Grief & Bereavement Evidence

Skip anything

Every question is optional. No one has to retell painful events, name a diagnosis, or choose a religion or identity to begin.

Pause or stop

Stop at any point. Nothing is sent anywhere, and nothing is shared unless the person chooses it in the sharing review.

Whose words

Record who said each thing: the person, a caregiver or surrogate, or a professional. A caregiver's needs get their own field.

Support to take part

Extra time, a quieter place, pictures, an interpreter or a trusted person can help someone say what matters. Ask what helps.

Barriers are not preferences

Cost, travel, work, housing, caring for others and digital access are written down as barriers, not as what the person wants.

Meaning, religious or not

Hope, purpose, faith, relationships and identity can be part of the conversation if the person wants. None is assumed.

• Physician or nurse: What to expect, comfort care, and what happens after a death.
• Palliative or hospice team: Support before and after a death, where available.
• Social worker: Practical matters, funeral costs and family support.
• Bereavement counselor or support worker: Grief support and follow-up, where available.
• Chaplain or spiritual-care provider: Meaning, distress, hope and relationships, for people of any faith or none.
• Interpreter or communication specialist: Language and communication support so the person's own words come through.
• People the person chooses: Family, friends, or a community or faith contact, only if the person wants them. Never assumed safe, available or wanted.

Roles, titles and training differ by country and service. Not every role exists everywhere.

A small set of places chosen for contrast, not a ranking or a representative survey: Global, Netherlands, Canada, Brazil, Zimbabwe, India, Japan, Iran, New Zealand. Each example states what its source establishes and what it does not. Policy on paper is not proof that a service is available.

Guidance, not outcomes:

Shows what is written or recommended. It does not show that it is followed or what results.

Abstract only:

Read from the abstract. The full paper may add or qualify this.

Place from authors:

The place is taken from the authors' affiliations, not from where data were collected.

Service as described:

Describes a service when the source was written. Whether it still runs is not verified.

• Global · Guidance · 2020

  WHO's September 2020 COVID-19 interim guidance on managing dead bodies says that if the family wishes to view the body, staff should allow it, with instructions not to touch or kiss the body.

  Limits: Guidance, not outcomes

  What others could learn: Ask early whether the family wants to see the body and which customs of contact matter to them. The guidance pairs allowing a viewing with precautions and asks staff to identify local alternatives to touching and kissing where contact is customary.

  Conditions, limits and source

  Conditions that matter:

  Hand hygiene supplies and personal protective equipment for anyone tending the body; trained mortuary staff; local agreement on alternatives to contact; where mortuary services are absent, the guidance says families and traditional burial attendants can be equipped and instructed.

  Cannot be inferred:

  Not current WHO policy for other causes of death; does not show how often viewing was allowed in practice; does not say what any family's tradition requires or how a given family should be asked.

  Limits:

  Interim COVID-19 guidance of 4 September 2020; WHO stated it would expire 2 years after publication unless updated. It is infection-control guidance and measures no family experience or outcome. Later WHO or national updates were not checked.

  Source: World Health Organization, Infection prevention and control for the safe management of a dead body in the context of COVID-19: interim guidance, 4 September 2020 (Section 'Advice for mortuary care/funeral home', PDF p. 2 (same page: 'Identify local alternatives to kissing and touching the dead body in settings where such contact is traditionally part of funeral procedures'); 'Burial by family members or for deaths at home' follows). Where: Global. Population: Families of people who died of suspected or confirmed COVID-19; mortuary, funeral and health-facility staff. Published 2020-09-04; retrieved 2026-10-11.

• Global · Guidance · 2024

  WHO's Ebola outbreak psychological first aid guide (second edition, 2024) says helpers should encourage people who cannot bury loved ones in a traditional ceremony to think of alternative ways to honor, remember and grieve.

  Limits: Guidance, not outcomes

  What others could learn: Where usual rituals around a death are not possible, a first conversation can listen, allow time to talk about the person, and help the family think of its own safe ways to remember. The guide suggests considering religious leaders to help develop safe alternatives and gives a page to record local ones.

  Conditions, limits and source

  Conditions that matter:

  Trained helpers; safe and dignified burial teams working with communities; risk information given alongside reassurance that other ways of grieving exist; links to religious and community leaders to develop local alternatives.

  Cannot be inferred:

  Does not show these steps reduce prolonged grief; written for outbreak deaths, not for other deaths; does not say what any tradition requires.

  Limits:

  Operational guide for Ebola outbreaks, with no evaluation of its effect on grief. The example rituals it lists (planting trees, memorial services around photographs) are ideas reported from past outbreaks, not tested options.

