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BACKGROUND: This study describes the design, implementation and evaluation of a national bereavement helpline developed as proactive tiered response to immediate be reavement care during the COVID pandemic, operated in partnership between a national charity and the National Health Service. The service was based on Psychological First Aid principles adapted to integrate bereavement education. Its aim was to provide asupportive compassionate listening service, education advice resources and sign posting to community services. METHODS: Two independent psychologist were commissioned to undertake a retrospective service evaluation of six months of the operation of the line, using a volunteer survey, interviews and line usage data. RESULTS AND CONCLUSIONS: Results show that the line is meeting a need, PFA + Bereavement is providing a useful framework for service delivery, and there is good adherence to the model. Volunteers are experiencing working on the line as challenging but rewarding. Supervision and debriefing are essential for volunteer well being and confidence. Approximately 10% of callers were referred onto other services. Management report that they good oversight of governance issues and are planning for the future development, and funding of the line for the next two years.

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Objetivo: El objetivo de este trabajo es describir y comparar el tipo y las características de atención al duelo en Europa y España, así como actualizar e identificar avances en España con el fin de mejorar la atención al duelo. Método: Estudio observacional, descriptivo, prospectivo y comparativo. Realizado a partir de los datos del grupo de trabajo de duelo de la EAPC relativos a España, recogidos mediante un cuestionario que consta de 54 preguntas en 6 secciones: antecedentes, apoyo, personal, acceso y niveles de cuidado, aspectos comunitarios, recursos y modelo de atención. Fue distribuido por correo electrónico a través de la EAPC a 56 asociaciones nacionales de CP. Las comparaciones entre Europa y España se realizaron utilizando la prueba de Chi-cuadrado de Pearson. Resultados: La atención al duelo se ofrece en el 83 % de los 314 servicios que responden en Europa y en el 73 % de 56 servicios en España, con datos similares a estudios anteriores españoles. La mayoría de servicios corresponden a unidades hospitalarias. El tipo de soporte o intervención especializada depende del nivel de atención en ambos grupos. En Europa, el 32 % dispone de directrices o guías nacionales de duelo en su país, en España el 61 % de los servicios, lo que facilita la actuación. Los “instrumentos formales de riesgo” son utilizados solo por una cuarta parte de los servicios. Conclusiones: Este estudio presenta un avance y un reto futuro en la atención al duelo en Europa y España. Los datos han mostrado que la atención al duelo no forma parte de todos los servicios. El número de respuestas a los cuestionarios no ha aumentado ni se han incrementado los servicios en España. Tanto en Europa como en España es necesario seguir potenciando, formalizando e incrementando servicios con atención al duelo, como una parte esencial de los cuidados paliativos. (AU)

Objetive: To describe and compare the type and characteristics of bereavement care in Europe and Spain. To update and identify advances in Spain for improving grief care. Method: An observational, descriptive, prospective and comparative study. Made on data from the EAPC bereavement group relating to Spain, collected through a questionnaire consisting of 54 questions in 6 sections: background; support; personal; access, levels of care; community aspects; resources and care model. It was distributed by online mail via the EAPC to 56 national PC associations. Comparisons between Europe and Spain were made using Pearson’s χ2 test. Results: Bereavement care is offered by 83 % of the 314 responding services in Europe and in 73% of 56 services in Spain, with similar data to previous Spanish studies. Most services correspond to hospital units. The type of support or specialized intervention depends on level of care in both groups. In Europe, 27 % have National Grief Guides in their country, in Spain 61 % of services, which facilitates action. “Formal risk instruments” are used by only a quarter of the services. Conclusions: This study presents an advance and a future challenge in bereavement care in Europe and Spain. Data have shown that bereavement care is not included in all services. The numbers of responses to questionnaires have not increased, nor have services in Spain increased. Both in Europe and in Spain, it is necessary to continue promoting, formalizing and increasing services with attention to grief as an essential part of palliative care services. (AU)

