In palliative care the family is recognized as the ‘unit of care’ and bereavement care is believed to be an integral component of the care we provide. Therefore, our responsibility in developing a comprehensive palliative care program should include offering bereavement care to the family following the death. It is generally agreed that grief is a normal reaction to loss and most people manage fairly well with no intervention at all. However, it is also recognized that general support and relatively simple interventions such as information about grief’s common experiences, are helpful to bereaved individuals.[1]

A smaller percentage of individuals may require additional follow-up and intervention for more complex grief. During the caregiving period preceding death, health care providers may plan to utilize a Bereavement Risk Assessment Tool (BRAT), such as the one developed by the Victoria Hospice Society.[2] An assessment tool such as the BRAT offers a concrete, effective way of gauging how individual family members are coping and helps to identify personal, social, emotional and spiritual factors that may place certain individuals at risk after the death of someone close and therefore, require additional follow-up and counselling.

The following considerations may guide decision-making and program development for your community of practice:

• Will a bereavement risk assessment tool be utilized during the caregiving period by the health care team involved?
• At the time of death, will you provide a basic information brochure/handout to family members? This might include a brief overview of what family members might experience in bereavement, additional resources (e.g. Canadian Virtual Hospice website), and contact numbers if the individual wishes to explore further information, support, or counselling. Will this be given to the family at the time of death or mailed inside a sympathy card at a later date?
• Are you able to screen, teach and engage hospice volunteers in providing bereavement services (to assist with mail-outs and/or follow-up phone calls)? Experience tells us that bereaved individuals often reach out or benefit from some additional support approximately 3 months following the death, when the reality of the loss sets in and yet others (family, friends, work colleagues) around them have moved on and expect them to be ‘over it’.
• If additional counselling/intervention is required, are there other resources that your program can link these individuals to (e.g. counsellors with the cancer care agency, employee assistance programs, social workers at a local hospital/clinic, local clergy or spiritual care providers, crisis counselling telephone lines)?
  

In initiating new services, it is often best to keep the plan simple and realistic, and build from there.

See also: Grief Work and Grief in Times of Celebration: The Empty Spot

References

1. Victoria Hospice Society & Cairns M, Thompson M & Wainwright W. Transitions in Dying and Bereavement: A Psychosocial Guide for Hospice and Palliative Care. Health Professionals Press: 2003.

2. http://www.virtualhospice.ca/en_US/Main+Site+Navigation/Home/For+Professionals/For+Professionals/Tools+for+Practice/Grief+and+bereavement/Bereavement+Risk+Assessment+Tool+%28BRAT%29.aspx#id_1cbe94fbefb0be0c2d72f7a6ccc58ce0

Resource

Companioning the Bereaved: A Soulful Guide for Caregivers, a book by Alan D. Wolfelt, presents a model for grief counselling based on his "companioning" principles.