Grief during the COVID-19 pandemic: considerations for palliative care providers
Open accessAbstract
The COVID-19 pandemic is anticipated to continue spreading widely across the globe throughout 2020. To mitigate the devastating impact of COVID-19, social distancing and visitor restrictions in health care facilities have been widely implemented. Such policies and practices, along with the direct impact of the spread of COVID-19, complicate issues of grief that are relevant to medical providers. We describe the relationship of the COVID-19 pandemic to anticipatory grief, disenfranchised grief, and complicated grief for individuals, families, and their providers. Furthermore, we provide discussion regarding countering this grief through communication, advance care planning, and self-care practices. We provide resources for health care providers, in addition to calling on palliative care providers to consider their own role as a resource to other specialties during this public health emergency.
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As the pandemic progresses with many deaths, lack of preparation, restrictions, and physical, mental, and social consequences of distancing, pathological or chronic grief may appear complicated.
“the pathological or chronic grief may appear complicated (Lobb et al., 2010; Wallace et al., 2020).”
With the high COVID-19 death rate in the UK, grief is likely to be implicated in mental health challenges.
“With the high COVID‐19 death rate in the UK, grief is likely to be implicated in mental health challenges (Wallace et al., 2020).”
From Living through lockdown: A qualitative exploration of individuals' experiences in the UK. (2022) · cites this paper as Wallace et al., 2020
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“Although, such policies and regulations immensely help in controlling the spread of COVID-19, however, it complicates the process of grief (Wallace et al., 2020).”
BackgroundInfluentialMitchinson, L., Dowrick, A., Buck, C., Hoernke, K., Martin, S., Vanderslott, S., Robinson, H., Rankl, F., Manby, L., Lewis‐Jackson, S., et al. (2021) · Palliative Medicine · doi:10.1177/02692163211004228 · Cited by 71 · see citing works
Palliative care for patients with severe covid-19
Ting, R., Edmonds, P. M., Higginson, I. J., & Sleeman, K. E. (2020) · BMJ · doi:10.1136/bmj.m2710 · Cited by 67 · see citing works
The Many Faces of Grief: A Systematic Literature Review of Grief During the COVID-19 Pandemic
Kumar, R. M. (2021) · Illness Crisis & Loss · doi:10.1177/10541373211038084 · Cited by 74 · see citing works
“Complicated grief results from multiple stressors and is characterized by excessive rumination, alienation, hopelessness, and intrusive thought for the dead (Wallace et al., 2020).”
BackgroundThe perception of nurses towards their roles during the COVID‐19 pandemic
Abuhammad, S., AlAzzam, M., & Mukattash, T. L. (2020) · International Journal of Clinical Practice · doi:10.1111/ijcp.13919 · Cited by 67 · see citing works
Chen, C., & Tang, S. (2021) · European Journal of Psychotraumatology · doi:10.1080/20008198.2021.1947563 · Cited by 70 · see citing works
Garagiola, E. R., Lam, Q., Wachsmuth, L. S., Tan, T. Y., Ghali, S., Asafo, S. M., & Swarna, M. (2022) · Behavioral Sciences · doi:10.3390/bs12070220 · Cited by 71 · see citing works
Mitchell, S., Maynard, V., Lyons, V., Jones, N. R., & Gardiner, C. (2020) · Palliative Medicine · doi:10.1177/0269216320947623 · Cited by 61 · see citing works
Klop, H. T., Nasori, M., Klinge, T. W., Hoopman, R., de Vos, M. A., du Perron, C., van Zuylen, L., Steegers, M. A. H., ten Tusscher, B. L., Abbink, F. C. H., et al. (2021) · BMC Health Services Research · doi:10.1186/s12913-021-07095-8 · Cited by 58 · see citing works
Harrop, E. J., Mann, M. K., Semedo, L., Chao, D., Selman, L. E., & Byrne, A. (2020) · Palliative Medicine · doi:10.1177/0269216320946273 · Cited by 55 · see citing works
Family Meetings in the Intensive Care Unit During the Coronavirus Disease 2019 Pandemic
Piscitello, G. M., Fukushima, C. M., Saulitis, A. K., Tian, K., Hwang, J. M., Gupta, S., & Sheldon, M. (2020) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/1049909120973431 · Cited by 54 · see citing works
Can a ‘second disaster’ during and after the COVID-19 pandemic be mitigated?
