BACKGROUND
Evidence-based bereavement care is not routinely delivered by trained staff in Australian hospitals. In 2020, there were 2,212 deaths in the Nepean Blue Mountains Local Health District (NBMLHD). For every death, four to nine people are affected by bereavement, meaning there are between 8,000-20,000 bereaved each year in NBMLHD. Providing consistent evidence-based bereavement care reduces morbidity, mortality, and health service usage.
AIM
This research aimed to develop a bereavement model of care that ensures identification and appropriate management of all bereaved within the diverse communities of the NBMLHD.
METHODS
A systematic review was conducted to identify international bereavement care models and implementation factors relevant to the Australian context. Interviews with NBMLHD staff/volunteers who provide bereavement care were conducted to explore current practice, gaps in care, and barriers/facilitators to implementing care. Data were triangulated to develop a bereavement model of care relevant to the NBMLHD context.
RESULTS
Common services provided in bereavement models reported in the literature included bereavement information packs, condolence cards, and follow up phone calls. Most models also provided training for those delivering bereavement services. Less common components of bereavement models included support for staff/volunteers, formal assessment for complicated grief, and program evaluation. Barriers to implementing bereavement models were resourcing, and staff discomfort with grief and providing bereavement care. Facilitators included established protocols and processes, ongoing evaluation, dedicated bereavement staff/volunteer roles, multidisciplinary leadership, and training and support for those who deliver bereavement care.
Interviews revealed seven themes: Definition of bereavement encompassing pre and post death care; Formal versus informal protocols, processes, and responsibilities; Current bereavement care, referral pathways and evaluation; Facilitators to accessing and providing care; Barriers to accessing and providing care; and ideal bereavement model of care.
CONCLUSIONS
We developed a stepped approach - universal care to all bereaved, specialist services for those at risk of complicated grief - with appropriate resources and referral pathways at each step. Care is tailored on pre vs. post death, and to sudden vs. expected deaths. Difference in delivery of bereavement services between oncology/palliative care and deaths in other services suggest that care be tailored at a service level.
This bereaved-centred model considers individual care preferences, including appropriate cultural/spiritual/language resources. Underpinning the model is staff/volunteer training and support, coordination of care, and continual improvement.
Key to implementation success and model sustainability within NBMLHD is appropriate resourcing, and training and support for those who deliver bereavement care.