Sylvester Researchers, Collaborators Call for Greater Investment in Bereavement Care

Viewpoint in The Lancet Public Health notes current funding, resources inadequate to address this public health issue.

The public health toll from bereavement is well-documented in medical literature, with bereaved persons at greater risk for many adverse outcomes, including mental health challenges, decreased quality of life, health care neglect, cancer, heart disease, suicide and death.

Now, in a paper published in The Lancet Public Health, researchers sound a clarion call for greater investment at both the community and institutional level in establishing support for grief-related suffering.

Bereavement Support Woefully Underfunded

The authors emphasized that increased mortality worldwide caused by the COVID-19 pandemic, suicide, drug overdose, homicide, armed conflict and terrorism have accelerated the urgency for national and global frameworks to strengthen the provision of sustainable and accessible bereavement care.

Unfortunately, current national and global investment in bereavement support services is woefully inadequate to address this growing public health crisis, said researchers with Sylvester Comprehensive Cancer Center, part of the University of Miami Miller School of Medicine, and collaborating organizations.

They proposed a model for transitional care that involves firmly establishing bereavement support services within health care organizations to ensure continuity of family-centered care while bolstering community-based support through development of “compassionate communities” and a grief-informed workforce. The model highlights the responsibility of the health system to build bridges to the community that can help grievers feel held as they transition.   

The Center for the Advancement of Bereavement Care at Sylvester is advocating for precisely this model of transitional care.

“We need a paradigm shift in how health care professionals, institutions and systems view bereavement care,” said Wendy Lichtenthal, Ph.D., FT, FAPOS, founding director of the center and associate professor of public health sciences at the Miller School. “Sylvester is leading the way by investing in the establishment of this center, which is the first to focus on bringing the transitional bereavement care model to life.”

Evidence-Based, Community-Engaged Care

What further distinguishes the Center for the Advancement of Bereavement Care is its roots in bereavement science, advancing care approaches that are both grounded in research and community-engaged.

The authors focused on palliative care, which strives to provide a holistic approach to minimize suffering for seriously ill patients and their families, as one area where improvements are critically needed. They referenced groundbreaking reports of the Lancet Commissions on the value of global access to palliative care and pain relief that highlighted the “undeniable need for improved bereavement care delivery infrastructure.” One of those reports acknowledged that bereavement has been overlooked and called for reprioritizing social determinants of death, dying and grief.

“Palliative care should culminate with bereavement care, both in theory and in practice,” explained Dr. Lichtenthal, who is the article’s corresponding author. “Yet, bereavement care often is under-resourced and beset with access inequities.”

Transitional Bereavement Care Model

How do health systems and communities prioritize bereavement services to ensure that no bereaved individual goes without needed support? The transitional bereavement care model offers a roadmap.

“We must reposition bereavement care from an afterthought to a public health priority. Transitional bereavement care is necessary to bridge the gap in offerings between health care organizations and community-based bereavement services,” Dr. Lichtenthal said. “Our model calls for health systems to shore up the quality and availability of their offerings, but also recognizes that resources for bereavement care within a given health care institution are finite, emphasizing the need to help build communities’ capacity to support grievers.”

Key to the model, she added, is bolstering community-based support through development of “compassionate communities” and “upskilling” of professional services to assist those with more substantial bereavement-support needs.

The model contains these pillars:

• Preventive bereavement care: Health care teams engage in bereavement-conscious practices and compassionate communities are mindful of the emotional and practical needs of dying patients’ families.

• Ownership of bereavement care: Institutions provide bereavement education for staff, risk screenings for families, outreach and counseling or grief support. Communities establish bereavement centers and “champions” to provide bereavement care at workplaces, schools, places of worship or care facilities.

• Resource allocation for bereavement care: Dedicated personnel offer universal outreach and bereaved stakeholders provide input to identify community barriers and needed resources.

• Upskilling of support providers: Bereavement education is integrated into training programs for health professionals, and institutions offer dedicated grief specialists. Communities have trained, accessible bereavement specialists who provide support and are educated in how to best support bereaved individuals, increasing their grief literacy.

• Evidence-based care: Bereavement care is evidence-based and features effective grief assessments, interventions and training programs. Compassionate communities remain mindful of bereavement care needs.

Dr. Lichtenthal said the center will strive to materialize these pillars and aims to serve as a global model for other health organizations. She hopes the paper’s recommendations “will cultivate a bereavement-conscious and grief-informed workforce as well as grief-literate, compassionate communities and health systems that prioritize bereavement as a vital part of ethical health care.”

“This paper is calling for health care institutions to respond to their duty to care for the family beyond patients’ deaths,” Dr. Lichtenthal said. “By investing in the creation of the Center for the Advancement of Bereavement Care, Sylvester is answering this call.”

Tags: Cancer Support Services, Dr. Wendy Lichtenthal, Sylvester Comprehensive Cancer Center