Bereavement support for families in specialized palliative care: a mixed methods evaluation with bereaved persons

Abstract Background Health-promoting bereavement support, which strengthens families’ resilience and coping and seeks to identify those at risk for prolonged grief, denotes an evidence-informed practice in palliative care yet is often insufficiently implemented. To address this know-do gap, we implemented a family bereavement support pathway in two specialized palliative care services in Switzerland, with ‘assessing family situation’, ‘providing tailored information’, and ‘ensuring continuity and coordination’ as core components, and evaluated it. As part of the overall evaluation, this study aimed to assess the appropriateness, coherence, and quality of the pathway from the perspective of bereaved family members. Methods We conducted a cross-sectional, convergent mixed-methods study, combining surveys and semi-structured interviews. The survey assessed service outcomes using validated measures and self-developed items. The interviews explored participants’ experiences with bereavement support and were analysed using inductive qualitative content analysis. A joint display was used to report (in)consistencies. Results Twenty-one bereaved family members participated. At least 70% of participants reported having received each component of the bereavement support pathway. The most frequently rated fully helpful practices before/around patient death were receiving information about changes in the patient’s condition (80%) and asking about coping (78%), while information on self-help groups was most unhelpful when received (33%). Family member reported empathetic and compassionate care, high satisfaction with care before death and during follow-up (median 9/10 for both, r = 0.75, p = 0.0003), and mostly (79%) felt they had received as much help and support as needed after the patient’s death. Qualitative analysis revealed two main themes with sub-themes: ‘Shifting focus from intense days in palliative care to the grieving process’ and ‘Bereavement care makes you feel like you haven't been forgotten’. Integration of qualitative and quantitative findings revealed that ‘compassionate care’, ‘presence and support’, and the ‘sympathy card’ were consistently perceived as supportive across both data types, reflecting strong satisfaction among family members. Conclusions Structured bereavement support may enhance families’ sense of continuity and emotional security following the death of a loved one. The findings underscore the importance of individualized support within standardized approaches to meet diverse needs and optimize integration of bereavement care in specialized palliative care settings. Trial registration https://osf.io/qgr7y .