February 2020 Monthly Scoping Review

Bereavement Support

Cai, S., Q. Guo, Y. Luo, Y. Zhou, A. Abbas, X. Zhou and X. Peng (2020). "Spiritual needs and communicating about death in nonreligious theistic families in pediatric palliative care: A qualitative study." Palliative Medicine: 269216319896747.Center for Clinical Epidemiology and Evidence-Based Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.

School of Nursing, Capital Medical University, Beijing, China.

Beijing Key Laboratory of Pediatric Hematology Oncology; National Key Discipline of Pediatrics (Capital Medical University); Key Laboratory of Major Diseases in Children, Ministry of Education; Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.

BACKGROUND: Spiritual support should be offered to all patients and their families regardless of their affiliated status with an organized religion. AIM: To understand nonreligious theistic parents' spirituality and to explore how parents discuss death with their terminally ill children in mainland China. DESIGN: Qualitative study. SETTING/PARTICIPANTS: This study was conducted in the hematology oncology center at Beijing Children's Hospital. Participants in this study included 16 bereaved parents. RESULTS: Participants described themselves as nonreligious but showed a tendency toward a particular religion. Parents sought religious support in the face of the life-threatening conditions that affected their child and regarded the religious belief as an important way to get psychological and spiritual comfort after experiencing the death of their child. Religious support could partially address parents' spiritual needs. Parents' spiritual needs still require other supports such as bereavement services, death education, and family support groups. Some parents stated that it was difficult to find a way to discuss death with their children. For patients who come from nonreligious theistic families, their understanding of death was more complex and may be related to atheism. CONCLUSION: Religious support could be an element of spiritual support for nonreligious theistic parents of terminally ill children. Multiple strategies including religious supports and nonreligious supports should be rationally integrated into spiritual support of nonreligious theistic family. Patient's personal belief in death should be assessed before discussing death with them.

 Camacho Avila, M., I. M. Fernandez Medina, F. R. Jimenez-Lopez, J. Granero-Molina, J. M. Hernandez-Padilla, E. Hernandez Sanchez and C. Fernandez-Sola (2020). "Parents' Experiences About Support Following Stillbirth and Neonatal Death." Advances in Neonatal Care. Gynaecology and Obstetrics Unit, Hospital de Torrevieja, Alicante, Spain (Mr Camacho Avila); Department of Nursing, Physiotherapy and Medicine, University of Almeria, Spain (Drs Fernandez Medina, Jimenez-Lopez, Granero-Molina, Hernandez-Padilla, and Fernandez-Sola); Department of Nursing, University Catolica de San Antonio, Murcia, Spain, and Gynaecology and Obstetrics Unit, Hospital de Torrevieja, Alicante, Spain (Dr Hernandez Sanchez); and Faculty of Health Sciences, Universidad Autonoma de Chile, Temuco, Chile (Dr Fernandez-Sola).

BACKGROUND: Stillbirth and neonatal death are one of the most stressful life events, with negative outcomes for parents. Society does not recognize this type of loss, and parental grieving is particularly complicated and intense. PURPOSE: The aim of this study was to describe and understand the experiences of parents in relation to professional and social support following stillbirth and neonatal death. METHODS: This was a qualitative study based on Gadamer's hermeneutic phenomenology. Twenty-one semistructured interviews were carried out. Inductive analysis was used to find themes based on the data. RESULTS: Twenty-one parents (13 mothers and 8 fathers) from 6 families participated in the study. The analysis identified 2 main themes: (1) "professional care in dealing with parents' grief," with the subthemes "important aspects of professional care," "continuing of pathways of care"; and (2) "effects of social support in parental grief," including the subthemes "the silence that surrounds grieving parents," "family and other children: a key element," and "perinatal loss support groups: a reciprocal help." IMPLICATIONS FOR PRACTICE: Counseling and support according to parents' requirements by an interdisciplinary team of professionals educated in perinatal loss and ethical family-centered care is needed. A social support system for families is necessary to avoid negative emotional consequences. IMPLICATIONS FOR RESEARCH: Further research is needed to analyze midwives' and nurses' experience as facilitators to improve parental grief and the difficulties experienced by the family, other children, and friends of parents with perinatal loss in providing support.

