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Background: Stillbirth is a major global concern. However, most research has been conducted in high-income countries. Understanding of the experience and management of stillbirth in low-middle income countries is needed. Objective: This qualitative study explored health professionals’ experiences of providing stillbirth care in the Lao People’s Democratic Republic, a lower-middle-income country in South-East Asia. Methods: In-depth interviews were conducted with 33 health professionals (doctors, midwives and nurses) and thematic analysis was undertaken. Results: All participants acknowledged stillbirth as a concern, but its incidence and causes were largely undocumented and unknown. A lack of training in managing stillbirth left health professionals often ill-equipped to support mothers and provide responsive care. Social stigma surrounds stillbirth, meaning mothers found limited support or opportunities to openly express their grief. Conclusions: Better awareness of stillbirth causes could promote more positive experiences for healthcare providers and parents and more responsive healthcare. This requires improved training for healthcare professionals and awareness raising in the wider community.

Introduction: Fibrotic interstitial lung disease (f-ILD) comprises a group of diseases with lung scarring and reduced life expectancy. The short time from diagnosis to death affects the patients’ bereaved spouses, who risk developing prolonged grief. In Denmark palliative care is most often offered to cancer patients. Aim: We aimed to investigate the experience of spouses of f-ILD patients during the final stages of illness and up to the first year after the patient's death to investigate if palliative care could ease the transition and prevent PGD. Methods: Our study had a qualitative design triangulating in-depth interviews, field notes, participant diaries and the prolonged grief questionnaire PG-13. We included 20 spouses and applied thematic analysis. Initial coding was performed deductively according to the chronological stages of before, during and after the death of the patient. We subsequently coded inductively within the stages. Results: During the final days the spouses experienced emotional ambivalence shifting between hope, acceptance and despair. Factors affecting the spouses during the final hours were the timing, location, and process of death. After the patient's death the spouses experienced feelings of grief and optimism as they moved toward a new life on their own. Conclusions: Some of the factors affecting the spouses and potentially causing prolonged grief might be alleviated by offering palliative/supportive care and advance care planning to f-ILD patients and their family.

Studies have shown that grief after losing a child is more intense and prolonged than after the loss of a spouse or a parent. Children are expected to outlive their parents, and losing one’s child has been described as one of the most traumatic experiences possible. While a majority of bereaved parents adjust to the loss of a child without professional help, a significant minority will experience persistent and intensive grief reactions and may need treatment. Siblings are often called “the forgotten grievers” based on the idea that they are not the focus of family, friends, and health-care professionals, who often primarily focus on the ill child and the parents. Unfortunately, research has shown that a majority of siblings still grieve many years after the loss. As research shows that long-term psychological morbidity, including grief, among parents and siblings is affected by modifiable and/or avoidable factors during illness, end of life, and after the loss, family bereavement care should start early and beyond the child’s death. This chapter describes factors that can contribute to the psychological outcomes for parents and siblings after bereavement. Symptom management in the end of life has shown important as well as a good relationship between the health-care professionals and the parents/siblings during the illness trajectory. Parents and siblings need open and honest communication relating to diagnosis, prognosis, and impending death as it allows them to better prepare for the loss—something that are important for their psychological well-being years after bereavement. Bereavement support for the family after the loss is also described in this chapter. For example, it is important for families to have access to the care team after the loss of the child as they have expressed a need for, e.g., remembrance ceremonies and for obtaining more knowledge about the end-of-life care. Parent support groups are much appreciated by the parents but lack evaluation of t

In recent years there has been an increasing emphasis upon public health perspectives that place palliative care in the context of end-of-life services across whole populations. There is little corresponding public health interest in bereavement. Yet if we have to develop relevant, coherent, and comprehensive end-of-life care policies and practices, public health approaches to palliative care need to be accompanied by public health approaches to bereavement care. We argue here that palliative care services should match their commitment to providing a good death with a commitment to supporting good grief, and that this means investing their efforts principally in developing community capacity for bereavement care rather than seeking to deliver specialized bereavement services to relatives and friends of those who have received palliative care services.

