Literature Review on Support for Children and Families Experiencing Parental Bereavement ()
1. Introduction
In the United States, 92.5% of hospice care institutions provide bereavement support for families for up to one year after the patient’s death. Bereavement support services are diverse and tailored to the needs of the bereaved, facilitating access to support [1] . Among these services, there is the “Family Bereavement Program (FBP)”, which specifically addresses the grieving process of family members [2] . Similarly, in Japan, programs such as the “Butterfly Program” are implemented to provide bereavement care for families who have lost a parent, including children who have lost a parent [3] . According to a survey by the National Cancer Center in Japan, the estimated number of cancer patients who have children under 18 years old is 56,143 annually, with these children numbering 87,017. The average age of patients is 46.6 years for males, and 43.7 years for females, and the average age of children whose parents are diagnosed with cancer is 11.2 years [4] . From these data, it is evident that among approximately 87,000 children who experience parental bereavement annually, those whose parents did not explain their condition and experienced sudden bereavement may undergo a pathological grieving process [5] , and children who experience parental bereavement tend to prolong their grief due to a lack of understanding of grief expression [6] . The child’s needs are not addressed, and the school-age child’s learning performance is affected by poor concentration, physical discomfort, and changes such as rebellious behavior, avoidance of interactions with others, and solitary behavior [7] . Also, looking at the grieving of the remaining partner, in the solitude of raising a child alone, he felt confused about how to deal with a child who had experienced bereavement [8] , but surrounding adults may unintentionally remove children from discussions [9] . Because children who are not included in discussions may feel alienated, which can affect the trust between parent and child [10] , families with children need to understand that children are recognized, respected, and supported as members of the family [9] [11] . International studies have also shown that family communication is affected by the sense of communication difficulties between children who have bereaved parents and their families and the family’s adaptation to the new situation, especially when remembering and talking about the bereaved parent, which helps children cope with their feelings of grief, also shown to influence the onset of subsequent physical or psychological problems [12] . This suggests that there is a high demand for support for families, including children who experience parental bereavement. Furthermore, nurses need to have the knowledge and skills to provide bereavement support, and learning communication skills in training has been shown to improve self-efficacy and high satisfaction in nursing care [13] . It is important for nurses to ensure that children can participate in their parents’ end-of-life care and can say a satisfying goodbye [8] , and to encourage them to provide explanations about death that are appropriate for their age [14] . In addition, it is necessary to facilitate networking with local communities and professionals such as schools that support children [15] , and to help children receive social support from their surroundings. While research on children with terminally ill parents has increased in recent years, studies on families left behind, including children, are still limited. In Japan, a survey on bereavement care services revealed that over 70% of facilities consider “establishing a system for providing bereavement care as an organization” as a future task, and this situation has remained unchanged for 10 years [16] . Therefore, it is possible that care for families, including children, is inadequate in Japan and that the needs of children and families in need of support are not being met, and that the current situation lags behind that of care for bereaved families in other countries. In order to further develop support for families including children who have experienced parental bereavement in Japan, we believe that a review of overseas literature will provide new knowledge about support, and from this we can consider issues of nursing support in clinical practice in Japan, which will lead to practical efforts.
2. Method
2.1. Aim
The purpose of conducting a review of overseas literature on support for children who have experienced parental bereavement and their families is to gain an understanding of the actual nursing support and the required support from a broad perspective. This aims to clarify the future challenges of nursing support in clinical practice in Japan.
2.2. Literature Collection Method
The literature collection method involved searching for literature available as of May 2023 using PubMed. We used PubMed because it has more than 36 million entries in the biomedical and life science literature, is published through a peer-review process, is highly reliable, and has MeSH terms assigned to each of the included references, making it an efficient way to search the literature. To ensure a comprehensive search, the search spanned from the year 2000 to 2023, as narrowing it down to the years 2013 to 2023 resulted in a decrease in the number of relevant articles. Keywords are “terminal care”, “terminally ill”, and “family support”, “family nursing”, “child”, “parental death”, and “palliative care”. “Palliative care” was multiplied as shown in Figure 1, 158 references were retrieved, and the target literature was selected from the obtained references. The inclusion criteria were: 1) original articles, 2) availability of full text, 3) focus on parental end-of-life care, 4) inclusion of children or parents with dependent children as recipients of support during end-of-life care, and 5) relevance to nursing support during end-of-life care, including interdisciplinary collaboration. The reasons for these inclusion criteria were that we thought we could collect more literature on the topic and that we would be able to learn how nurses and multidisciplinary collaboration supported children who lose a parent and their families in end-of-life care. Exclusion criteria involved thorough reading of the texts to exclude literature on parental death by suicide or those not relevant to the theme (Figure 1). The reason for the exclusion criteria was that in this study, the process of bereavement of a parent who died by suicide was considered different from that of a parent who died of illness, and the support
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Figure 1. Literature search process for this study.