Gersons, B. P. R., Smid, G. E., Smit, A. S., Kazlauskas, E., & McFARLANE, A. C. (2020) · European Journal of Psychotraumatology · doi:10.1080/20008198.2020.1815283 · Cited by 54 · see citing works
Tam, C. C., Sun, S., Yang, X., Li, X., Zhou, Y., & Shen, Z. (2020) · AIDS and Behavior · doi:10.1007/s10461-020-03068-w · Cited by 54 · see citing works
“, the high risk of infectious exposure, shortage of personal protection equipment, and increasing workloads) detrimental to their psychological health [7, 8].”
BackgroundMenichetti, J., Borghi, L., Marco, E. C. D. S., Fossati, I., & Vegni, E. A. M. (2021) · International Journal of Psychology · doi:10.1002/ijop.12742 · Cited by 52 · see citing works
“Recent contributions have proposed literature-based recommendations for supporting COVID-19 bereaved families and preventing dysfunctional grief (Carr et al., 2020; Selman et al., 2020; Wallace et al., 2020).”
BackgroundSchloesser, K., Simon, S. T., Pauli, B., Voltz, R., Jung, N., Leisse, C., van der Heide, A., Korfage, I. J., Pralong, A., Bausewein, C., et al. (2021) · BMC Health Services Research · doi:10.1186/s12913-021-06987-z · Cited by 51 · see citing works
“[2] found that some grief processes during the SARS-CoV2 pandemic were novel related to physical distancing and isolation alongside experiencing uncertainty and self-blame related to infection.”
BackgroundEisma, M. C., & Tamminga, A. (2022) · European Journal of Psychotraumatology · doi:10.1080/20008198.2022.2062998 · Cited by 51 · see citing works
“…studies focused only on a few lossrelated characteristics and circumstances proposed to affect grief due to COVID-19 deaths (e.g. Eisma et al., 2021; Tang et al., 2021), the present study focused on a more comprehensive selection of potential risk-factors (Eisma et al., 2020; Wallace et al., 2020).”
BackgroundInfluentialMubarak, N., Safdar, S., Faiz, S., Khan, J., & Jaafar, M. (2020) · International Journal of Mental Health Nursing · doi:10.1111/inm.12819 · Cited by 55 · see citing works
“2020), has been an ongoing pandemic that has threatened the world with devastating consequences (Wallace et al. 2020).”
BackgroundDeath and Mourning Process in Frontline Health Care Professionals and Their Families During COVID-19
Das, S., Singh, T., Varma, R., & Arya, Y. K. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.624428 · Cited by 50 · see citing works
Selman, L. E., Sowden, R., & Borgstrom, E. (2021) · Palliative Medicine · doi:10.1177/02692163211017023 · Cited by 49 · see citing works
“36,37 Social distancing, quarantining and curfews might also affect usual bereavement processes; for example, ‘restoration-oriented’ activities undertaken to help accommodate a loss might be put on hold.”
BackgroundCOVID-19 and Mental Health—What Do We Know So Far?
dos Santos, C. F., Picó‐Pérez, M., & Morgado, P. F. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.565698 · Cited by 50 · see citing works
Existential Suffering in Palliative Care: An Existential Positive Psychology Perspective
Wong, P. T. P., & Yu, T. T. F. (2021) · Medicina · doi:10.3390/medicina57090924 · Cited by 50 · see citing works
Wiener, L. S., Rosenberg, A. R., Pennarola, B. W., Fry, A., & Weaver, M. S. (2021) · Palliative & Supportive Care · doi:10.1017/s1478951521000225 · Cited by 44 · see citing works
“It has been posited that COVID-induced patient isolation likely leads to higher rates of complicated grief for bereaved families as this phenomenon is predicted by an inability to say “goodbye,” fragmented communication within families, lower social support, and lack of family preparation prior to death (Siddiqi, 2020…”
BackgroundResultInfluentialArmstrong, S. J., Porter, J. E., Larkins, J., & Mesagno, C. (2022) · BMC Health Services Research · doi:10.1186/s12913-022-08409-0 · Cited by 44 · see citing works
Cognitive, Behavioral, and Emotional Disorders in Populations Affected by the COVID-19 Outbreak
Pera, A. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.02263 · Cited by 40 · see citing works
“Wallace et al. (2020) hold that affected persons are experiencing a deterioration of physical and psychological health throughout the COVID-19 crisis, sometimes being isolated or quarantined in facilities where, through regulations to restrict physical contact, the loved ones are not permitted to spend time with them.…”
BackgroundLatsou, D., Bolosi, F.-M., Androutsou, L., & Geitona, M. (2022) · Health Services Insights · doi:10.1177/11786329221096042 · Cited by 41 · see citing works
Killikelly, C., Smid, G. E., Wagner, B., & Boelen, P. A. (2021) · Public Health · doi:10.1016/j.puhe.2020.10.034 · Cited by 43 · see citing works
Marton, G., Vergani, L., Mazzocco, K., Garassino, M. C., & Pravettoni, G. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.588762 · Cited by 40 · see citing works
“In COVID-19’s phase 1, the pick of infected people was at its maximum and HCWs had to make rapid and often ethically challenging decisions on who and how to care (Wallace et al., 2020).”
