confusion, with relational and situational factors shaping decisions. Hybrid support models that combine asynchronous online resources with family association services may enhance accessibility and provide caregivers with sustained support in dementia care.

BackgroundEnd-of-life care affects both patients with advanced cancer and their relatives but is often assessed from only one perspective, namely that of bereaved relatives. This study aimed to gain insight into the quality of care as experienced by patients with advanced cancer and their relatives.MethodsA total of 367 patients with stage IV cancer, 242 relatives and 163 bereaved relatives were included from a large prospective, longitudinal study (eQuiPe), which ran from November 2017 until March 2020. Patients and their relatives completed a questionnaire during the last 3 months of the patient’s life. Bereaved relatives completed a questionnaire within six months after the patient’s death.ResultsAt the end of life, patients reported a mean satisfaction with care score of 72/100 (SD 21), and relatives a mean score of 59/100 (SD 28) for the care they received themselves. Continuity with care, the extent to which the care received from different healthcare professionals was coordinated, was associated with higher satisfaction with care in patients (β 2.1, 95% CI 1.6–2.6). Bereaved relatives reported that most patients died peacefully (87%) and at home (73%). Most bereaved relatives (66%) were contacted by a healthcare professional after the patient’s death, but over half were not informed about grief (52%) or the available options for bereavement support (58%), with about 20% reporting they would have appreciated this.ConclusionsQuality of end-of-life care was generally perceived as good. This study highlights the importance of good continuity of care as it is associated with higher satisfaction with care in patients. Also, one-fifth of the bereaved relatives reported that they had not been informed about bereavement care despite desiring it, which emphasizes the need for better care for relatives before and after the patient’s death.

When a person chooses assisted dying, the impact on their family can be profound. Legislation and professional guidelines not only regulate and standardize practice, but also support the delivery of high-quality care. Within this framework, bereavement care plays a vital role by helping families prepare for the death and potentially reducing the risk of prolonged grief. This study explored how current legislation and clinical guidelines on assisted dying address the role and needs of family members, particularly regarding bereavement care. It examined the frequency of the term "family" and its synonyms, as well as the extent to which bereavement support services for relatives are described. A content analysis was conducted on legislative and guideline documents from countries where physician-administered assisted dying is legal. Documents were collected between August 2022 and June 2023, and both quantitative and qualitative analyses were used to assess references to families and descriptions of bereavement care. In total, 22 legislative frameworks and 38 clinical guidelines from nine countries were analyzed. References to family appeared far more often in guidelines (N = 1,213) than in legislation (N = 147). The frequency of these terms varied significantly, with guidelines ranging from two to 83 mentions, and legislation from zero to 18. Eight key themes related to bereavement care emerged, though specific guidance was often lacking. To improve quality care, there is a clear need to better integrate family support into assisted dying guidelines by establishing best practices for bereavement care. Future research should focus on family members' perspectives and needs.

Discrepancies in Coronial and Bereavement Support for Families in Australia Following Sudden Unexpected Child Death.

Talking SUDEP: Gaps, confidence and training needs among Spanish epilepsy professionals.

When a loved one dies, some grievers report experiencing phenomena for which no rational explanation seems to exist. This qualitative study, based on a secondary analysis of interview data, aimed to contribute to a deeper understanding of the value and meaning of unexplainable grief experiences for 23 parents who lost a child to cancer and to integrate these insights into bereavement support. Many cancer-bereaved parents had a variety of unexplainable experiences, and none of them gave the impression that they had to hide or suppress these experiences because of perceived stigma. Although these experiences, as a form of continuing bonds, seemed to alleviate the grieving process, their impact on bereaved parents was often bittersweet. To improve grief support to bereaved families, healthcare practitioners should be aware of how the need or desire for such unexplainable experiences interacts with parents’ concerns about how to sustain their child’s memory.