after bereavement was also considered different.
2.3. Analysis Method
From the 11 target literatures, we extracted the author’s name, literature title, year of publication, purpose, methods, and target audience, and furthermore, we extracted support for children and families from each literature according to the theme and created a summary sheet (Table 1). From the 11 targeted literatures, a close reading was conducted focusing on 1) children who have lost a parent and their families. 2) Support for children and families was extracted and coded. 3) Similar codes were merged to generate subcategories. 4) Similar subcategories were merged to generate categories (Table 2). 5) In order to obtain reliability and clarity in each process, the data analyzed independently were cross-checked with nursing researchers specializing in pediatric and family nursing to ensure that the interpretations were consistent.
3. Result
In this study, there were 11 target literature items, all of which were observational studies, as summarized in Table 1. The distribution of literature by year was as follows: one item from 2000 to 2010, and ten items from 2011 to 2023, with nine out of the ten items published after 2015. Based on the information in Table 1, we categorized the content related to support for children and their families
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Table 1. List of international literature on support for children who have experienced parental bereavement and their families.
from the end-of-life care of parents to support after their death into two categories: 1) for support provided to children and 2) for support provided to families. We then conducted category classification. For support for children, five subcategories and four categories were extracted from 13 codes. For support for families, eleven subcategories and four categories were extracted from 36 codes, as summarized in Table 2. In the text, categories will be denoted by [], subcategories by <>, and codes by “”.
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Table 2. Results of a close reading of the international literature on the content of support for children who have experienced parental bereavement and their families.
3.1. For Support Provided to Children
3.1.1. Effective Instruction of Communication Techniques with Surviving Family
In supporting children, it was necessary to encourage
by engaging in “legacy work to maintain the parent-child bond after the parent’s death”. Additionally, support was needed to
, because “open communication with their family will be reduces the risk of long-term grief symptoms in children”. Legacy work involves communication methods utilizing letters, photographs, tangible items, future plans, etc. Teaching such methods to children facilitated effective communication with the family.
3.1.2. Positive Provision of Information Regarding Parental End-of-Life Care
“Providing information to children about their parent’s inevitable death” should be honest and open, creating an atmosphere where children feel comfortable asking anything they want to know. Additionally, support for children required “making positive plans for the future, addressing realistic and financial matters”. Furthermore, it was crucial to provide
, such as “maintaining everyday life as much as possible, creating memories while utilizing social networks as needed”.
3.1.3. Support Provided by Multidisciplinary Teams
“All professionals involved with the family have a role to play in ensuring that they can participate in discussions and information sharing to the extent desired by the child. This role includes both direct interaction with the child and indirect support through working with parents and other family members”. Furthermore, it has been shown that “providing continuous care and maintaining contact with the family after bereavement can serve as a source of support for the child”. It became apparent that while “many families tend to be hesitant to discuss the illness with their children, children prefer to receive explanations about their parent’s illness rather than being left out”. This underscores the need for
as part of supporting children.
3.1.4. Support for Overcoming Grief
“Immediately after the death of a parent, it is crucial to utilize family-centered bereavement support groups, providing support and practical guidelines to both single parents and children. Peer support was deemed necessary to normalize the grieving experience and promote hope for the future”. Additionally, it was beneficial for bereaved families “receiving family support services to meet others who had undergone similar experiences, as this provided opportunities to listen to others’ stories, gain insight into how to overcome milestones after the parent’s death, and facilitate dialogue among children”. “Recognizing that other children had also lost parents provided hope for the future through shared experiences”, underscoring the importance of peer support.