BackgroundRogers, J. B., Constantine, L., Thompson, J. M., Mupamombe, C. T., Vanin, J. M., & Navia, R. O. (2021) · American Journal of Hospice and Palliative Medicine® · doi:10.1177/1049909121989987 · Cited by 39 · see citing works
“Moreover, staff may experience increases in psychosocial stressors.(11)”
BackgroundKinser, P. A., Jallo, N., Moyer, S. W., Weinstock, M., Barrett, D., Mughal, N., Stevens, L., & Rider, A. (2022) · Midwifery · doi:10.1016/j.midw.2022.103313 · Cited by 39 · see citing works
Aguiar, A., Pinto, M. S. D. S., & Duarte, R. (2022) · PLoS ONE · doi:10.1371/journal.pone.0265284 · Cited by 41 · see citing works
“All over the world, new guidelines and policies for the management of dead bodies, funerals, and burials are being implemented to contain the spread of infection [4, 8].”
BackgroundExploring the Use of Virtual Funerals during the COVID-19 Pandemic: A Scoping Review
MacNeil, A., Findlay, B., Bimman, R., Hocking, T., Barclay, T., & Ho, J. (2021) · OMEGA - Journal of Death and Dying · doi:10.1177/00302228211045288 · Cited by 40 · see citing works
“Such examples of suffering include impaired physical health and reduced quality of life, increased suicidality, substance use issues, relationship challenges, and mental health issues including heightened depression and anxiety (Goveas & Shear, 2020; Wallace et al., 2020).”
BackgroundInfluentialCaycho‐Rodríguez, T., Valencia, P. D., Vilca, L. W., Lee, S. A., Carbajal‐León, C., Vivanco-Vidal, A., Saroli-Araníbar, D., Reyes-Bossio, M. A., White, M., Rojas-Jara, C., et al. (2021) · OMEGA - Journal of Death and Dying · doi:10.1177/00302228211048566 · Cited by 38 · see citing works
“(Wallace et al., 2020), due to the inability to say goodbye to the deceased, excessive levels of guilt, and lack of social support (Mortazavi et al., 2020).”
BackgroundThe grief experience during the COVID-19 pandemic across different cultures
Adiukwu, F. N., Kamalzadeh, L., da Costa, M. P., Ransing, R. S., de Filippis, R., Pereira-Sánchez, V., Larnaout, A., González-Díaz, J. M., Eid, M., Syarif, Z. O., et al. (2022) · Annals of General Psychiatry · doi:10.1186/s12991-022-00397-z · Cited by 38 · see citing works
“Unexpected deaths, social distancing rules and visitor restrictions in healthcare facilities have posed a heavier burden on the loss and have heightened the risk of grievers experiencing complicated or persistent grief [7].”