To identify and synthesise the available evidence of nurses' perceptions and experiences of providing bereavement care. Systematic literature review of qualitative studies with meta-synthesis of findings. We searched six databases, PubMed, Web of Science, the Cochrane Library, Embase, CINAHL, and PsyINFO. Initial search in October 2023, and updated in December 2024. The systematic review was conducted in accordance with the JBI methodology for systematic reviews of qualitative evidence. Two reviewers independently conducted study selection and data extraction, and quality appraisal was assessed using the Critical Appraisal Skills Program tool for qualitative research. Data synthesis was conducted using thematic analysis. A total of thirteen studies were included, revealing nine sub-themes and three descriptive themes: challenges in bereavement care, coping strategies, and multifaceted job requirements. Six sub-themes were graded as high confidence and the other three were moderate confidence. Bereavement care is a personalised, long-term and complex process, presenting nurses with unique challenges and requirements that must be measured through the authentic experiences of this group. Educational and practice policies should focus on nurse-centred strategies. Through this meta-synthesis, we can demonstrate to healthcare administrators how to enhance nurses' bereavement care practice experiences and meet their needs, thereby advancing future palliative care development and fostering professional fulfilment. This systematic review synthesises evidence concerning nurses' experiences of providing bereavement care, revealing the multidimensional challenges, coping strategies, and professional demands encountered in practice. The findings offer significant implications for nursing education, clinical practice, and health policy development. Currently, research on nurses delivering bereavement support remains insufficient; further investigation into this group could help bridge gaps between grief counselling theory and practice while highlighting the identified societal issues they face. Not applicable. PROSPERO: CRD42024590469.

Bereavement and loss significantly impact upon children’s educational and emotional outcomes. This paper explores the effects of bereavement on children’s aspirations, emotional health, and overall well-being, emphasising the need for schools to provide effective bereavement support. A whole school approach to supporting pupils with grief and loss is recommended, involving policies, staff training, and partnerships with local bereavement services. There is a need for schools to consider how to broaden pupil peer support and also change the narrative that grief and loss support is something that happens out-with the classroom. The paper also demonstrates the positive outcomes for pupils who have attended Seasons for Growth groups and promotes the wider impact of this programme can have if regular reconnector sessions and normalising grief and loss at a whole school level are implemented.

Multidisciplinary neuro-palliative care has been increasingly recommended for the management of patients with motor neuron disease. While international guidelines have highlighted the importance of early palliative care referral, the best model of practice has not been well-defined. The objective of this study is to evaluate the outcomes of a structured multidisciplinary neuro-palliative care model developed in regional hospitals in Hong Kong. A 10-year retrospective chart review. Adult motor neuron disease patients under care of three regional hospitals in Hong Kong. Data of patients under the care of multidisciplinary neuro-palliative care taskforce and those who were not were analyzed. There were 140 motor neuron disease patients included in study. Patients in multidisciplinary neuro-palliative care group received more healthcare intervention and palliative care services, including occupational therapist (92.86% vs 78.57%, p = 0.021), dietician (67.35% vs 42.86%, p = 0.007) and speech therapist (96.94% vs 76.19%, p = 0.000) services, community support by non-governmental organizations (74.49% vs 19.05%, p = 0.000) and formal bereavement support (78.26% vs 17.07%, p = 0.000). Significantly more patients in multidisciplinary neuro-palliative care group had completed Advance Medical Directives (46.94% vs 4.76%, p = 0.000). Patients under multidisciplinary care had longer survival compared to those who were not (HR 0.539, 95% CI 0.372-0.782, p = 0.001). This remains significant after adjusting for factors affecting survival in multivariate analysis. Multidisciplinary neuro-palliative care demonstrated benefits in motor neuron disease patients in terms of better care coordination and service delivery, higher rate of Advance Medical Directive completion, with possible better survival observed. Future prospective studies are warranted to assess the impact on patient-centered outcomes.

BackgroundGrief is a natural process, and many people will adjust in time with support from family and friends. However, evidence suggests that around 40% of bereaved people may benefit from additional assistance, including support from bereavement volunteers. Despite the recognition that bereavement care is a public health priority, availability of bereavement support is inconsistent across the UK and internationally. The continuing expansion of online connectivity offers opportunities to develop digital health interventions to help address the needs of grieving individuals. To improve access to bereavement support, we developed an online intervention based on Acceptance and Commitment therapy-based Training (ACT) ‘My Grief My Way’ and trained volunteers to provide bereavement support in line with ACT-based principles.AimTo describe the views and experiences of bereavement support volunteers who undertook online ACT-based bereavement support training designed to help bereaved individuals cope with grief and improve quality of life.DesignSemi-structured interviews and focus groups were conducted with a convenience sample of bereavement support volunteers from two not-for-profit bereavement services in UK. Analysis was guided by the framework approach via NVivo-14.ResultsA total of 17 participants were recruited; age range 33–76 years, female, n = 15 (88%); ethnicity white, n = 17 (100%). Of these, 15 completed ACT-based My Grief My Way training. Nine participants took part in two focus groups (n = 7) or individual interviews (n = 2), Training was perceived positively, with resulting themes and subthemes indicating there was something to suit everyone’s learning preferences. Participants described the benefits of incorporating ACT-based principles and strategies as valuable additional tools to current practice, underlining the model’s relevance, compatibility and practical application, and was viewed as a good fit irrespective of which therapeutic approach they used with clients. Online ACT-based training and the delivery of ACT-based bereavement support was therefore, perceived as a valuable approach in this context.

