Bereavement Support Research Articles

Qualitative interview study of strategies to support healthcare personnel mental health through an occupational health lens

BackgroundEmployee Occupational Health (‘occupational health’) clinicians have expansive perspectives of the experience of healthcare personnel. Integrating mental health into the purview of occupational health is a newer approach that could...

Pride in Death.

Background: While all ageing populations share common concerns as they plan for old age and end of life, many older LGBTQIA+ people face significant additional challenges.
 Prevailing social, religious, and cultural attitudes which existed in Ireland until relatively recently, mean older LGBTQIA+ people grew up in society where asserting their identity often led to exclusion and isolation.
 Planning for end of life can make things easier but these factors create barriers for older LGBTQIA+ people who may fear that asserting their identity will lead to discrimination or neglect.
 Research has demonstrated while many LGBTQIA+ people feel uncomfortable disclosing their sexual orientation to health care professionals and allied health staff they are also considerably more likely to rely on formal support services as they get older due to diminished support networks in comparison to their heterosexual peers.
 During Palliative Care Week we encourage people to have tender conversations about death, dying and bereavement and what it means to them. Therefore we sought to engage and have honest conversations with the LGBTQIA+ community at a death cafe type event, to understand key issues for the community, relating to death and dying, and what really matters to them in planning ahead for their end of life care. 
 Who Was Engaged: AIIHPC leads Palliative Care Week and engaged with LGBT Ireland as the gateway organisation to the LGBTQIA+ community. We also engaged with the Irish Hospice Foundation (IHF) who has expertise in advance care planning. Liz Gleeson from Shapes of Grief also joined as a facilitator given her expertise on bereavement. Bettina Korn also joined as a facilitator given her expertise as an end of life coordinator at St James Hospital and an LGBT Champion.
 Impact:
 - LGBTQIA+ Bereavement Support Groups are needed in the Republic of Ireland. LGBTQIA+ people suffer from ambiguous and complicated grief, making the creation of specific bereavement support groups essential.
 - Intergenerational Networks. Younger and older LGBTQIA+ people want connect with one another. Currently spaces outside pubs are lacking.
 - Creation of LGBTQIA+ Reference Group to co-design health information resources. LGBTQIA+ people do not see themselves reflected in the health information provided and are thus, less likely to inform themselves.
 - Need for creativity around funeral planning outside of religious rituals that mutes the voice of the individual.
 Learning for an International Audience: By having honest conversations with people from different communities, we gain insight into their real needs. Sounds simple enough but open and honest conversations can only take place in a safe space where trust exists. Trust can be gained by working with gateway organisations of underrepresented communities, to ensure services are co-designed with the true individual at heart.
 Next Steps:
 - LGBTQIA+ death cafe being held on 8th of December in Dublin.
 - Training of IHF Bereavement Support Line by LGBT Ireland
 - Engaging with other gateway organisations of underrepresented communities such as homeless, refugees, people with disabilities, amongst others to provide a safe space for conversations to take place.

Enhancing the Adult and Paediatric Palliative Care System: Spanish Professionals' and Family Caregivers' Suggestions for Comprehensive Improvement.

This research critically explores deficiencies in the palliative care system, focusing on evaluation and treatment aspects for both adult and paediatric patients. Using a qualitative methodology, the study engages healthcare professionals and family caregivers to uncover perspectives on the existing state of palliative care. Conducted through three focus groups and a semi-structured in-depth interview with participants recruited from Virgen de la Arrixaca University Clinical Hospital, this research illustrates critical issues, highlighting the insufficient healthcare workforce and resources to meet the comprehensive needs of patients and their families. Recommendations include holistic care addressing social, emotional, psychological, socio-familiar, and economic dimensions, supported by embedded support groups and the enforcement of relationships with palliative associations. This study also advocates for improved health institutional coordination, social worker support, and ongoing health professional satisfaction monitoring. In paediatric care, specific demands involve specialised units, medical team continuity, 24 h paediatrician care, and a more professional paediatric approach. Beyond problem identification, this study offers valuable insights for shaping health policies and tools, incorporating new indicators and introducing grief bereavement support in clinical reports, contributing to the advancement of patient evaluation in palliative care.

Age-Friendly Communities: Are they also "Friendly" for Death, Dying, Grief, and Bereavement?

