Essential Component 9
Supporting people through loss and grief

Grief is a normal response to loss and can affect all parts of your life

Why is this an Essential Component?

Evidence for Inclusion

Grief is a normal and inevitable response to loss, and can affect every part of a person’s life (ACGB, 2014). Grief and bereavement support encompasses the “entire experience of family members and friends in the anticipation, death, and subsequent adjustment to living following the death of a loved one” (Christ et al, 2003).

To deliver the highest standard of care there is a requirement to ensure that the patient, their caregiver/s and family have access to bereavement care, information and support services.

Intended Beneficial Outcomes

  • Grief and bereavement support is available.
  • Family members, carers and significant others are supported as they grieve.
  • Care providers across all settings are supported and resourced to support carers and families through their loss and grief.
  • Bereavement services are recognised as an essential component of care to family and carers.
  • Bereavement services are resourced and are a routine part of palliative and end of life care.
  • There are models and guidelines to support best practice in bereavement services including bereavement risk assessments.
Grief is a normal response to loss and can affect all parts of your life

What tools/resources could support the implementation of this component?

The Agency for Clinical Innovation commissioned CareSearch (Palliative and Supportive Services, Flinders University) to identify local, national and international tools or resources that can potentially be used to implement each of the ten (10) Essential Components of Care within the Blueprint.

To be included, tools and resources were required to be in English, be applicable to the Australian context and be supported by evidence (such as published validation studies, clinical guidelines representing expert consensus, or advice from expert clinicians who were consulted).

The set of tools and resources provided is not intended to be exhaustive, nor is any one tool specifically recommended. Click here for more information on the methodology adopted by CareSearch in identifying these tools and resources.

Core Palliative Care Tools

  • After Death Bereaved Family Interview
    Designed to guide quality improvement, the tool can be adjusted to focus on one or care domains. The survey is not intended to be self-administered by the respondent (e.g. in mail-back surveys). Versions tailored to hospice, nursing home and hospital settings are available.
    Registration is required but no fee is payable. Author, Joan Teno confirmed her agreement to use of the tools and provided copies of the survey instruments and toolkit scoring packet. The author should be cited and the copyright and permission notice (shown on the tool itself) must appear in the supporting documentation (8/4/2015).
  • Bereavement Risk Assessment Tool (BRAT)
    The BRAT identifies personal, interpersonal and situational factors that may place a caregiver or family member at greater risk for a significantly negative bereavement. May inform the care team of immediate concerns or guide bereavement resource allocation. BRAT is a 40 point list of both risk factors (36 items) and protective factors (4 items) that predict complicated bereavement and results in a risk rating, where level 1 represents no known risk to level 5 – high risk. In response to a query regarding the tool, a Californian service provider has invited collaboration on the use of this tool as apparently only one article has been published on its validity.
    Registration and purchase of the tool is required to obtain a valid version of the tool, instructions and permissions.
  • Bereavement Risk Index (BRI)
    An assessment tool designed to distinguish levels of risk amongst bereaved individuals. The BRI is completed after the patient’s death by a primary care nurse, not one of the bereaved. The tool has a predictive approach using an 8 variable risk index.
    No requirement for registration or payment. The modified version (Kristjanson et al, 2005) accommodating the Australian language and care context can be used with permission from the original author

Core Resources

Additional Tools for Specific Populations

  • Prolonged Grief Disorder [PG -13]
    PG-13 is a diagnostic tool. A patient meeting the criteria for PGD, suggests that he or she should seek a more thorough evaluation from a mental health professional. Only an in-person assessment by a mental health professional can determine for certain the clinical significance of the reported symptoms, and provide recommendations or referrals for treatment.
    As the tool is copyright protected, permission is required from authors - Holly G. Prigerson, Ph.D., Paul K. Maciejewski, Ph.D.