BackgroundPrevalence of grief symptoms and disorders in the time of COVID‐19 pandemic: A meta‐analysis
Kustanti, C. Y., Jen, H., Chu, H., Liu, D., Chen, R., Lin, H., Chang, C., Pien, L., Chiang, K., & Chou, K. (2023) · International Journal of Mental Health Nursing · doi:10.1111/inm.13136 · Cited by 38 · see citing works
Teleoncology: The Youngest Pillar of Oncology
Pareek, P., Vishnoi, J. R., Kombathula, S. H., Vyas, R. K., & Misra, S. (2020) · JCO Global Oncology · doi:10.1200/go.20.00295 · Cited by 37 · see citing works
“Extremely emotionally challenging tasks such as communicating bad news and even providing bereavement care may also be done through teleoncology.(39,40)”
BackgroundTupper, S. M., Ward, H., & Parmar, J. (2020) · Canadian Geriatrics Journal · doi:10.5770/cgj.23.476 · Cited by 37 · see citing works
“Long-term impacts of complicated grief have been reported by family members of patients and residents who die during periods of visitation restriction.(5) Staff members also report increased workload, stress, sadness, and vicarious trauma from bearing witness to patient/resident loneliness and distress from isolation,…”
BackgroundSkalski‐Bednarz, S. B., Konaszewski, K., Dobrakowski, P. P., Surżykiewicz, J., & Lee, S. A. (2021) · Current Psychology · doi:10.1007/s12144-021-01731-6 · Cited by 38 · see citing works
“In addition, funerals and burials are postponed or organized remotely, often without the presence of the deceased person’s family (Wallace et al., 2020).”
BackgroundResultGuité‐Verret, A., Vachon, M., Ummel, D., Lessard, É., & Francoeur-Carron, C. (2021) · International Journal of Qualitative Studies on Health and Well-Being · doi:10.1080/17482631.2021.1996872 · Cited by 36 · see citing works
Please Scream Inside Your Heart: Compounded Loss and Coping during the COVID-19 Pandemic
Scheinfeld, E., Gangi, K., Nelson, E. C., & Sinardi, C. C. (2021) · Health Communication · doi:10.1080/10410236.2021.1886413 · Cited by 35 · see citing works
“However, much of the work examines loneliness and isolation in palliative care (e.g., Ishikawa, 2020), casualties and prolonged grief (e.g., Eisma et al., 2020), and considerations for families and health care providers at the end-of-life (e.g., Wallace et al., 2020).”
BackgroundEnd-of-life care in natural disasters including epidemics and pandemics: a systematic review
Kelly, M., Mitchell, I., Walker, I. A., Mears, J., & Scholz, B. (2021) · BMJ Supportive & Palliative Care · doi:10.1136/bmjspcare-2021-002973 · Cited by 35 · see citing works
The COVID-19 pandemic has changed dying and grief: Will there be a surge of complicated grief?
Jordan, T. R., Wotring, A. J., McAfee, C. A., Polavarapu, M., Cegelka, D., Wagner-Greene, V. R., & Hamdan, Z. (2021) · Death Studies · doi:10.1080/07481187.2021.1929571 · Cited by 34 · see citing works
“of stress, anxiety, and depression (Wallace et al., 2020), which are risk factors for unhealthy coping and complicated grief (APA, 2020).”
BackgroundInfluentialMcMillan, K., Wright, D. K., McPherson, C. J., Ma, K., & Bitzas, V. B. (2021) · Global Qualitative Nursing Research · doi:10.1177/23333936211051702 · Cited by 34 · see citing works
Bowen, J., Bulbena, A., & Fatjó, J. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.622060 · Cited by 35 · see citing works
“The process of grieving has been negatively affected by reduced social interactions due to restrictions and lockdowns, financial insecurity, fear of contagion, and the limitations on the holding of funerals and burials that have resulted from pandemic control measures (2).”
BackgroundLee, S. A., Neimeyer, R. A., & Breen, L. J. (2021) · Journal of Palliative Medicine · doi:10.1089/jpm.2021.0103 · Cited by 33 · see citing works
“Clearly, the unique needs of mourners during the pandemic pose a substantial challenge to palliative care.(6,9) The Pandemic Grief Scale (PGS) is a short screener designed to identify probable cases of dysfunctional grief due to a COVID-19 loss.”