The age-friendly movement aims to ensure that people can live healthy and meaningful lives as they age. It is committed to activity and inclusion, with policies, services, and structures that enable older adults to remain engaged in activities that they value. We suggest that there is further opportunity for communities to increase inclusion and reduce ageism by improving their "death-friendliness". A death-friendly approach could lay the groundwork for a community in which people do not fear getting old or alienate those who have. To this end, we consider the merits of the compassionate communities framework which has emerged out of palliative care and critical public health. Compassionate communities focus on end-of-life planning, bereavement support, and improved understandings about aging, dying, death, loss, and care. The age-friendly and compassionate communities initiatives are complementary in their objectives but have not yet converged in practice. We suggest that they should.

The value of peer contributions and different forms of social support in rare dementia bereaved caregiver groups

AbstractBackgroundPeer support has a key role to play in national and local health services worldwide given growing need, pressure on resources, and strategic drives towards supporting people to manage their own health. Yet evaluation of peer‐only and multi‐component peer and professional group services is held back by research methodology gaps, including the absence of direct, within‐session evaluation tools. The current study evaluates the relationship between participation and conversational characteristics using linguistic analysis of a series of online bereaved support groups.MethodParticipants were bereaved family caregivers (N = 102) attending Rare Dementia Support bereaved support group meetings between March 2017 and March 2022. Attendance rates and (virtual) travel distance were compared for in person meetings (N = 9 sessions; 2017‐2019) and online meetings (N = 26 sessions; 2020‐2022). During each online session, notable phrases & contributions were recorded using a verbatim note‐making process and shared with participants post‐session as a reminder of the experiences shared by group members. These text files (660 phrases comprised of 9,600 words) were analysed using Linguistic Inquiry and Word Count (LIWC; Pennebaker et al., 2015) software, automatically classifying words into LIWC categories of analytical thinking, clout, authenticity and affect variables.ResultThe switch to online sessions increased accessibility to bereaved support in terms of attendance rates (Figure 1A), geographical proximity (Figure 1B) and group consistency (Figure 1C, e.g. higher proportion of online attendees returned for further sessions [in person 42%, online 69%; McNemar χ2 = 3.84, p = 0.0001]). Linear regression analyses with robust standard errors revealed that greater session attendance (mean number of sessions attended by participants present) was associated with conversations that were more authentic and less emotional and definitive (i.e. more reflective) over time (regression coefficients: Authentic: 0.111 [0.073, 0.149]; Affect: ‐0.637 [‐1.089, ‐0.185]; Clout: ‐0.066 [‐0.112, ‐0.020]; see Figures 2A‐C). The level of analytical thinking was maintained across sessions (Analytic: ‐0.012 [‐0.086, 0.061]; see Figure 2D).ConclusionOnline peer groups offer a practical and effective medium for bereavement support. Shifting the focus of evaluation to the processes of social support – how it is delivered and received – rather than just the outcomes, offers insights into the mechanisms of peer support.

The impact of COVID-19 on the provision of bereavement support in Australian intensive care units: A national survey

BackgroundBereavement support is a vital part of caring for families when a patient dies in the intensive care unit (ICU). Previous research has demonstrated that while many ICUs provide some informal aspects of bereavement care, formalised follow-up programmes are uncommon. The impacts of COVID-19 on ICU-based bereavement support are currently unknown. ObjectivesThe objectives of this study were to explore the current provision of bereavement support in Australian ICUs and identify the impacts of the COVID-19 pandemic on these services. MethodsA cross-sectional exploratory web-based survey was used. The survey was distributed to one senior nurse in each public and private adult, paediatric, and neonatal ICU in Australia between April and July 2022. Descriptive statistics and reflexive thematic analysis were used to analyse the data. Ethical approval was received from La Trobe University. ResultsOne hundred and four ICUs from 82 hospitals responded to the survey, with 36 units reporting a formal bereavement follow-up service. When compared to prepandemic levels, almost all of the common bereavement care practices explored in the survey were significantly reduced during the COVID-19 pandemic. Open-ended responses also demonstrated significant impacts of COVID-19 on bereavement care provision, particularly related to Restricted family togetherness, Logistical Challenges, and Impacts on Staff. Staff members reported adjusting care provision in response to these challenges by exploring Alternative family communications, Facilitation of family togetherness, and Increasing familysupports. ConclusionsMany of the common elements of ICU-based bereavement care were significantly reduced during the COVID-19 pandemic. In addition, the number of formal bereavement follow-up services in Australian ICUs remains largely unchanged since 2015. Ongoing research is needed to explore the long-term effects of these changes on staff and family wellbeing and on ongoing provision of ICU-based bereavement support.

From i-coping to we-coping: A retrospective qualitative study on parent-child dyadic coping in widowed families.