Grief is a natural process, and many people will adjust in time with support from family and friends. However, evidence suggests that around 40% of bereaved people may benefit from additional assistance, including support from bereavement volunteers. Despite the recognition that bereavement care is a public health priority, availability of bereavement support is inconsistent across the UK and internationally. The continuing expansion of online connectivity offers opportunities to develop digital health interventions to help address the needs of grieving individuals. To improve access to bereavement support, we developed an online intervention based on Acceptance and Commitment therapy-based Training (ACT) 'My Grief My Way' and trained volunteers to provide bereavement support in line with ACT-based principles. To describe the views and experiences of bereavement support volunteers who undertook online ACT-based bereavement support training designed to help bereaved individuals cope with grief and improve quality of life. Semi-structured interviews and focus groups were conducted with a convenience sample of bereavement support volunteers from two not-for-profit bereavement services in UK. Analysis was guided by the framework approach via NVivo-14. A total of 17 participants were recruited; age range 33-76 years, female, n = 15 (88%); ethnicity white, n = 17 (100%). Of these, 15 completed ACT-based My Grief My Way training. Nine participants took part in two focus groups (n = 7) or individual interviews (n = 2), Training was perceived positively, with resulting themes and subthemes indicating there was something to suit everyone's learning preferences. Participants described the benefits of incorporating ACT-based principles and strategies as valuable additional tools to current practice, underlining the model's relevance, compatibility and practical application, and was viewed as a good fit irrespective of which therapeutic approach they used with clients. Online ACT-based training and the delivery of ACT-based bereavement support was therefore, perceived as a valuable approach in this context.

AStepped Bereavement Care Model for Children and Young People Abstract: Objective: Losing a caregiver can have a profound impact on the health and quality of life of children and young people (CYP). The provision of needs-based support for this group is questionable. Germany lacks a structured framework that could organize bereavement care for CYP, incorporate the various professional groups and institutions involved, and lead to the establishment of quality standards. This article discusses an Irish stepped-care model at an international level. Adapting it to the German context and disseminating can contribute to the professionalization of bereavement care for CYP. Method: We adapted the stepped-care model through an iterative consensus process involving experts in psychology, psychotherapy, grief counselling, bereavement support, and social work. Results: The German adaptation outlines a four-stage model, beginning at the societal level. Support is tailored to the specific needs of CYP and their families, with support options including the social environment, low-threshold services, and psychotherapy. Facilitating transitions between the levels of care is particularly important to accommodate the dynamic nature of support needs. Conclusions: Establishing a stepped-care framework can contribute to a more needs-based approach to caring for bereaved CYP. Implementing this model requires a systematic identification of needs to avoid potential gaps in care.

Sibling relationships, often the longest in a person’s life, carry deep emotional bonds, making their loss complex yet underrepresented in grief literature. This interpretive, meta-ethnographic qualitative synthesis explored adult sibling bereavement due to illness or accident, analyzing 10 English-language studies (2003–2024) using Noblit and Hare’s (1988) protocol. Three meta-themes were developed: (1) Death’s Ripple Effect, (2) The Space Between Grief and Healing, and (3) Navigating a New Reality. This paper highlights the unique challenges faced by surviving siblings—such as their fractured parallel life, role substitution, and identity disruption—and emphasizes the need for bereavement support that is specifically tailored to these dynamics. The authors recommend that program design is informed by research evidence that shows the importance of age as well as identity-focused and role-sensitive approaches. Existing bereavement interventions are effective but lack specificity, especially for sibling loss, highlighting the need for more targeted and evidenced support.

The death of a loved one is one of life's most ubiquitous events that can increase risk of mental health difficulties. Bereavement support is one of the few factors influencing grief-related mental health outcomes that can be modified after bereavement. This study sought to determine the proportion of bereaved people that want and receive support from different sources following a bereavement, and the bereavement and mental health-related factors associated with wanting and receiving bereavement support. Data was derived from a cross-sectional survey of bereaved adults (n = 1170) living in Ontario, Canada. Over a third of the sample (38.9%; n = 455) reported wanting support in coping with their loss. These individuals exhibited distinct loss-related characteristics and reported higher levels of anxiety, depression, and prolonged grief symptoms. Most of these individuals received support and a small number of participants who didn't want support received it regardless. The most common sources of support were family members, friends, and other bereaved individuals, and these sources were generally found to be helpful. Those who accessed multiple types of support were those with the highest levels of anxiety, depression, and prolonged grief symptoms. Most individuals wanting support after a loss can access it and find it beneficial. The desire for support is closely tied to psychological distress, highlighting the need to prioritize formal support for those in distress and rely on existing social networks for those who are not. Such an approach embodies an 'assets-based' bereavement model, enhancing community capacity for effective support provision.