Furthermore, “sharing concerns about children’s well-being with teachers at school when there are worries about the children proved to be beneficial for both the children’s safety and the reassurance of the bereaved family”. This sharing served as a source of support within the family.
It was also emphasized that “discussing the deceased parent within the family was important. For many bereaved families, it was crucial to continue family interactions to ensure that children did not forget about the deceased parent”. This ongoing involvement with the family was highlighted as essential for children’s
.
3.2. For Support Provided to Families
3.2.1. Encouraging Families on How to Communicate the Dying Process of a Parent to Children
It was indicated that “there is no ‘appropriate time’ to tell children, but it is best to have such difficult conversations when children have time to understand the severity of the prognosis”. And it was crucial that “‘when it is optimal to tell children’ should regard when parents have time to understand and accept the illness themselves, and to convey this information when they are physically capable”. As for the suggesting that “‘location for the conversation’ should choose a time and place where the parent’s conversation will not be interrupted, to talk slowly with the child, and to create an environment where emotions can be expressed and after talking to the child, it was recommended for parents to plan family events that are not burdensome, such as going for a walk”. Furthermore, it was suggested that “regarding ‘who should convey the information to the children,’ parents, who know their children best, are the ones who should communicate with them”. It was also required to “provide honest information to children about the parent’s prognosis and inevitable death, as well as to make positive plans for the future, maintain daily life as much as possible, and create memories while utilizing social networks as needed”. Additionally, it was emphasized “using age-appropriate, clear, and fact-based language, avoiding euphemistic expressions when discussing ‘what words are appropriate.’” These supports for
were deemed important as support for families.
Moreover, it was reported that “parents need to consider what children can and cannot handle, and that not informing children about the situation indicates the difficulty in expressing their grief”. “Regarding the emotional expressions of the ill parent, it was stated that the remaining parent has a responsibility to explain their behavior to the child”. Therefore, it was required to
.
3.2.2. Facilitating Communication about the Deteriorating Condition of the Dying Parent to Children
It was emphasized that “deepening family knowledge about parenting in the terminal stage is crucial as effective support for the entire family in preparation for losing a significant family member”. Additionally, “methods such as legacy work (utilizing letters, photographs, tangible items, and future plans) were indicated as necessary to maintain the bond between parent and child after the parent’s death”. Furthermore, it was suggested that “in families with children who have a terminally ill parent, having open communication between children and family members enables smooth everyday life after the parent’s death”, highlighting the importance of
.
It was reported that “38% of mothers with illnesses did not inform their children about their imminent death, and 26% did not feel peaceful about dying, with 90% of fathers worrying about the burden on their children after the spouse’s death”. Moreover, “clear communication between wives and doctors regarding prognosis” was associated with lower scores on the Center for Epidemiologic Studies Depression Scale (CES-D) and the Texas Revised Inventory of Grief (TRIG) in fathers. Additionally, it was shown that “only half of the fathers reported saying goodbye to their wives and children during the last few weeks of life, with spouses who received hospice services having a higher rate of saying goodbye to each other before the wife’s death”. Furthermore, reports from “fathers indicated that clear communication between doctors and wives regarding prognosis was also related to saying goodbye to spouses and children”, indicating the need for medical support for
.
“Fathers considered raising children in a way that reflected the intentions of the sick mother, discussing whether and how to talk to children about the mother’s death, and how the mother wanted to be remembered as the most crucial communication at the End of Life (EOL)”. Moreover, “fathers who reported that the terminally ill mother worried about the children tended to prioritize parenting reflecting the mother’s intentions”. Furthermore, it was suggested that “supporting the communication of the single parent at EOL, medical professionals could promote bonding between family members”, indicating the need for
.
For single parents, there were several acceptable supports available, such as “informational leaflets or educational lectures on communication with children”. Although some single parents were hesitant to accept support from healthcare professionals regarding support for children, “support from healthcare professionals about death and dying was crucial in facilitating communication with children”. Additionally, “as family needs progressed, there was a need for medical professionals to enhance their ability to adjust”, highlighting the importance of support in
.