In a widowed family, the surviving parent and children face the loss together. However, most previous research in bereavement has focused on individual experiences. Although the family perspective has been introduced into the field, neither theories nor empirical research has explored mutual interaction. Dyadic coping reflects the family perspective and has been proven to be an influential factor in couples facing life adversities. Nevertheless, it has not been explored in the context of bereavement-specific stressors, including loss- and restoration-related stressors, nor in the parent-child relationship. This research is the first exploration of parent-child dyadic coping in widowed families in the bereavement context and aims to form a comprehensive conceptualization of parent-child dyadic coping following bereavement. Qualitative semistructured interviews were conducted with 20 parents and children from widowed families in mainland China (11 surviving children and nine widowed parents, representing 19 families). Constructivist grounded theory was used to guide the analysis. The main themes identified were dyadic coping-related cognitions, loss-oriented dyadic coping, restoration-oriented dyadic coping, and contextual factors. Three foci (thou, we, and I) were identified for both loss- and restoration-oriented dyadic coping. A conceptualization model of bereavement dyadic coping within widowed families was developed. This study extends the single I-coping perspective in bereavement coping to a we-coping perspective, provides an interactional- and operational-level knowledge on dual-process coping, acknowledges the bilateral interaction in parent-child relationships, and offers implications for bereavement support practice for widowed families. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

"There's So Much More Support We Could Have Provided": Child Life Specialists' Stories of the Challenges Working in Adult Oncology.

A cancer diagnosis in patients who are parents of minor children is uniquely stressful for both parents and children. Children need developmentally appropriate information and support to help reduce their fears and worries. Child life specialists (CLSs) are health professionals who work in pediatric environments to support children and families with the stress and uncertainty of illnesses. Increasingly, CLSs have been called upon to support children of patients in adult clinical environments. Our objective was to elucidate CLS caregiving narratives related to working with children of adult cancer patients. We used narrative inquiry to interview four CLSs working in adult oncology. Canadian CLSs who have experience providing care for children and families affected by parental cancer were recruited via convenience sampling. We used narrative analysis methods that included multiple close reads of the data, generating narrative themes, and noting conflicts or tensions in the data. CLSs' caregiving stories often highlighted the complexities of working in an adult oncology environment. Their narratives included challenges in providing optimal care to the children, including family-level barriers (such as parental wishes to withhold information from their children) and systemic barriers (such as late referrals and limited options for bereavement support). CLS participants identified several challenges of working with families in adult oncology. The CLSs highlighted a desire for additional institutional support for children of adult oncology patients and for themselves working in these environments in order to achieve what they believed to be optimal care.

An exploration of women’s lived experiences of care and support following perinatal death in South-Western Nigeria: A hermeneutic phenomenological study

BackgroundPerinatal death results in long-lasting intense grief for bereaved mothers with a potential to negatively impact on their short- and long-term outcomes and quality of life if inadequately supported in coping with and managing their experience. AimThis study aimed at exploring the lived experience of women, of care and support following perinatal death in South-Western, Nigeria. MethodsA qualitative methodology using Heideggerian phenomenology was used. Fourteen women who had experienced perinatal death in South-Western Nigeria within the last (5) five years were interviewed, and Van Manen’s approach to hermeneutic phenomenology was used in data analysis. FindingsFour main themes were identified: “they did not tell me the baby died”, “response of health care professionals after the baby died”, “moving on from hospital”, and “support from family”. The physical health status of mothers determined how they were informed of perinatal death. Health care professionals were distant, rude, nonempathetic and did not offer emotional support, in some cases. Mothers were given opportunity to see and hold their babies. There was no routine follow-up support in the community, besides a postnatal check-up appointment offered to all mothers regardless of their birth outcome. Family provided emotional support for mothers on discharge. ConclusionThis study was the first to explore the lived experience of women of the care and support following perinatal death in South-Western, Nigeria. There is a need for healthcare systems to review bereavement care and support provisions for women who experience perinatal death.

The role of intensive care unit diaries in the grieving process: A monocentric qualitative study.