Background: Access to palliative care is limited in many low-resource settings, despite being a fundamental component of universal health coverage. This paper presents a practical perspective on initiating and scaling up palliative care services, based on the collective experiences of healthcare professionals from diverse regions. Methods: Structured multidisciplinary group discussions were conducted during a Fellowship in Palliative Care program and thematically analyzed. Insights were informed by institutional experiences, regional models, and supporting literature. Results: There were experiential perspectives from ten clinicians and 36 supporting publications. To cultivate awareness and competence, the integration of palliative care into health sciences curricula and continued professional education is recommended. Nurse-led palliative care clinics, community volunteer training, and telemedicine services are identified as scalable, context-sensitive models to extend care beyond traditional settings. Initiatives such as Hope Cafes are proposed to normalize conversations around serious illness and dying and offer supportive environments for patients, caregivers, and the public. Challenges such as limited manpower, inadequate funding, medico-legal constraints, and sociocultural barriers are acknowledged. Solutions suggested include cross-sector partnerships, targeted training, use of digital platforms, and alignment with existing health and social systems. The role of bereavement support and palliative care research is highlighted as essential to holistic palliative care service delivery. Conclusion: This paper offers a roadmap for institutions and regions aiming to introduce or strengthen palliative care services. Through leveraging available human resources, community structures, and innovative delivery models, a compassionate, culturally sensitive, and scalable palliative care framework can be achieved, even in resource-constrained environments.

Schools are well placed to provide bereavement support for pupils, yet teachers do not always feel equipped or confident to provide support and children and young people do not always feel well supported. This article investigates the factors that facilitate or hinder schools’ engagement in supporting bereaved children through a systematic literature analysis from the years of 2018–2025, providing an overview of the most current literature. Papers were analyzed thematically within the categories of: support available, factors that facilitate support and factors that block support. All barriers had a parallel facilitating factor; the evidence base therefore was identified to show how the factors that block schools engaging in bereavement support can also be mediated. The review reflects on how the educational psychology profession may have a role in supporting schools to provide support through supervision, emotional containment and training.

ABSTRACT CAREs is a bereavement care programme for family caregivers of deceased home hospice patients in Singapore. Adopting a public health model, it provides grief resources and connection through five touchpoints over six months post-death. An evaluation surveyed 351 respondents, 306 of whom engaged with the intervention (87.2%). 71.2%–91.5% of responses agreed/strongly agreed that CAREs offered emotional comfort, support, and grief literacy. The findings highlight the demand for grief resources and validate a public health approach to bereavement care, ensuring universal access without pathologizing grief.

Psychosocial interventions are recognized as effective nonpharmacological treatments that can enhance the mental well-being of women dealing with perinatal loss. However, as these interventions vary widely, there is currently no review that systematically evaluates and ranks their effects on the mental health of women affected by perinatal loss. The aim of this study is to integrate the existing evidence, assess and compare the effects of psychosocial interventions on negative emotions among women experiencing perinatal loss, rank the effect sizes of various interventions, and identify the most effective intervention on the basis of different outcome measures. Seven English-language databases were systematically searched for randomized controlled trials (RCTs) focusing on women experiencing perinatal loss, with publications up to August 20, 2024. Traditional pairwise meta-analyses were performed using Review Manager 5.4.1, while Stata 18.0 was employed for network meta-analysis and evidence synthesis. The surface under the cumulative ranking curve (SUCRA) was used to assess the efficacy of the interventions. The protocol was registered with PROSPERO under number CRD42024530312. A total of 30 RCTs encompassing 6181 participants were included in the analysis. On the basis of the SUCRA rankings, problem-solving therapy was identified as an effective treatment for alleviating depression and anxiety among women experiencing perinatal loss (depression: SUCRA = 82.55%, SMD = -1.34, 95% CI [-2.41, -0.27]; anxiety: SUCRA = 97.7%, SMD = -2.83, 95% CI [-4.26, -1.40]). Additionally, bereavement intervention emerged as the most effective approach for improving grief symptoms (SUCRA = 81.60%, SMD = -1.11, 95% CI [-2.14, -0.09]). Compared with traditional treatment, psychosocial intervention can improve the psychological state of women with perinatal loss, and the differences in the effects of face-to-face and technology-assisted interventions should be further explored. Moreover, problem-solving therapy has proven to be effective and appears to be the most effective method for alleviating depressive and anxiety symptoms among women experiencing perinatal loss, while bereavement support is the most effective method for grief due to perinatal loss. Nursing and health policymakers can develop various intervention strategies according to the varied psychological states of women experiencing perinatal loss.

