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Harrop E, Mann M, Semedo L, Chao D, Selman LE, Byrne A. What elements of a systems' approach to bereavement are most effective in times of mass bereavement? A narrative systematic review with lessons for COVID-19 Palliative Medicine. 2020.
• What are systems-level responses to mass bereavement events?
• The global COVID-19 pandemic has left health and social care systems facing the challenge of supporting large numbers of bereaved people in difficult and unprecedented social conditions.
• Health and social systems are responsible for not only supporting those who are grieving, but also continuing to treat those with severe disease and prevent the virus from spreading exponentially.
• Previous reviews have not yet examined the evidence on the response of health and social care systems to mass bereavement events.
• The aim of this systematic review is to synthesize the evidence regarding systems-level responses to mass bereavement events, including natural and human-made disasters as well as pandemics, to inform service provision and policy during the COVID-19 pandemic and beyond.
• Review authors conducted a detailed search of four research databases for eligible studies published between 2000 and 2020.
• Reference lists were screened for further relevant publications.
• A total of 700 papers were retrieved and screened for the review, 12 of which were included.
• Authors of this review were supported by the Marie Curie core grant funding (Grant No. MCCC-FCO-11-C), the Wales Cancer Research Centre (Grant No. WCRC514031), and a Career Development Fellowship from the National Institute for Health Research.
• All 12 included articles reported on interventions and support programs initiated in response to human-made and natural disasters. None of the articles described bereavement support programs in the context of pandemics, and none were of high quality.
• Most of the interventions and programs involved national or state-level coordination of support by multiple statutory and voluntary organizations, commonly in community settings. Across all programs, psychologists, psychiatrists, therapists and social workers were primarily responsible for delivering the support.
• Several key service features were identified across interventional approaches: proactive outreach to those in need; structured psycho-education and group-based support; use of existing social networks; central coordination of locally delivered support; training for providers in crisis-specific core competencies; formal risk assessment for prolonged grief disorder; and development of referral pathways for specialist mental health support.
• Policymakers and those delivering services should design or adapt bereavement support to best serve the population in need. This includes advertising services widely to enable access to support for those who need it, providing training in core competencies specific to the COVID-19 context; and providing options for individual and group support in the context of social distancing restrictions.
• In addition, bereavement support providers, including palliative care services, should integrate prospective evaluation alongside service delivery and ensure real-time feedback to inform practice.
• The conclusions that can be drawn from this review in relation to COVID-19 are limited by the quantity, quality and applicability of the evidence.
• Some consistent messages, however, can be drawn from previous support programs initiated in response to human-made and natural disasters.