The growing importance of psychological recovery for patients and their families following intensive care unit (ICU) experiences in recent years cannot be overemphasized. The ICU diary is used to aid patients in reducing the prevalence of post-traumatic stress disorder, anxiety, and depression. The usefulness of maintaining a diary during the grieving process has not yet been thoroughly investigated. To investigate the role of ICU diaries in the grief process experienced by family members of a person who died in the intensive care unit. Nine family members of seven deceased ICU patients with an ICU diary were contacted and interviewed by phone using a semi-structured interview. A qualitative data analysis was performed using thematic synthesis. Italian general intensive care unit. Interviewed family members felt that the diary helped them during the grieving process. The return of diaries was desired by family members for support and to remember one's loved one. The diary helped them process their losses in various ways, including signs of evidence of care, emotional involvement, consideration, and coping with grief. Four main themes emerged from the analysis: writing the diary, reading the diary, talking about the diary, and the diary during the grieving process. The overall perception of the ICU diary was positive. The diary mostly helped relatives to "give back something of what we lost". This study also affirms the positive link between ICU diaries and bereavement in Italian ICU. Further studies are required to confirm the usefulness of this tool in the grieving process. The ICU diary can help patients' family members understand what happened to their loved one and play an important role in the grieving process. The diary served as a valuable source of information that aided in providing bereavement support to the family by helping them to gain a rational and emotional understanding of the patient's death.

Fighting for Connection: A Socially Distanced Grief Experience

The purpose of this study was to explore people’s experiences with grief and loss during the COVID-19 pandemic and how they may have been impacted by public health restrictions. Restrictions on social gatherings were in place during highly sensitive and emotional times including visitation of dying loved ones admitted to hospital and impacted funeral arrangements as well. This study was conducted using a grounded theory approach to identity strategies that participants used to navigate grief and loss in the context of such restrictions. From the findings, a core category emerged Fighting for Connection which represents an ongoing “fight” to maintain and/or regain connection with dying loved ones using five specific strategies. The long-term impacts of socially distanced grief are unknown and cannot be fully appreciated at this time. These findings may be significant to healthcare professionals who offer bereavement support to individuals experiencing complicated and/or unresolved grief.

Parents’ Views on Autopsy, Organ Donation, and Research Donation After Neonatal Death

Parents who experience neonatal loss have the option to participate in autopsy, organ donation, and research donation. However, clinicians are uncomfortable discussing autopsy and may not be aware of research and organ donation opportunities. To capture the perspectives of parents who had experienced neonatal loss about autopsy, organ donation, and research donation. This qualitative study used virtual focus groups with parents who attended a local bereavement support group in the US. Participants were recruited from Helping After Neonatal Death, a support group with a local chapter. Participants self-selected from an email request if they met the following criteria: aged 18 years or older, English speaking, at least 6 months elapsed since neonatal death, and access to a video conference device with internet. Focus groups took place between April and September 2021. The recorded sessions were analyzed using a grounded theory-informed approach by the research team that included parents with experience of neonatal loss. Data were analyzed from December 2021 through December 2022. A total of 14 mothers engaged in the focus group; 9 (75%) were aged 30 to 39 years, and 8 (66%) were White. The mothers were overall well educated. The first main theme grew from the lived experience of neonatal loss, specifically the importance of offering all parents the option to donate, rather than prejudging who would or would not be interested. Parents of neonates who die have few opportunities to parent that child and make loving decisions for them. Participants emphasized that the conversation about autopsy, organ donation, and research donation, albeit difficult, can offer a meaningful parenting experience. A second main theme that emerged related to how organ or tissue donation could provide additional meaning to a child's life. These choices contributed to building a legacy to honor their child's memory, which also helped with grief and coping with their loss. A third theme included recommendations to clinicians and health systems for improving communication, including written information for parents and communication training for health care professionals. In this qualitative study, parents who experienced neonatal loss endorsed the importance of offering parents the choice of autopsy, organ donation, or research donation with skillful and empathetic communication. They provided practical recommendations to improve communication and empower families.

Etiquette in the Context of Death and Dying: Communication and Conversation.

Death, bereavement, and grief are experiences suffused with conflict and disenfranchisement. Intricately connected is 'etiquette' - the sense of 'should' 'must' 'right' 'wrong' 'appropriate' and 'inappropriate' individuals feel in death and bereavement situations. This paper is the first of two answering the question, 'where does etiquette arise in death and bereavement situations and what does this 'look like?'' The theme The etiquette of communication and conversation is described, highlighting the importance of early communication for resolving conflict, what is considered 'appropriate' communication and support, and the social values underpinning these. Data highlighted how the CBT concept of 'shoulding and musting' manifests in death and bereavement situations, gave insight into etiquette's role in disenfranchising grief through shaping conversations, and offered suggestions for bereavement support. Though the term 'etiquette' may be misleading out of context, the concept resonated with the bereaved community and provided language to discuss the nuances of their experiences.