3.2.3. Support Provided by Multidisciplinary Teams
The category of [Support Provided by Multidisciplinary Teams] also emerged in support of children. It was indicated that “the most common type of support provided to families was through written materials, with over 90% provided before and after the death of a parent. Individual face-to-face consultations were in the late 80s to early 90s percentile, and web-based support guidance was in the late 80s percentile, with significantly more support provided after the death of the parent than before”. Specialized counselors reported providing support before and after the death of a parent in 70% - 80% of cases, with nurses, social workers, and pastors regularly providing support, although “they were more involved before the death than after, while psychologists and psychiatrists were the least involved professionals in providing support”. Additionally, it was noted that “over 80% of hospices supported both partners and their children before and after the parent’s death”. From these findings, it was evident that
was carried out by a multidisciplinary team.
Moreover, it was observed that while some families required only encouragement to continue communication between parent and child, others “needed more specialized support to enhance communication between the single parent and the child”. Hence,
was deemed necessary for families.
“Involving children in conversations about their parent’s illness or bereavement not only respects the child’s perspective but also helps them find meaning in what is happening”. It was shown that all professionals involved with families have a role in “ensuring that children can participate in discussions and information-sharing to the extent they desire”. This role includes both direct engagement with children and indirect engagement through supporting parents and other family members. Community practitioners have a broad knowledge of how to communicate based on family functioning, from family relationships, can be used to support patients, families, and children, and can inform the larger health care team about the holistic needs of the patient, including support needed for the child. That is why “community practitioners have an important role here and need to nurture, develop, and labor them”. Additionally, “the ability to maintain contact with the family even after the parent’s death was highlighted, which contributes to providing ongoing care and becoming a source of support for children”, emphasizing the importance of
.
3.2.4. Support for Overcoming Grief
Support for overcoming grief was provided not only to children but also to the surviving family members. It was shown that “encouragement should be given to both parents to prepare for the prognosis immediately after receiving a poor prognosis. This includes conveying to children the reality of their parent’s poor prognosis, the inevitability of death, and managing realistic and economic matters for the future”. “Healthcare providers were noted to play a crucial role in facilitating such preparation by providing information surrounding the reality of the parent’s poor prognosis and simultaneously offering necessary information to children as death approaches, using age-appropriate language”. This was deemed necessary as
.
For single parents, it was important that they practice self-care and utilize support from social networks while feeling lonely and striving to be perfect parents. Immediate support after the parent’s death involved providing practical support to both the surviving single parent and the child in “family-centered bereavement support groups and encouraging peer support, which helps normalize the grieving experience and foster hope for the future”. It was noted that bereaved families who received family support services benefited from “meeting others who had experienced similar situations and gained insights into how to overcome milestones after the parent’s death by listening to others’ stories”. Additionally, “recognition of the presence of other children who had lost parents through dialogue among children” allowed them to gain hope from others’ experiences. Furthermore, some single parents found reassurance and support by “sharing their concerns about their children with teachers at school”, ensuring their children’s safety and the peace of mind of the bereaved family. The importance of “continuing communication about the deceased parent within the family” was emphasized for many bereaved families to ensure that children do not forget about the deceased parent, suggesting the encouragement of
.
4. Discussion
4.1. For Support Provided to Children
4.1.1. Effective Instruction of Communication Techniques with Surviving Family
Engaging in legacy work, where bonds and connections with parents are felt, as well as having open communication within the family, was linked to reducing the risk of prolonged grieving symptoms in children. Legacy work provides a space for children to express difficult emotions and feelings, assuring them that such emotions are natural and providing a sense of comfort and shared time [9] [17] . Additionally, open communication within the family not only affects psychological adjustment but also has implications for health [17] [18] . Therefore, teaching effective communication skills is considered beneficial in supporting children.
4.1.2. Positive Provision of Information Regarding Parental End-of-Life Care
It was necessary to support children by honestly conveying positive information about the parent’s situation to ensure that they do not worry about the future and that they can maintain as normal a daily routine as possible. Children are interested in knowing about their parent’s situation [19] , and it has been shown that confusion and anxiety can arise from not knowing the truth [19] , so providing children with positive information about the parent’s situation is believed to contribute to their mental stability. Additionally, since there can be a fear of changes in the previous routine [20] , maintaining a daily life similar to before is also considered to contribute to emotional stability in children. Therefore, it is considered necessary to provide support for children’s adaptation to daily life while sharing information with them about the parent’s situation.
