Condolence letters, a rare practice
Literature on follow-up with grieving families essentially concerns deaths in oncology units and in hospice care. These studies focus above all on the follow-up practices of oncology and hospice care physicians for grieving families: participation in rituals (funerals, for example), home visits, phone calls or condolence letters. Three studies [5–7] highlight heterogeneous and also very unpredictable practices: condolence letters written in 30–70 % of cases, few phone calls, little participation in grieving rituals. These three studies also highlight the barriers to condolence practices: lack of time or resources, the importance of maintaining professional distance, fear of professional burn-out, the difficulty of identifying which family member to contact, and, finally, the lack of recommendations for writing condolence letters. A literature review on the subject of interventions proposed to bereaved families demonstrates that many interventions are tested (from grief support groups to drug treatments to psychotherapy) without significant conclusions and that the majority of these studies suffer from significant methodological weaknesses [8]. Some studies ask the question of the identity of the person who could participate in the follow-up of grieving families: most often the doctor is cited and sometimes the nurse [9].
It is interesting to note that most studies focus on the practices of clinicians (oncologists and hospice care), but no study measures precisely the impact of these strategies on grieving individuals themselves. Two studies address this point, without it being the subject of the study, and demonstrate that a good interaction with the referring doctor of the dying patient, before and after his death, reduces complications in the grieving process [10] and, in the case of a phone call, diminishes the feelings of abandonment and solitude of family members [11]. Caring for family members after the death of a patient is one of the pillars of a good palliative approach. In its Clinical Practice Guidelines for Quality Palliative Care, the National Consensus Project for Quality Palliative Care [12] puts forward that among the nine points defining palliative care, one is dedicated to aiding families during their loved one’s illness and after death, during the grieving process. In the practical recommendation section on psychological care of patients and families, one section is dedicated to post-death follow-up and aiding grieving families during the first year of bereavement: after the patient’s death, family members may need help and follow-up allows them to be referred to professionals, if that is judged necessary, allows their pain to be recognized, and allows them to express themselves and to get back in touch with the care team if necessary. Therefore, contact with bereaved family members in the form of a condolence letter could be part of the care recommended by these guidelines.