Providing a voice to the experience of bereavement support at Mexican workplaces

Literature on grief in the workplace is mainly represented in the last three decades and is predominantly western focused. An interpretative phenomenological research study was conducted using criterion sampling to recruit nine participants working full time in Mexican organizations who had a death loss of a close family member in 2018, 2019, 2020, or the first six months of 2021. Participants were interviewed to explore the types of practices offered from their workplace and the implications of those practices, and the felt experience as they made meaning through narrative and visual representation. Results revealed inconsistencies in organizations related to bereavement practices, such as organizations inconsistent communication of bereavement, providing time off, providing flexible bereavement support, and providing financial support for employees exists in the Mexican workplace. The implications of such practices were those of lack of organizational compassion, and insufficient flexibility around work expectations, financial support, and psychological support.

Palliative Care in Children with Inherited Metabolic Diseases: Why does it matter?

Inherited metabolic diseases (IMD) bring considerable burden on the child and family. Challenging areas for health care include the identification of distressing symptoms, prognostic uncertainty, and bereavement. Literature regarding the impact of paediatric palliative care (PPC) is scarce. This study aims to evaluate children with IMD referred to a PPC team (PPCT) and to analyse its impact on home care, decision to limit treatment (DLT), use of hospital resources (emergency department admissions - EDA, hospital admissions - HA, intensive care admissions - ICA) and end of life support. Retrospective cohort study of children with IMD referred to a specialized PPCT (2016-2022). We assessed clinical data: symptoms control, time of referral and length of the follow-up period, DLT, device dependency, use of hospital resources prior to and after referral, place of death and end-of-life support. Fifteen children with IMD were referred to PPCT (8% of total referrals), with median age of 7 years (4 months - 17 years); 53% female. All children were non or pre-verbal. Most prevalent symptoms were neurologic and motor impairment (100%), respiratory and gastrointestinal (75%). 80% had tube feeding, 90% had some respiratory device (non-invasive ventilation in 23%). All children had multidrug use, with a mean of 6 drugs per child (2-9). 73% had home PPC and 80% had DLT planned. Nine children died (78% in hospital), after a mean of 17 months of follow-up (2 months to 4 years), all with DLT planned. 67% had support from PPCT at the end of life. All these families received emotional support. Decrease in EDA (10 vs 2) was noticed before and after PPCT. No impact was seen in HA and ICA (6 vs 5 and 1 vs 1, respectively) and there was a longer mean of hospitalisation stay (15 vs 32 days). Our cohort includes a group of children with severe, complex and neurodegenerative IMD. They need multiple medications for symptoms control, are highly dependent on medical devices and consume significant healthcare resources. Communication impairment adds complexity being a major barrier to symptom assessment. PPCT referral allowed home support, anticipated care plans development with end of life and bereavement support, as well as a tendency towards a reduction in EDA. These findings reinforce the need for holistic approach to identify and address the PPC needs of children with IMD.

Grieving Children' Death in an Intensive Care Unit: Implementation of a Standardized Process.

Background: The grief that accompanies witnessing the death of a child puts health care professionals at risk of secondary trauma, burnout, and turnover when left unaddressed. Objective: Support staff well-being and promote resiliency. Methods: Descriptive implementation of a structured, peer-to-peer bereavement support program for intensive care unit (ICU) staff at a tertiary children's hospital. Results: Thirty-five virtual sessions were held over the period of one year.Through these sessions, participants shared perspectives and normalized reactions, and explored potential coping strategies. Post-session feedback surveys demonstrated the negative impact of a death on the personal or work life of ICU staff. Additionally, nearly all reported some level of burnout. Conclusions: The sessions were feasible and positively impacted staff coping and well-being. Barriers and facilitators to session attendance, as well as suggestions for improvement, were also explored. Implications for practice and future research are discussed. No clinical trial registration is applicable.

The Development of a Bereavement Support Group Curriculum for Bereaved Parents of Young Adult Children: Bridging the Gap.

