The Role of General Practice in Bereavement Care after Death in the Acute Setting: a scoping review and model

Problem

Every GP in the country can expect an average of 20 patient deaths per year. Some studies report up to 72% of the adult population will have lost a loved one in the last five years. In short, bereavement will come to us all. General practice is well placed to offer care for bereaved patients in the community. Increasingly, patients spend their final moments in an acute hospital setting. It is well documented both in practice and the literature that an unexpected death, including in hospital, is a risk factor for developing complex or prolonged grief. For these patients in particular, their GP has the potential to intervene through effective and long-lasting bereavement support, yet provision can be patchy across the socio-economic continuum.

Approach

This scoping review explores the current role of primary care in bereavement support and suggests a model to optimise this care after death in the acute setting. This work was conducted according to the Arksey & O’Malley framework for a scoping review. MEDLINE and EMBASE were searched extensively to identify relevant studies. There were no predetermined exclusion criteria, in keeping with an exploratory study. A total of 23 articles dating from 1998-2022 were included, from a variety of healthcare settings.

Findings

Analysis of the literature suggests a tripartite role for primary care in bereavement support, particularly in the case of an unexpected death in the acute setting. The first area to address is a robust method to identify affected patients within a practice population, such that they could then be offered relevant care. The bereavement support offered by general practice can then be split into conversations had ‘in-house’ whereby a therapeutic relationship is fostered, and the role of the GP as a ‘broker’ to facilitate access to other organisations for further, perhaps non-medical support. This can be summarised via a novel ‘Triple Forte’ model for bereavement care: Find, Foster, Facilitate.

Consequences

This review highlights multiple avenues for further research. Key areas include early intervention from general practice for potential complex grief following unexpected death, and exploration of the non-medical bereavement support services available to patients in the community. Improved understanding of the needs of this cohort and the resources available or desired is key to improving both provision and access to bereavement support across the social spectrum.