Cao, X. C., C. M. Yang and D. H. Wang (2020). "The Impact on Mental Health of Losing an Only Child and the Influence of Social Support and Resilience." Omega-Journal of Death and Dying 80(4): 666-684.[Cao, Xiancai; Wang, Dahua] Beijing Normal Univ, Inst Dev Psychol, 19 Xinjiekouwai St, Beijing 100875, Peoples R China. [Yang, Chongming] Brigham Young Univ, Sch Family Life, Provo, UT 84602 USA.

Wang, DH (reprint author), Beijing Normal Univ, Inst Dev Psychol, 19 Xinjiekouwai St, Beijing 100875, Peoples R China. wangdahua@bnu.edu.cn

The number of parents who have lost their only child (PLOCs) has increased annually with the implementation of the birth control policy in mainland China. This study aimed to investigate the mental health status of PLOCs and the influence of social support and resilience. Study 1 recruited 100 PLOCs and 88 nonbereaved parents, and compared differences in depression, anxiety, and loneliness. Study 2 investigated the influence of social support and resilience on the mental health of PLOCs via a mediating model. Results indicate that PLOCs reported more anxiety and depression symptoms than nonbereaved counterparts. Perceived close family support, objective support, and resilience negatively predicted anxiety and depression. In addition, perceived close family support was found to influence mental health via resilience. The current findings reveal that losing an only child has long-term negative impacts on the mental health of PLOCs. However, perceived close family support and objective support can protect their mental health either directly or indirectly via resilience. 

DeMuth, M., A. Taggi-Pinto, E. G. Miller and M. A. Alderfer (2020). "Bereavement Accommodations in the Classroom: Experiences and Opinions of School Staff." Journal of School Health 90(3): 165-171.Sidney Kimmel Medical College at Thomas Jefferson University, 1025 Walnut Street, Philadelphia, PA, 19107.

Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803.

Sidney Kimmel Medical College at Thomas Jefferson University, Chief, Division of Palliative Medicine, Department of Pediatrics, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803.

Sidney Kimmel Medical College at Thomas Jefferson University, Center Director (Delaware Valley) and Principal Research Scientist, Center for Healthcare Delivery Science, Nemours/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803.

BACKGROUND: Bereaved children often struggle in the school environment and school personnel often feel inadequately prepared to support them. This pilot study explored the experiences and opinions of school staff regarding approaches to addressing the needs of bereaved students in the classroom. METHODS: Teachers/school personnel (N = 29) completed written open-ended questions about their experiences with bereaved students and opinions regarding a bereavement-focused accommodation (ie, 504) plan. Responses were summarized using qualitative content analysis. RESULTS: Most participants (93%) reported interacting with bereaved students and: (1) providing emotional support; (2) making classroom accommodations; (3) collaborating with the family/community; and (4) referring the student for counseling. Many (72%) expressed interest in a templated bereavement plan (21% did not respond; 7% said no) with education/resources for school personnel and suggested accommodations for students. CONCLUSIONS: Teachers encountering grieving students would welcome a templated bereavement plan to help meet students' needs. Such a plan would allow staff to become more knowledgeable about grief and provide guidance for developing specific strategies to accommodate grieving students both emotionally and academically.

Grunauer, M., G. Bustamante and K. Zambrano (2020). "Grief and Bereavement Support for Families and Healthcare Professionals as Part of Integrated Care in Pediatric/Neonatal Intensive Care Units around the World." Journal of Pain and Symptom Management 59(2): 427-427.[Grunauer, Michelle; Bustamante, Gabriela; Zambrano, Kevin] Univ San Francisco Quito, Quito, Ecuador.

Hein, K., K. Knochel, V. Zaimovic, D. Reimann, A. Monz, N. Heitkamp, G. D. Borasio and M. Fuhrer (2020). "Identifying key elements for paediatric advance care planning with parents, healthcare providers and stakeholders: A qualitative study." Palliative Medicine: 269216319900317.Center for Pediatric Palliative Care, University Children's Hospital, Ludwig-Maximilians University of Munich, Munich, Germany.

Palliative Care Service, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.

