Table 2

Bereavement care changes during COVID-19

Changes toYesNoUnsureIllustrative comment examples
Use of telephone, video or other remote support704 (90%)52 (7%)22 (3%)We were not using video call before covid and rarely offering counselling by phone, but this is now primary to our service. (#40 hospice bereavement service manager)

Learning about the different ‘platforms’ has needed energy to understand. New data protection has also been needed in relation to information stored on phones. (#293 community nurse)

It is more difficult picking up on subtleties of the consultation remotely, touch is obviously not possible either- everything is now done remotely for mental health in general practice. (#444 general practitioner)
Supporting people bereaved from non-COVID conditions during the pandemic586 (76%)157 (20%)33 (4%)Very challenging at first as we did not know how to support the bereaved as events were folding at a high and fast speed. Every case was treated as though it was Covid-19. Lots of gaps and lessons to be learned as some non-Covid patients were just classified as positive patients. (#141 chaplain)

I have found families who have lost a member during the pandemic feel their loss is not as big as that of people dying of COVID. Or as important. (#234 hospice social worker)

It is hard to differentiate between COVID and non-COVID deaths. The death may not be certified as COVID related, but the bereaved person experience may well be impacted by the COVID restrictions. (#440 service manager/head of department)
Supporting people bereaved from COVID500 (65%)189 (24%)85 (11%)Sudden, more unexpected deaths, different bereavement response and reactions. Disbelief. Practical questions about how long they should self-isolate for after the death if they visited the hospital. (#74 palliative medicine doctor)

Visiting restrictions have meant much less face to face contact. For example I have talked with a spouse in the car park at social distance. (#153 palliative medicine doctor)

There was a lot of anger about having Covid on the death certificate if they had been suffering from a long term illness prior. (#572 hospice bereavement counsellor)
Supporting people already experiencing bereavement when the pandemic started468 (61%)214 (28%)84 (11%)Pandemic caused relapse to clients who were beginning to look forward and manage their grief, necessitating offering extra support (#127 hospice bereavement counsellor)

Many clients receiving counselling have refused offers of telephone, preferring to wait until 'normal services resume'. (#682 hospice social worker)

We are beginning to see more extreme reactions from people who were bereaved before the pandemic and who had begun to find ways of living in their altered world, but who now find that most of the outlets that they were using to help themselves are now closed to them. (#271 hospice social worker)
Restrictions regarding funeral arrangements446 (61%)181 (25%)108 (15%)Families will talk to us about how unfair they feel the restrictions are regarding funerals, especially if their loved one did not die from Covid 19. (#267 hospital bereavement manager)

The bereaved have found it very difficult not being involved in the physical process of collecting death certificates, taking them to the registrar, then physically going to the funeral directors - these rituals are part of a process. (#766 citizens advice administrator)

Bereaved relatives don't come back and collect the death certificate - it gets scanned to the registry office. We do an online cremation form which we email to the funeral directors. We do not need to see the patient after death and don't go to funeral directors. Part 2 GPs are not needed. (#545 palliative medicine doctor)
Identifying bereaved people who might need support437 (56%)291 (37%)59 (7%)We've been unable to see as many family members face-to-face as we normally would, so it’s been harder for us to identify people. (#58 hospice social worker)

More difficult to assess those who need support with distancing and limited visiting. This influenced our ability to form relationships with relatives and identify their needs. (#104 palliative medicine doctor)

As a clinical team we were much more proactive, checking every bereaved family/carer and doing it twice and taking longer periods of time to make sure it was as right as it could be, impacting hours worked. (#802 quality improvement lead)
Managing complex forms of grief356 (48%)256 (34%)135 (18%)These are just more difficult cases to tackle, and the isolation - not having been able to visit a loved one in hospital who’s subsequently died - exacerbates this. (#7 general practitioner)

We have at times entered territory/topics that are new and we do not have the answers to. (#526 hospice family services manager)

Increase in referrals regarding this. (#540 assistant psychologist)
Access to specialist services for the bereaved301 (41%)292 (40%)134 (18%)These have reduced enormously and people have been left without an accessible service. (#378 counselling and bereavement services manager)

Services like Cruse Bereavement Care have been so inundated that families do not get seen to as quickly as they normally would. Also, we usually advise that if families are struggling with their grief then they should visit their GP to get a referral to a counselling service, of course, GP’s have been restricting appointments so this has become very challenging as to where we can sign post bereaved families to. (#158 medical examiners officer)

Limited access as specialist services such as psychological support staff were redeployed. (#104 palliative medicine doctor)