The rising population of older people in the UK (Office for National Statistics 2010) and pressure on healthcare services to reduce costs indicate the necessity of developing strategies that enable coping and independence. Loss through death of close family members, partners and friends is a key factor that inhibits physical, emotional and social well being of older people. The research carried out for this thesis explored bereavement in healthcare settings where contacts with bereaved older people commonly occur, and used data collected to develop guidelines for practice. The guidelines provide research informed enhancement to bereavement care and develop opportunities for meaningful interactions. They complement current policy development work on bereavement in healthcare settings (The Scottish Government 2011). A qualitative design drawing on phenomenological methodology was used to explore healthcare staffs experiences of caring for bereaved older people, and older peoples experiences of being bereaved and bereavement care. Theoretical sampling took place to recruit staff from a range of roles in general practice and community nursing, hospital wards and care homes, as well as a small sample of bereaved older people. Thirty nine participants took part in in-depth interviews that yielded four key themes: bereavement care depends on a relationship between healthcare staff and relatives; preparation for a relatives death may not equate to preparedness for bereavement; the Open Door to bereavement care is only slightly ajar, and bereavement care supports progression of the Rolling Ball of life. The themes informed development of the guidelines in terms of structure and content. Recommendation statements consider bereavement care before the death; at the time of the death; and follow up in the weeks and months afterwards. Criteria in the recommendations provide suggestions for enhancements to practice that facilitate appropriate response to bereavement in older peopl

The Socio-Economic Costs of Bereavement in Scotland (SECOB) research study was funded by the Scottish Government Health Directorates in late 2010 as part of ongoing work to inform national policy on bereavement and bereavement care practice. The project aimed to: a) articulate the likely nature and scope of the impact of bereavement on social and economic aspects of life for Scottish citizens as evidenced in relevant literature; b) seek to estimate the socio-economic costs of bereavement in an emergent sub-set of key aspects, and c) develop methodological approaches that will enhance capacity for large-scale research into the socio-economic impact of bereavement.

The rising population of older people in the UK (Office for National Statistics 2010) and pressure on healthcare services to reduce costs indicate the necessity of developing strategies that enable coping and independence. Loss through death of close family members, partners and friends is a key factor that inhibits physical, emotional and social well being of older people. The research carried out for this thesis explored bereavement in healthcare settings where contacts with bereaved older people commonly occur, and used data collected to develop guidelines for practice. The guidelines provide research informed enhancement to bereavement care and develop opportunities for meaningful interactions. They complement current policy development work on bereavement in healthcare settings (The Scottish Government 2011). A qualitative design drawing on phenomenological methodology was used to explore healthcare staffs experiences of caring for bereaved older people, and older peoples experiences of being bereaved and bereavement care. Theoretical sampling took place to recruit staff from a range of roles in general practice and community nursing, hospital wards and care homes, as well as a small sample of bereaved older people. Thirty nine participants took part in in-depth interviews that yielded four key themes: bereavement care depends on a relationship between healthcare staff and relatives; preparation for a relatives death may not equate to preparedness for bereavement; the Open Door to bereavement care is only slightly ajar, and bereavement care supports progression of the Rolling Ball of life. The themes informed development of the guidelines in terms of structure and content. Recommendation statements consider bereavement care before the death; at the time of the death; and follow up in the weeks and months afterwards. Criteria in the recommendations provide suggestions for enhancements to practice that facilitate appropriate response to bereavement in older peopl

The Socio-Economic Costs of Bereavement in Scotland (SECOB) research study was funded by the Scottish Government Health Directorates in late 2010 as part of ongoing work to inform national policy on bereavement and bereavement care practice. The project aimed to: a) articulate the likely nature and scope of the impact of bereavement on social and economic aspects of life for Scottish citizens as evidenced in relevant literature; b) seek to estimate the socio-economic costs of bereavement in an emergent sub-set of key aspects, and c) develop methodological approaches that will enhance capacity for large-scale research into the socio-economic impact of bereavement.