BACKGROUND: Although international guidelines recommend discussions about goals of care and treatment options for children with severe and life-limiting conditions, there are still few structured models of paediatric advance care planning. AIM: The study aimed at identifying key components of paediatric advance care planning through direct discussions with all involved parties. DESIGN: The study had a qualitative design with a participatory approach. Participants constituted an advisory board and took part in two transdisciplinary workshops. Data were collected in discussion and dialogue groups and analysed using content analysis. SETTING/PARTICIPANTS: We included bereaved parents, health care providers and stakeholders of care networks. RESULTS: Key elements were discussions, documentation, implementation, timing and participation of children and adolescents. Parents engage in discussions with facilitators and persons of trust to reach a decision. Documentation constitutes the focus of professionals, who endorse brief recommendations for procedures in case of emergencies, supplemented by larger advance directives. Implementation hindrances include emotional barriers of stakeholders, disagreements between parents and professionals and difficulties with emergency services. Discussion timing should take into account parental readiness. The intervention should be repeated at regular intervals, considering emerging needs and increasing awareness of families over time. Involving children and adolescents in advance care planning remains a challenge. CONCLUSION: A paediatric advance care planning intervention should take into account potential pitfalls and barriers including issues related to timing, potential conflicts between parents and professionals, ambiguity towards written advance directives, the role of non-medical carers for paediatric advance care planning implementation, the need to involve the child and the necessity of an iterative process.

Lizotte, M. H., K. J. Barrington, S. Sultan, T. Pennaforte, A. Moussa, C. Lachance, M. Sureau, Y. Zao and A. Janvier (2020). "Techniques to Communicate Better With Parents During End-of-Life Scenarios in Neonatology." Pediatrics 145(2).Centre de Recherche.

Department of Pediatrics, Hopital de Rimouski, Rimouski, Canada

Division of Neonatology.

Departments of Pediatrics.

Psychology, and.

Education, Universite de Montreal, Montreal, Canada; and.

Mother-Child Simulation Center.

Soins Palliatifs, and.

Centre de Pedagogie Appliquee aux Sciences de la Sante, and.

Parent Representative.

Centre de Recherche, anniejanvier@hotmail.com.

Unites des Ethique Clinique and.

Bureau du Partenariat Patients-Familles-Soignants, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Canada.

Bureau de L'ethique Clinique.

BACKGROUND AND OBJECTIVES: Clinicians are urged to optimize communication with families, generally without empirical practical recommendations. The objective of this study was to identify core behaviors associated with good communication during and after an unsuccessful resuscitation, including parental perspectives. METHODS: Clinicians from different backgrounds participated in a standardized, videotaped, simulated neonatal resuscitation in the presence of parent actors. The infant remained pulseless; participants communicated with the parent actors before, during, and after discontinuing resuscitation. Twenty-one evaluators with varying expertise (including 6 bereaved parents) viewed the videos. They were asked to score clinician-parent communication and identify the top communicators. In open-ended questions, they were asked to describe 3 aspects that were well done and 3 that were not. Answers to open-ended questions were coded for easily reproducible behaviors. All the videos were then independently reviewed to evaluate whether these behaviors were present. RESULTS: Thirty-one participants' videos were examined by 21 evaluators (651 evaluations). Parents and actors agreed with clinicians 81% of the time about what constituted optimal communication. Good communicators were more likely to introduce themselves, use the infant's name, acknowledge parental presence, prepare the parents (for the resuscitation, then death), stop resuscitation without asking parents, clearly mention death, provide or enable proximity (clinician-parent, infant-parent, clinician-infant, mother-father), sit down, decrease guilt, permit silence, and have knowledge about procedures after death. Consistently, clinicians who displayed such behaviors had evaluations >9 out of 10 and were all ranked top 10 communicators. CONCLUSIONS: During a neonatal end-of-life scenario, many simple behaviors, identified by parents and providers, can optimize clinician-parent communication. 

Nicholas, D., L. Beaune, M. Belletrutti, J. Blumberg, S. Ing, A. Rapoport and M. Barrera (2020). "Engaging Fathers in Pediatric Palliative Care Research." J Soc Work End Life Palliat Care: 1-15.Faculty of Social Work, University of Calgary, Edmonton, Alberta, Canada.

Stollery Children's Hospital, Edmonton, Alberta, Canada.

Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.

The Hospital for Sick Children Family Advisory Network, Toronto, Ontario, Canada.

Health, Safety, and Wellness at Municipality of Chatham-Kent, Chatham, Ontario, Canada.

Emily's House Children's Hospice, Toronto, Ontario, Canada.

Departments of Paediatrics and Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada.

The Hospital for Sick Children, Toronto, Ontario, Canada.

Fathers are under-represented in pediatric palliative care research despite frequently playing a key role in the lives of their children. The purpose of this study was to identify factors that affected paternal study invitation and participation. A secondary mixed-methods evaluation design guided examination of interview and focus group data as well as field notes from a qualitative study that examined the experiences and support needs of fathers of children with a life-limiting illness. Facilitators of paternal participation in the study consisted of: fathers' desire to gain from study participation either for themselves or others, perception of the study's importance, sense of appreciation for the study's focus on fathers and an established relationship with recruiting health care providers. Barriers to study participation included: recruiting health care providers' appraisal of fathers' lack of well-being, bereaved fathers' self-reported poor coping and the inability to locate and contact fathers, particularly after a child's death. Strategies for improving the engagement of fathers into research entailed: educating recruitment personnel, designing "father-focused" studies, communicating the value of the research to recruitment personnel and potential participants, and ensuring that child health records are accurate and include fathers' contact information. 

Petersen, C. L. (2020). "Spiritual Care: Minimizing the Vulnerability of Parents Whose Children With Cancer Face the End of Life." Journal of Pediatric Oncology Nursing 37(2): 105-115.Carthage College, Kenosha, WI, USA.

There is a distinct lack of literature related to the spiritual care of parents whose children with cancer are at the end of life. This has led to a dearth in evidence about how nurses may intervene with spiritual care interventions to best support these vulnerable parents. The purpose of this scoping review was to examine the evidence regarding the value of spirituality/spiritual care in minimizing the vulnerability of parents whose children were diagnosed with cancer and who faced the end of life. The Arksey and O'Malley methodological framework guided the analysis of the reviewed quantitative and qualitative literature. Spirituality and spiritual care provided bereaved parents and parents of children with cancer with necessary support and enhanced coping to allow them to better deal with this devastating experience. Spirituality and spiritual care instilled hope, assisted in the search for meaning and purpose, and guided parents to develop continuing bonds with their child. Through skillful communication, pediatric oncology nurses may guide parents of children who face the end of life to strengthen relationships that offer support, plan activities that provide opportunities for hope and connection, and identify sources of meaning in their experiences.

Raharjo, C., K. Hetherington, L. Donovan, J. E. Fardell, V. Russell, R. J. Cohn, N. Morgan, J. Siddiqui and C. E. Wakefield (2020). "An evaluation of By My Side: Peer support in written form is acceptable and useful for parents bereaved by childhood cancer." Journal of Pain and Symptom Management.School of Women's and Children's Health, UNSW Sydney, Kensington, NSW, Australia; Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia.

School of Women's and Children's Health, UNSW Sydney, Kensington, NSW, Australia; Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia. Electronic address: k.hetherington@unsw.edu.au.

School of Women's and Children's Health, UNSW Sydney, Kensington, NSW, Australia; Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia; Paediatric Palliative Care Service, Lady Cilento Children's Hospital, Brisbane, QLD, Australia.

Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia; Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia.

School of Women's and Children's Health, UNSW Sydney, Kensington, NSW, Australia; Behavioural Sciences Unit, Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia; Kids Cancer Centre, Sydney Children's Hospital, Randwick, NSW, Australia.

Redkite, Brisbane, QLD, Australia.

