Bereavement care interventions: a systematic review

Amanda L Forte¹ , Malinda Hill² , Rachel Pazder¹ and Chris Feudtner¹^,3^,4

¹Pediatric Advanced Care Team and Pediatric Generalist Research Group, Division of General Pediatrics, The Children's Hospital of Philadelphia, PA, USA

²Department of Social Work and Family Services, The Children's Hospital of Philadelphia, PA, USA

³The Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA

⁴Center for Bioethics, University of Pennsylvania, Philadelphia, PA, USA

author email corresponding author email

BMC Palliative Care 2004, 3:3doi:10.1186/1472-684X-3-3


Published:	26 July 2004

Abstract

Background

Despite abundant bereavement care options, consensus is lacking regarding optimal care for bereaved persons.

Methods

We conducted a systematic review, searching MEDLINE, PsychINFO, CINAHL, EBMR, and other databases using the terms (bereaved or bereavement) and (grief) combined with (intervention or support or counselling or therapy) and (controlled or trial or design). We also searched citations in published reports for additional pertinent studies. Eligible studies had to evaluate whether the treatment of bereaved individuals reduced bereavement-related symptoms. Data from the studies was abstracted independently by two reviewers.

Results

74 eligible studies evaluated diverse treatments designed to ameliorate a variety of outcomes associated with bereavement. Among studies utilizing a structured therapeutic relationship, eight featured pharmacotherapy (4 included an untreated control group), 39 featured support groups or counselling (23 included a control group), and 25 studies featured cognitive-behavioural, psychodynamic, psychoanalytical, or interpersonal therapies (17 included a control group). Seven studies employed systems-oriented interventions (all had control groups). Other than efficacy for pharmacological treatment of bereavement-related depression, we could identify no consistent pattern of treatment benefit among the other forms of interventions.

Conclusions

Due to a paucity of reports on controlled clinical trails, no rigorous evidence-based recommendation regarding the treatment of bereaved persons is currently possible except for the pharmacologic treatment of depression. We postulate the following five factors as impeding scientific progress regarding bereavement care interventions: 1) excessive theoretical heterogeneity, 2) stultifying between-study variation, 3) inadequate reporting of intervention procedures, 4) few published replication studies, and 5) methodological flaws of study design.