Rituais fúnebres na pandemia de COVID-19 e luto: possíveis reverberações
Giamattey, M. E. P., Frutuoso, J. T., Bellaguarda, M. L. D. R., & Luna, I. J. (2021) · Escola Anna Nery · doi:10.1590/2177-9465-ean-2021-0208 · Cited by 33 · see citing works
Caring for a Relative With Dementia in Long-Term Care During COVID-19
Mitchell, L. L., Albers, E. A., Birkeland, R. W., Peterson, C. M., Stabler, H., Horn, B., Cha, J., Drake, A., & Gaugler, J. E. (2022) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2021.11.026 · Cited by 31 · see citing works
COVID-19 Suicide Survivors—A Hidden Grieving Population
Pinto, S., Soares, J., Silva, A., Curral, R., & Coelho, R. C. (2020) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2020.626807 · Cited by 32 · see citing works
“Although mostly associated with the loss of a affectively close person due to death, people are subjected to multiple significant losses in their daily living, particularly in the pandemic context—loss of their health, of financial security, loss of social and affective connections, loss of freedom to move and to plan…”
BackgroundAli, N., Feroz, A., Akber, N., Feroz, R., Meghani, S. N., & Saleem, S. (2020) · BMJ Open · doi:10.1136/bmjopen-2021-049851 · Cited by 24 · see citing works
“, 2020,families that were unable to grieve in accordance with traditional funeral practices or being unable to attend a loved one's burial undergo feeling of grief and sorrow [14]”
BackgroundEnea, V., Candel, O., Zancu, S. A., Scrumeda, A., Bărbuşelu, M., Largu, A., & Manciuc, C. (2021) · Death Studies · doi:10.1080/07481187.2021.1928331 · Cited by 18 · see citing works
“The capacity to be compassionate in the workplace may be reduced by the concern about potentially contracting the virus themselves or unknowingly exposing the family members or friends (Wallace et al., 2020).”
BackgroundUncertainty, shock and anger: Recent loss experiences of first‐wave COVID ‐19 pandemic in Italy
Cipolletta, S., Entilli, L., & Filisetti, S. (2022) · Journal of Community & Applied Social Psychology · doi:10.1002/casp.2604 · Cited by 30 · see citing works
This Was My Crimean War: COVID-19 Experiences of Nursing Home Leaders
Savage, A., Young, S., Titley, H. K., Thorne, T. E., Spiers, J. A., & Estabrooks, C. A. (2022) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2022.08.001 · Cited by 31 · see citing works
Fontes, W. H. D. A., de Assis, P. C. P., dos Santos, E. P., Maranhão, T. L. G., Júnior, J. L., & Gadelha, M. D. S. V. (2020) · ID on line REVISTA DE PSICOLOGIA · doi:10.14295/idonline.v14i51.2557 · Cited by 30 · see citing works
Grief loss and the COVID-19 pandemic
Breen, L. J. (2020) · Australian Journal of General Practice · doi:10.31128/ajgp-covid-20 · Cited by 30 · see citing works
Blood cancer caregiving during COVID-19: understanding caregivers’ needs
Fisher, C. L., Wright, K. B., Hampton, C. N., Vasquez, T. S., Kastrinos, A. L., Applebaum, A. J., Sae‐Hau, M., Weiss, E. S., Lincoln, G., & Bylund, C. L. (2021) · Translational Behavioral Medicine · doi:10.1093/tbm/ibab021 · Cited by 30 · see citing works
- Authors
- Wallace, C. L., Wladkowski, S. P., Gibson, A., & White, P.
- Affiliations
- Saint Louis University (US)
- Eastern Michigan University (US)
- University of Kentucky (US)
- Washington University in St. Louis (US)
- Corresponding author
- Wallace, Cara L.
- Venue
- Journal of Pain and Symptom Management
- Publisher
- Elsevier BV
- Published
- 2020-07
- Volume
- 60
- Issue
- 1
- Pages
- e70-e76
- ISSN
- 0885-3924 (ISSN-L)
- PMC
- PMC7153515
- OpenAlex
- W3016258882
- Cited by
- 635
- References
- 37
- Citations by year
- 2026: 17 · 2025: 31 · 2024: 58 · 2023: 103 · 2022: 140 · 2021: 173 · 2020: 112 · 2013: 1
- FWCI
- 52.74
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Pain and Symptom Management (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Grief, Bereavement, and Mental Health
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Palliative Care and End-of-Life Issues
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Keywords
- COVID-19 pandemic, grief, palliative care providers, anticipatory grief, disenfranchised grief, complicated grief, advance care planning, self-care, communication, social distancing, visitor restrictions, healthcare workers
- MeSH terms
- COVID-19, Communication, Grief, Humans, Palliative Care, Pneumonia, Viral, Self Care, Coronavirus Infections, Advance Care Planning, Pandemics
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