CONTEXT: Cancer is the leading cause of non-accidental death in childhood, with the death of a child representing a devastating loss for families. Peer support offers a valuable way to support parents' adjustment in bereavement. The By My Side book provides written peer support by sharing bereaved parents' stories to normalise grief experiences and reduce parents' isolation. It is available free of charge. AIM: This project evaluated the acceptability, relevance, emotional impact and usefulness of By My Side. DESIGN: Bereaved parents and healthcare professionals provided feedback via a questionnaire. We used descriptive statistics and qualitative analysis of open-ended responses to analyse the data. SETTING: /participants: We mailed a study invitation and evaluation questionnaire to parents and healthcare professionals who ordered a copy of By My Side. RESULTS: Twenty-four bereaved parents and seven healthcare professionals provided feedback. Parents thought the book's length (91.7%) and amount of information (83.3%) was 'just right'. 75% of parents reported that the book made them feel that their reactions to their child's death were normal/appropriate. Parents reported positive and negative emotional reactions to the book (e.g., 87.5% felt comforted, 87.5% felt sadness). All parents and healthcare professionals reported that the book provided useful information about grief. 83.4% of parents and 85.7% of healthcare professionals would recommend it to others. CONCLUSION: By My Side was acceptable and useful to bereaved parents and healthcare professionals. Results suggest that peer support in written form may help normalise aspects of grief and comfort parents bereaved by childhood cancer.

Sedaghati, S. A., R. B. Bera and J. Baker (2020). Grief Support. StatPearls. Treasure Island (FL), StatPearls Publishing

StatPearls Publishing LLC.

Physicians frequently deal with the loss of a patient in the emergency department and in intensive care units. These deaths are often due to unforeseen violent circumstances, such as gunshot wounds, motor vehicle accidents, suicides, and homicides. Only after extensive, failed resuscitation attempts will the emergency department team end their efforts. This harrowing experience takes not only a physical but emotional toll on the providers, as they are the last hope of survival for the patient. The loss of a patient's life reflects immense personal and professional stress and anxiety on the emergency physician. However, they must put aside their grief to disclose the bad news to family members of a patient who has died unexpectedly. The physician likely lacks a prior intimate relationship with the family. This lack of familiarity makes it important that health professionals are aware of and ready for various emotional reactions from the family so that he or she can alleviate extended grief and bereavement.[1][2][3][4][5]

Shakespeare, C., A. Merriel, D. Bakhbakhi, H. Blencowe, F. M. Boyle, V. Flenady, K. Gold, D. Horey, M. Lynch, T. A. Mills, M. M. Murphy, C. Storey, M. Toolan and D. Siassakos (2020). "The RESPECT Study for consensus on global bereavement care after stillbirth." International Journal of Gynaecology and Obstetrics.School of Population Health sciences, Bristol Medical School, University of Bristol, Department of Women and Children's Health, The Chilterns, Southmead Hospital, Bristol, UK.

Maternal, Adolescent, Reproductive & Child Health (MARCH) Centre, London School of Hygiene and Tropical Medicine, Keppel Street, London, UK.

Stillbirth Centre for Research Excellence, Mater Research Institute, University of Queensland, Brisbane, Australia.

Department of Family Medicine, Department of Obstetrics and Gynaecology, University of Michigan, Ann Arbor, USA.

Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK.

School of Nursing and Midwifery, University College Cork, Cork, Ireland.

International Stillbirth Alliance, Bristol, UK.

University College London, London, UK.

OBJECTIVE: To develop global consensus on a set of evidence-based core principles for bereavement care after stillbirth. METHODS: A modified policy-Delphi methodology was used to consult international stakeholders and healthcare workers with experience in stillbirth between September 2017 and October 2018 Five sequential rounds involved two expert stakeholder meetings and three internet-based surveys, including a global internet-based survey targeted at healthcare workers in a wide range of settings. RESULTS: Initially, 23 expert stakeholders considered 43 evidence-based themes derived from systematic reviews, identifying 10 core principles. The global survey received 236 responses from participants in 26 countries, after which nine principles met a priori criteria for inclusion. The final stakeholder meeting and internet-based survey of all participants confirmed consensus on eight core principles. Highest quality bereavement care should be enabled through training of healthcare staff to reduce stigma and establish respectful care, including acknowledgement and support for grief responses, and provision for physical and psychologic needs. Women and families should be supported to make informed choices, including those concerning their future reproductive health. CONCLUSION: Consensus was established for eight principles for stillbirth bereavement care. Further work should explore implementation and involve the voices of women and families globally.

Smith, L. K., J. Dickens, R. Bender Atik, C. Bevan, J. Fisher and L. Hinton (2020). "Parents' experiences of care following the loss of a baby at the margins between miscarriage, stillbirth and neonatal death: a UK qualitative study." BJOG: An International Journal of Obstetrics and Gynaecology.Department of Health Sciences, University of Leicester.