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INTRODUCTION: Miscarriage is one of the most common complications of pregnancy, and recurrent miscarriage affects approximately 1% of couples. The psychological impact of early pregnancy loss on women has been well documented in the literature; however, the burden of miscarriage on men remains largely unexplored. METHODS: This qualitative research involved semi-structured interviews with five men whose partners had experienced at least two consecutive miscarriages. Participants were recruited through an early pregnancy loss clinic in a large, tertiary maternity hospital. Interviews were recorded and transcribed verbatim and analysed thematically. RESULTS: Recurrent miscarriage had a pronounced psychological impact on all the men interviewed, which worsened with each successive miscarriage. Three primary themes were developed from the data: (1) the deeply emotional experiences of men following recurrent miscarriage; (2) frustrations experienced during the provision of support following recurrent miscarriage; and (3) a sense of feeling unimportant. Lack of timely provision of information about miscarriage as well as lack of access to services were highlighted as deficiencies in the quality of care provided after recurrent miscarriage. CONCLUSION: The experiences of men after recurrent miscarriage are based largely on their assumed role as the protector and supporter of their partner, which often results in neglect of their own psychological needs. The support required by men is similar to that required by women, and greater access to information and services is needed to improve the experiences of men following recurrent miscarriage. PATIENT CONTRIBUTION: Participants were recruited through the Pregnancy Loss Clinic at Cork University Maternity Hospital and were identified by specialist midwives. Participants were approached and interviewed by one of the researchers. Participation was voluntary and the men received no financial contribution for their time.

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BACKGROUND: The WHO definition of palliative care includes bereavement support as integral to palliative care, yet a previous survey of bereavement support in palliative care in Europe has shown a range of service responses to loss. A rigorous approach to agreeing and implementing a palliative care bereavement framework was required. AIM: The aim of this study was to develop consensus on best-practice recommendations for bereavement care principles, structures, processes and delivery based on current practice and evidence. DESIGN: In accordance with Guidance on Conducting and Reporting Delphi Studies, a consensus-building five-round Delphi technique was performed. A scoping review of research literature informed drafting of 54 statements by the EAPC Bereavement Task Force. Evaluation of the statements was performed by an expert panel using a 5-point Likert scale. ⩾80% agreement were defined as essential items and 75%-79% agreement were defined as desirable items. Items with a consensus rating <75% were revised during the process. SETTING/PARTICIPANTS: The Delphi study was carried out by an expert panel among membership organisations of the European Association for Palliative Care. RESULTS: In total, 376 email requests to complete Delphi questionnaire were distributed with a response rate of 23% (n = 87) and a follow-up response-rate of 79% (n = 69). Of the initial 54 statements in six dimensions, 52 statements were endorsed with 26 essential statements and 26 desirable statements. CONCLUSIONS: The six dimensions and 52 statements agreed through this Delphi study clarify a coherent direction for development of bereavement services in palliative care in Europe.

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BACKGROUND: There is a dearth of national and international data on the impact of social support on physical, mental, and financial outcomes following bereavement. METHODS: We draw from two large, population-based studies of bereaved people in Australia and Ireland to compare bereaved people's experience of support. The Australian study used a postal survey targeting clients of six funeral providers and the Irish study used telephone interviews with a random sample of the population. RESULTS: Across both studies, the vast majority of bereaved people reported relying on informal supporters, particularly family and friends. While sources of professional help were the least used, they had the highest proportions of perceived unhelpfulness. A substantial proportion, 20% to 30% of bereaved people, reported worsening of their physical and mental health and about 30% did not feel their needs were met. Those who did not receive enough support reported the highest deterioration in wellbeing. DISCUSSION: The compassionate communities approach, which harnesses the informal resources inherent in communities, needs to be strengthened by identifying a range of useful practice models that will address the support gaps. Ireland has taken the lead in developing a policy framework providing guidance on level of service provision, associated staff competencies, and training needs.

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To ascertain the meaning of their loss, the authors explored the experiences of 7 biological mothers bereaved by suicide. Purposive sampling was used and 1-to-1 interviews were conducted and analyzed using Interpretative Phenomenological Analysis. Four themes emerged: (a) silencing grief; (b) shattered assumptions; (c) constructing a narrative; and (d) the depth of a mother's grief. Mothers experienced intense prolonged grief with many psychological and physical symptoms; one acknowledged strong suicidal thoughts and one had attempted suicide. The findings suggest a need for care professionals to be aware of, and to target, this vulnerable subgroup.

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