Complicated grief - a challenge in bereavement support in palliative care: An update of the field

The philosophy of palliative care recognizes that end-of-life care impacts the whole family. Consequently, palliative care involves support for the family during illness and after the patient's death. Until recently, no clinical guidelines on bereavement support existed in palliative care. Little is known about the extent of bereavement follow-up provided by specialist services. A few surveys show that bereavement programmes may be common, but need to work with best-practice models to ensure optimal allocation of support. An increasing amount of research shows complicated grief as a clinical phenomenon and a distinct diagnostic entity. The fundamental issue is mapping universally valid norms of reactions, including the prevalence of complications, and lately also the pursuit of a diagnostic entity of complicated grief. In the recently released fifth edition of the American Diagnostic and Statistical Manual of Mental Disorders all proposals for diagnostic criteria for complicated grief were rejected. Instead, the committee chose to remove the 'bereavement exclusion' of the DSM-IV, which excluded individuals from a diagnosis of major depressive disorder right after a loss. This paper addresses issues related to complicated grief as a bereavement-related disorder, and current implications and challenges in palliative care bereavement support will be discussed. The academic society seems to support a public health framework based on a systematic and evidence-based approach, which builds on needs and risks, to inform the organization of bereavement services. Until a distinctive and clearly defined concept of complicated grief exists and validated assessment tools are applicable, attention to new effective interventions is of vital importance in the provision of bereavement care. Bereavement counsellors in palliative care need to work to provide a clearer platform for evidence-based treatments for complicated grief within the remit of palliative care, or the lack of focus on complicated grief in palliative care is a complicating factor for the bereaved caregivers.