  Source: World Health Organization, Psychological first aid during Ebola virus disease outbreaks, second edition (Section 'Offering psychological first aid to grieving people', printed pp. 47-48 (PDF pp. 56-57); passage on printed p. 48 (PDF p. 57)). Where: Global. Population: People bereaved during Ebola virus disease outbreaks, and the helpers who support them. Published 2024-12-03; retrieved 2026-10-11.

• Netherlands · Measured outcome · 2024

  In a mixed-methods study of 90 relatives of patients who died in six Dutch ICUs, 44% were asked by a hospital professional how they were doing afterward and 26% had a follow-up conversation.

  What others could learn: A routine check-in from a hospital professional in the weeks after a death, plus a follow-up conversation that families know they can ask for, may reach more relatives than leaving it to them to ask. The most common reason for no conversation was not knowing the option existed (44% of relatives with no conversation).

  Conditions, limits and source

  Conditions that matter:

  In these ICUs every bereaved relative could have a follow-up with the attending physician, but had to make the appointment themselves. The national ICU aftercare guideline places deaths outside its scope. Staff time and a way to reach relatives after discharge are needed.

  Cannot be inferred:

  Does not show follow-up conversations improve grief or health outcomes; not national; does not describe ICUs elsewhere; the pandemic-wave comparisons are not a trend.

  Limits:

  Six ICUs in one region. Ninety respondents, 92.2% with a Dutch cultural background and 82% medium or highly educated. Retrospective recall; aftercare measured with two questionnaire items. Pandemic-period groups are small (n=25, 39 and 26).

  Source: Amsterdam UMC (Renckens and colleagues); BMC Palliative Care, Experiences with and needs for aftercare following the death of a loved one in the ICU: a mixed-methods study among bereaved relatives (Abstract, Results; Table 3; Methods section 'Aftercare guidelines in the Netherlands and standard practice'). Where: Netherlands (six ICUs, northwestern region). Population: Relatives of patients who died in an ICU before or during the COVID-19 pandemic. Published 2024-03-04; retrieved 2026-10-11.

• Canada · Reported experience · 2020

  In a multicenter qualitative study of eight family members of ICU patients who died and who had high complicated grief ratings, interviews covered the ICU experience, post-death reactions, coping, support sources and advice for future programs.

  Limits: Abstract only · Place from authors

  What others could learn: Relatives with persistent grief can say how events before and at the death shaped it and what support they wanted. Their advice is a source for designing early ICU follow-up, which is the stated aim of the study.

  Conditions, limits and source

  Conditions that matter:

  A route to contact relatives after the death and staff or partners able to offer support. The abstract does not describe the service setting in detail.

  Cannot be inferred:

  Does not report what relatives said or advised; does not show that screening or support programs work; not representative of Canada or of all ICU deaths.

  Limits:

  Abstract only; the publisher site was not reachable. Eight participants chosen for high grief ratings, so not typical of all bereaved relatives. The abstract gives theme headings but no quotes or detail. It uses 'complicated grief', and this record does not treat that label as the same as prolonged grief disorder.

  Source: Downar, Sinuff and colleagues; Canadian Journal of Anaesthesia, A qualitative study of bereaved family members with complicated grief following a death in the intensive care unit (Abstract (PubMed 32052371), Results and Conclusion). Where: Canada (multicentre study; lead authors in Ottawa, Ontario; sites not listed in the abstract). Population: Family members of patients who died in an ICU and who had high six-month complicated grief ratings. Published 2020-01-31; retrieved 2026-10-11.

• Brazil · Measured outcome · 2024

  In an online survey of 142 relatives of people who died of COVID-19 (authors based in Brazil), prolonged grief disorder symptoms were associated with degree of kinship, and relatives expected a dignified farewell, effective communication and comfort.

  Limits: Abstract only · Place from authors

  What others could learn: Relatives' stated expectations are concrete: permission for a dignified farewell, plain communication about the patient's condition, and comfort care. A team can ask what a dignified farewell would mean to this family and what is possible within visiting limits, and note the answer.

  Conditions, limits and source

  Conditions that matter:

  Visiting or farewell arrangements that staff can adapt; a named person for communication with relatives; follow-up contact after the death to notice who is struggling, since the abstract links symptoms to kinship.

  Cannot be inferred:

  Direction of the kinship association is not in the abstract; symptom prevalence is not diagnosis; the sample is not representative of Brazil; does not show that any farewell arrangement prevents prolonged grief.