Bereavement Specialist Midwife, University Hospitals of Leicester NHS Trust and Postgraduate Researcher, University of Leicester.

National Director, Miscarriage Association.

Senior Research and Prevention Advisor, Sands, the stillbirth and neonatal death charity.

Antenatal Results and Choices.

Health Experiences Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford.

OBJECTIVE: To explore the health care experiences of parents whose baby died either before, during or shortly after birth between 20(+0) and 23(+6) weeks gestational age in order to identify practical ways to improve health care provision. DESIGN: Qualitative interview study SETTING: England through two parent support organisations and four NHS Trusts. SAMPLE: A purposive sample of parents METHODS: Thematic analysis of semi-structured in-depth narrative interviews Main outcome measures: Parents' healthcare experiences RESULTS: The key overarching theme to emerge from interviews with 38 parents was the importance of the terminology used to refer to the death of their baby. Parents who were told they were 'losing a baby' rather than 'having a miscarriage' were more prepared for the realities of labour, the birth experience and for making decisions around seeing and holding their baby. Appropriate terminology validated their loss, and impacted on parents' health and wellbeing immediately following bereavement and in the longer term. CONCLUSION: For parents experiencing the death of their baby at the margins between miscarriage, stillbirth and neonatal death, ensuring the use of appropriate terminology that reflects parents' preferences is vital. This helps to validate their loss and prepare them for the experiences of labour and birth. Reflecting parents' language preferences combined with compassionate bereavement care is likely to have a positive impact on parents' experiences and improve longer term outcomes.

Wainwright, V., L. Cordingley, C. A. Chew-Graham, N. Kapur, J. Shaw, S. Smith, B. McGale and S. McDonnell (2020). "Experiences of support from primary care and perceived needs of parents bereaved by suicide: a qualitative study." British Journal of General Practice 70(691): e102-e110.Faculty of Biology, Medicine and Health, University of Manchester, Manchester.

Midlands Partnership NHS Foundation Trust; NIHR Applied Research Collaboration (ARC), West Midlands; School of Primary, Community and Social Care, Keele University, Keele, Staffordshire.

Faculty of Biology, Medicine and Health, University of Manchester, Manchester; Greater Manchester Mental Health NHS Foundation Trust; NIHR Patient Safety Translational Research Centre.

Faculty of Biology, Medicine and Health, University of Manchester, Manchester; Greater Manchester Mental Health NHS Foundation Trust.

If U Care Share Foundation, Durham.

Suicide Bereavement UK; director, National Suicide Research Foundation Ireland, University College Cork, Cork, Ireland; patron, Support After Suicide Partnership, Suicide Bereavement UK, Manchester.

Suicide Bereavement UK; honorary research fellow, Faculty of Biology, Medicine and Health, University of Manchester, Manchester.

BACKGROUND: People bereaved by suicide are a vulnerable group, also at risk of dying by suicide. The importance of postvention support (intervention after suicide) has recently been highlighted; however, little is known about the support needs of parents bereaved by suicide in the UK, and the role played by general practice. AIM: To explore the perspectives, experiences, and support needs of parents bereaved by suicide. DESIGN AND SETTING: This was a qualitative study, with semi-structured interviews conducted between 2012 and 2014 in the north of England and the Midlands, with parents bereaved by their son or daughter's suicide. METHOD: Interviews explored parents' experiences of suicide bereavement following the death of their son or daughter, with a focus on their experiences of support from primary care. Interviews were analysed thematically using constant comparison. RESULTS: Twenty-three interviews were conducted. Three themes were identified from the data: the importance of not feeling alone; perceived barriers to accessing support; and the need for signposting for additional support. Some parents reported having experienced good support from their general practice; others described a number of barriers to accessing help, including triage processes. Primary care was considered to be an important avenue of support but GPs were often perceived as uncertain how to respond. The need for information, signposting to avenues of support, and the helpfulness of group support were also highlighted. CONCLUSION: Parents believed it was important that people working in general practice have an awareness of suicide bereavement and understanding of their needs, including knowledge of where to direct people for further support.