Provision of remote (online/telephone) bereavement support accelerated during the COVID-19 pandemic. However, the extent and impact of this change and lessons learnt are unknown. To determine the extent to which UK voluntary and community sector bereavement services moved to remote support provision during the pandemic, explore providers' perspectives on this shift, and consider implications. Mixed methods explanatory sequential study, conducted spring 2021: (1) Online survey of UK bereavement services; (2) Qualitative interviews with staff and volunteers. 147 services participated in the survey; 44.5% hospice/palliative care services; 15.1% national charities/organisations; 11.6% local charities/ organisations. 24 interviews were conducted across 14 services. Pre-pandemic, remote support was offered by <10% of bereavement organisations. By spring 2021, there had been increases in online: peer group meetings (3.4% pre-pandemic to 33% during, OR 13.8), facilitated group meetings (4.1%-56%, OR 30.48), 1:1 support (8.8%-83%, OR 50.3), and specialist intervention (3.4%-36%, OR 16.01). Telephone bereavement support was also more widely available. The appropriateness and acceptability of these changes differed by client group. Adaptations presented organisational/logistical challenges, and difficulties for support providers working from home. Smaller organisations with fewer resources found these harder to accommodate. Hybrid working and new technologies were reported to increase service efficiency and cost-effectiveness. Remote delivery of bereavement support increased support capacity and can potentially reduce inequities in access. However, it needs to be carefully tailored, and is not appropriate for everyone. Staff and volunteers providing remote services require training and support.

Mid-trimester pregnancy loss (MTL), defined as a pregnancy loss occurring between 14 + 0 and 21 + 6 weeks of gestation, causes significant physical and emotional distress to women and presents clinical challenges to healthcare professionals. It is acknowledged that in low-resource settings, this guideline might be applicable to births up to 28 weeks or babies weighing less than 1 kg. Risk factors for MTL include advanced maternal age, previous history of MTL, women of Black ethnicity, smoking, excessive alcohol consumption, obesity, and anatomical factors such as a short cervix, congenital uterine anomalies, and myomas. Medical risk factors include previous cervical trauma from loop electrosurgical excision procedure or Cesarean section in labor, placental dysfunction, infections, thrombophilias, endocrine disorders such as thyroid disease and polycystic ovary syndrome, and fetal chromosomal abnormalities. Early assessment and accurate diagnosis are fundamental to managing threatened and confirmed mid-trimester pregnancy loss. Our guideline emphasizes the importance of maternal vital signs monitoring, laboratory investigations, and ultrasound imaging to identify and manage those with threatened or confirmed mid-trimester pregnancy loss, as well as address potential maternal complications, including infection or hemorrhage. A multidisciplinary approach involving obstetricians, gynecologists, maternal-fetal medicine specialists, nurses, midwives, psychologists, and social workers is important for providing comprehensive care. The guideline advocates for personalized management plans tailored to individual women's preferences, medical history, and gestational age. Care for threatened MTL should be targeted to the likely cause and might include cervical cerclage, progesterone, and management of risk factors, for example antibiotics for urinary tract infections. Care for confirmed MTL might include expectant management, medical induction of labor, or surgical intervention such as dilation and evacuation. Acknowledging the profound emotional impact of mid-trimester pregnancy loss, our guideline underscores the importance of offering compassionate and culturally sensitive psychosocial support to women and their families. This includes providing access to bereavement care, counseling services, support groups, and resources for coping with grief and loss. Continued monitoring and follow-up care are essential components of managing mid-trimester pregnancy loss. Our guideline recommends regular postpartum assessments to evaluate physical recovery and emotional well-being and to address any ongoing medical or psychological concerns. Contraceptive counseling and future pregnancy planning should also be discussed as part of comprehensive care. It is important that, where possible, women receive continuity of care from healthcare professionals to help the coordination and provision of holistic and comprehensive care. Further research is needed to enhance our understanding of the etiology, risk factors, and optimal management strategies for threatened mid-trimester pregnancy loss. Additionally, education and training initiatives should be implemented to ensure healthcare professionals are equipped with the knowledge and skills necessary to deliver high-quality, woman-centered care to individuals and families experiencing this complication. Mid-trimester pregnancy loss represents a complex clinical scenario necessitating a holistic and compassionate approach to care. By adhering to the recommendations outlined in this clinical guideline, healthcare providers can strive to optimize outcomes and support individuals and their families through this challenging experience.