  Limits:

  Abstract only; the full text was not retrieved. Online sample, mostly female. The abstract does not say which kin groups had more symptoms. The study used a named prolonged grief instrument whose items are not reproduced here. Symptom prevalence in the abstract (11.4% beyond six months, 29.6% within six months) describes symptoms in this sample and is not a diagnosis.

  Source: Universidade Federal da Paraíba (Lucena and colleagues); Ciência & Saúde Coletiva, End-of-life care and grief: study conducted with family members of COVID-19 victims (Abstract (PubMed 38958311), last two sentences; prevalence of prolonged grief symptoms reported earlier in the abstract). Where: Brazil (inferred from authors' affiliations; the abstract names no country). Population: Family members of people who died of COVID-19. Published 2024-02-19; retrieved 2026-10-11.

• Zimbabwe · Measured outcome · 2023

  A feasibility cluster trial in two Chitungwiza, Zimbabwe, neighborhoods had lay supporters use a locally developed 9-cell tool to help bereaved people reflect on grief and find resources; six-month retention was 69% overall (91% intervention, 53% wait-list).

  What others could learn: Trained lay supporters in a low-resource urban area ran a structured conversation comparing a bereaved person's feelings with judgmental attitudes and family and community support over time. Keeping comparison participants engaged was harder.

  Conditions, limits and source

  Conditions that matter:

  Partnership with a hospice organization and local leaders who identified lay supporters; permission from local authorities; a training session for supporters; participants recruited within three weeks.

  Cannot be inferred:

  No evidence yet of effect on grief, mental health or social support (results not significant, as the paper states); does not describe national bereavement services or practices; two neighborhoods only.

  Limits:

  Feasibility study, not powered to detect effects. The abstract says at least 75% of participants were retained, but the Results report 74% at three months and 69% at six months, with far more loss in the wait-list control community (46 of 86 retained, versus 52 of 57 in the intervention community). Two neighborhoods in one city. An author is affiliated with the collaborating hospice organization.

  Source: Island Hospice and Healthcare Zimbabwe with King's College London (Mutedzi and colleagues); Pilot and Feasibility Studies, Improving bereavement outcomes in Zimbabwe: results of a feasibility cluster trial of the 9-cell bereavement tool (Abstract, Context; retention figures in Results, 'Retention rates of trial participants' and Table 4). Where: Zimbabwe (Chitungwiza, two neighborhoods). Population: Recently bereaved community members, and lay community bereavement supporters trained to deliver the tool. Published 2023-07-21; retrieved 2026-10-11.

• India · Reported experience · 2022

  Most of ten Hindu, Gujarati bereaved relatives interviewed by phone one month after a first-wave COVID-19 loss (authors in Vadodara, India) reported remorse at not seeing or bringing their loved one home and feeling deprived of traditional rituals.

  Limits: Abstract only · Place from authors

  What others could learn: Families in this study described phone-only contact and disrupted farewells as hard. When restrictions are unavoidable, a team might ask which contact and farewell matter most to the family.

  Conditions, limits and source

  Conditions that matter:

  Hospital visiting rules that allow exceptions; staff time for calls to families; a way to see the person after death or to take the person home, which the participants said they could not do.

  Cannot be inferred:

  Not representative of India or of Hindu or Gujarati families; says nothing about what any tradition requires; hospital practice may have changed since the first wave; no outcome measured.

  Limits:

  Abstract only. Ten participants from one language and religious community, one hospital, interviewed once by phone. The abstract does not name the hospital or give the full list of themes beyond communication, disrupted rituals and accepting changes.

  Source: GMERS Medical College Gotri, Vadodara (Patel and colleagues); Omega: Journal of Death and Dying, Lived Experiences of Bereaved Family Members During COVID-19 Pandemic in a Tertiary Care Hospital With Special Reference to Imposed Restrictive COVID Guidelines: a Qualitative Study (Abstract (PubMed 35184587), last sentences; PMC record PMC8863921 carries the abstract only). Where: India (tertiary care hospital; authors at Vadodara). Population: Ten family members bereaved during the first COVID-19 wave, interviewed one month after the loss. Published 2022-02-21; retrieved 2026-10-11.

• Japan · Measured outcome · 2024

  In a secondary analysis of a nationwide Japanese bereaved-family survey (9,123 families of patients with cancer), 1,338 (reported as 15.1%) were not prepared for bereavement; lower social support and acute hospital care were among associated factors.

  Limits: Abstract only

  What others could learn: Feeling unprepared for a death can be asked about before it happens. In this survey it was more likely when the family member was the patient's spouse, had lower social support, or the patient was in an acute hospital, so these are cues to check in about preparation. Whether doing so helps was not tested.