Purpose: There is limited research addressing the bereavement needs of parents whose young adult (YA) children have died from cancer. Research within oncology about the impact of child loss has tended to focus on parents of pediatric aged children. We adapted a general bereavement support group curriculum used with adults to address the unique needs of bereaved parents of YAs. Methods: Using a quality improvement framework, 25 bereaved parents of YA children participated in one of three 6-session bereavement support group programs during 2020 and 2021. Due to the coronavirus disease 2019 (COVID-19) pandemic, the programs were offered virtually. The participants provided feedback and completed an evaluation. Results: Nineteen mothers and six fathers participated with 20 (80%) completing the evaluation. The median time since the death of their child was 6 months. The participants evaluated the program highly, reporting that they felt less isolated (4.25/5 on a 5-point Likert scale); that their concerns were similar to others (4.45/5); and the discussion topics were relevant (4.20/5). Other topics that were identified included the impact on the family of losing a YA child, and how other relationships change. Forty-five percent of participants expressed a preference for a hybrid delivery model, incorporating in-person and virtual sessions. The majority also wished to continue meeting monthly, given they had little contact with other bereaved parents of YAs. Conclusion: The general bereavement support group curriculum was readily adapted for use with bereaved parents of YA children who died from cancer. A hybrid delivery model was the preferred method for future groups.

A comparison of four dementia palliative care services using the RE-AIM framework

BackgroundLiving with a life-limiting illness, people with dementia benefit from palliative care which considers the holistic needs of the person and their family. However, little is known about how palliative care may be best provided to people living with dementia at home in the community. We examined four exemplary dementia palliative care services for people with dementia in the community, to see what activities they were providing, what were the commonalities and differences, and what lessons could be learned.MethodsA long-list of dementia palliative care services in Ireland, Northern Ireland, England, Scotland, and Wales, was identified through a survey, and four exemplar services were chosen based on criteria including: in operation >six months; provides identifiable activities; availability of routinely collected service data; not exclusively for people with dementia in final hours or days of life. Mixed-methods of data collection included interviews, focus-groups and surveys with service staff, surveys of service users, and routinely collected service data. The RE-AIM framework was used to describe and understand the sample of dementia palliative care services.ResultsThe four services had varied organisational structures and were led by different disciplines. However, they all provided common core activities including holistic and person-centred care, early advance care planning with service user involvement, carer support, integrated healthcare services, continuity of care, 24/7 support, bereavement support. All had needs-based referral criteria, accepting any age or dementia sub-type. All supported people with dementia to remain living at home and to have a comfortable, dignified death in their preferred place.ConclusionsAn effective dementia palliative care service may take different forms. Whether the service is dementia-led or Specialist Palliative Care-led, efficacy is associated with providing a range of key activities and implementing them effectively. The data collected strongly suggests the benefits of the dementia palliative care services to a person with dementia and their families and offers valuable insight into the key factors for the establishment and successful running of such services.

"My Home Away From Home": Community Support for International Pediatric and Young Adult Patients and Their Families in End-of-Life Care and Bereavement.

Background: Foreign national patients and families can face life-limiting illness and end-of-life care far from home; this palliative need has not been well described. Case Description: We present a case of a 20-year-old Ugandan patient diagnosed with metastatic alveolar rhabdomyosarcoma who presented to a pediatric academic medical center in California. Despite treatment, her disease progressed and she was unable to return to Uganda due to symptom burden. The patient and her family met regularly with palliative care during their hospital stay; the palliative approach included cross-cultural sharing, connecting across differences, and fostering community. The family additionally cultivated a support system within the hospital and local African communities. This was illustrated in the memory album the patient created, and in her family's extensive bereavement support. Conclusions: This case explores opportunities for individualized psychosocial care and community-based support to enhance palliative care for foreign national patients and families.

Franchising the Disenfranchised: A Qualitative Content Analysis of Support Messages in American Miscarriage Sympathy Cards

Miscarriages are a common and unfortunate pregnancy experience; however, parents’ grief over the loss of their unborn child continues to be disenfranchized. One suggestion that miscarriage grief is beginning to be seen as a legitimate loss is with the existence of miscarriage sympathy cards. These cards, similar to other loss sympathy cards, are designed to convey condolence to grieving parents. The purpose of this study was to examine how American miscarriage sympathy cards might help to franchise miscarriage grief and to identify the types of bereavement support message strategies presented in the cards. The qualitative content analysis of miscarriage sympathy cards (N = 63) identified that miscarriage cards primarily rely on death euphuisms to talk about miscarriages and rarely acknowledge parents’ loss as real. Cards presented several support message strategies, the most common being expressing care and concern, providing a religious perspective to explain the loss, and providing a philosophical perspective to explain the loss. Miscarriage card messages also relied on hypothetical memories parents would never experience as a way to help parents remember and honor their unborn child. These results suggest that although the existence of miscarriage sympathy cards imply miscarriage grief is franchised, the language and messages used show that parents’ grief could still be disenfranchized as people struggle with how to offer condolence after a miscarriage.