  Conditions, limits and source

  Conditions that matter:

  A national bereaved-family survey that links care experiences to later reports; end-of-life discussions between physician and family, whose timing (late or early) was also associated with feeling unprepared.

  Cannot be inferred:

  Association, not cause; not tested whether preparation conversations reduce grief; does not cover non-cancer deaths or other countries; the figure describes survey respondents.

  Limits:

  Abstract only. Retrospective self-report by bereaved families; response rate and survey wave are not in the abstract. The authors note that preparedness may be associated with other factors. Cancer only.

  Source: Tohoku University Graduate School of Medicine (Matsuzaka and colleagues); Psycho-Oncology, Factors associated with the preparedness for bereavement in families of patients with cancer: a secondary analysis of a nationwide bereaved family survey (Abstract (PubMed 38282233), Results). Where: Japan. Population: Bereaved family members of patients with cancer. Published 2024-01; retrieved 2026-10-11.

• Iran · Reported experience · 2024

  In interviews with 15 mothers and 6 midwives in Iran, authors report that free counseling was available in health centers but many bereaved mothers did not know of it, and no counselor details were given at hospital discharge.

  Limits: Service as described

  What others could learn: At discharge after a death, hand over the name and contact details of an available counselor, and plan a follow-up call. One midwife proposed a phone check-in at least two weeks later; mothers did not assume they would be offered support. Informal messaging with a known midwife helped some.

  Conditions, limits and source

  Conditions that matter:

  Free counseling in health centers; midwives in government clinics provide free postpartum care at set visits; participants proposed a liaison midwife who tells the health center when a bereaved mother is discharged.

  Cannot be inferred:

  Does not show that the proposed tracking system exists or works; says nothing about adult deaths; not representative of Iran; not proof that services described still operate.

  Limits:

  Perinatal loss, so findings may not carry to deaths of adults. Small purposive sample; some interviews by phone because of COVID-19. The authors state qualitative findings are not meant to generalize. Mothers' and midwives' accounts, not a service evaluation.

  Source: Shahroud University of Medical Sciences (Atashsokhan and colleagues); Inquiry, Desired Care for Perinatal Bereavement: Meeting the Needs of Mothers After Discharge From the Hospital: a Qualitative Study (Results, category 'Continuous healthcare', sub-category 'Psychological Welfare Provision'; see also 'Comprehensive Mother Tracking System'). Where: Iran. Population: Mothers after perinatal loss (fetal loss, stillbirth or early neonatal death) and midwives. Published 2024-02-09; retrieved 2026-10-11.

• New Zealand · Reported experience · 2024

  Interviewing 28 Māori whānau bereaved during New Zealand's COVID-19 lockdowns, researchers report tangihanga policy required a funeral director to uplift the body immediately after the death certificate was signed, which the authors say breached whānau tikanga.

  What others could learn: Ask early about time with the body, who needs to be present and where the burial should be, then see what can be arranged inside the rules. In this study funeral directors helped some whānau gain hours or an overnight stay with the body, and the authors report no bereavement care was available afterward.

  Conditions, limits and source

  Conditions that matter:

  Policy that allows exceptions; funeral directors who know the rules and are willing to bend them within limits; access to elders and cultural leaders in person or online; technology for remote participation; funeral costs, which fell on families.

  Cannot be inferred:

  Does not describe New Zealand policy or hospital practice today; does not set out what tikanga requires, only what participants and authors report; not a rule for all Māori; hospital visiting is covered only in part.

  Limits:

  Policy content is as described by the authors; the underlying government orders were not retrieved. Families of people with a known life-limiting illness who died in two alert levels. The article states that policy changed over time. Findings describe these families, not all Māori or all New Zealanders.

  Source: University of Auckland, Te Ārai Palliative Care and End of Life Research Group (Moeke-Maxwell and colleagues); Journal of the Royal Society of New Zealand, Pōuritanga: Whānau Māori experiences of end-of-life caregiving, death and tangihanga (funeral customs) during New Zealand's COVID-19 lockdowns (Results, section on tangihanga and post-death care (policy and funeral directors); Discussion, 'Bereavement and grief'). Where: New Zealand. Population: Bereaved whānau Māori (28 families), plus health professionals and funeral directors (14 each). Published 2024-05-05; retrieved 2026-10-11.

• The sourced examples include guidance, measured outcome, reported experience. Each quote was matched to the source text; that is not independent expert review.
• The prompts and fictional case are original. They have not been tested with patients, caregivers or clinicians.
• Whether this workflow helps anyone is an open research question.
• Content is in English. Interface translations are not reviewed for this topic.