4.1.3. Support Provided by Multidisciplinary Teams
In supporting children, it was necessary to involve professionals from various disciplines. Children are highly sensitive to changes in the home environment and can quickly sense the severity of their parent’s condition or tension [21] . On the other hand, parents may fear upsetting their children and may be inhibited from discussing things with them due to feelings of wanting to protect them or thinking that they are too young to understand [22] . Additionally, it has been suggested that various professions provided support before and after parental bereavement [23] . Therefore, to minimize the gap between the feelings of parents and children, it is important to involve professionals from multiple disciplines, each utilizing their expertise to provide support while sharing information. This approach ensures continued support for children even after the loss of a parent.
4.1.4. Support for Overcoming Grief
After the loss of a parent, it has been shown to be important to provide support to children through bereavement support groups (where individuals who have experienced similar losses come together to share their grief) and family support services (where families supporting patients share their concerns with others and exchange information to address problems). Children may not spontaneously seek help without a prompt and may tend to prolong their grief [6] . It has also been reported that hearing the stories of other children in similar situations can provide children with an opportunity to express themselves and that counseling can be effective [6] [24] . Peer support is considered helpful in overcoming sadness, but efforts in Japan are still relatively passive compared to support abroad. This may be due to various barriers such as misconceptions among single parents who want to protect their children, the inadequacy of support systems for bereaved families, and a lack of understanding and knowledge among healthcare professionals about organizations supporting bereaved families. These are seen as challenges in providing support to families.
To ensure that children can safely navigate their lives at school, it is necessary for teachers to understand the parents’ situation. Children may exhibit various maladaptive behaviors at school when they feel unsettled [21] , so it is important for teachers to understand and be able to support children’s grief. Additionally, it has been shown that children believed they shouldn’t talk about the deceased parent because they didn’t want to upset their family members [9] . Therefore, it is important for families to create an environment where children feel comfortable talking about their deceased parent whenever they want.
4.2. For Support Provided to Families
4.2.1. Encouraging Families on How to Communicate the Dying Process of a Parent to Children
Parents often struggle with not being emotionally prepared to face the harsh reality that death is inevitable and worry about selecting age-appropriate words and responding to potentially difficult questions from their children [19] . Therefore, it is first necessary to ensure that the care of the parent, who is the patient, is fully provided. Then, it is important to jointly consider and provide support to the child based on the parent’s mental and physical condition. Young children tend to blame themselves, thinking they did something wrong, and even adolescents often blame themselves for causing stress [21] . Repeatedly telling children in conversations that “it’s not anyone’s fault” helps alleviate their feelings of guilt [21] . Therefore, it is important to discuss with parents about the characteristics of their child and jointly consider how to communicate with the child while providing support. Additionally, responding sincerely to children, even if they are young, is important in respecting them. Concealing the truth from children requires a lot of energy [21] and can have a significant impact on parent-child relationships and trust within the family. It is therefore important for healthcare professionals and families to understand these points and jointly consider how to inform children about the impending death of a parent as part of supporting the family.
Not informing children about the parent’s illness leads to suppressing their emotional expression [25] . Furthermore, it was necessary for the surviving parent to explain the sick parent’s emotional expressions to the children [25] . It has become clear that supporting children includes believing in their strength, responding sincerely to their questions, and providing opportunities for them to express their feelings throughout the period of illness to the time of separation [9] . It is necessary for healthcare professionals to provide information to reduce anxiety and stress and support each parent’s role in a state where they can fulfill their responsibilities.
4.2.2. Facilitating Communication about the Deteriorating Condition of the Dying Parent to Children
Supporting families involves deepening their knowledge about parenting, which is considered an effective form of support. Parents who openly accept their illness, share information within the family, express their feelings, share household responsibilities, and demonstrate their coping strategies provide opportunities for their children to learn [21] . Showing children both the role of being a parent and being a patient openly can lead to a transformation of roles within the family and increase family cohesion. Additionally, Legacy Work, while facilitating smooth family life, can also contribute to maintaining the bond between parents and children, making it an effective method for communication with children.
It is also necessary for healthcare professionals to have good communication skills, as they can affect how children spend time and understand the remaining spouse and children’s lives, given the recognition of prognosis [26] . Furthermore, in end-of-life (EOL) communication, healthcare professionals were also expected to support communication between the surviving parent and the child. Maintaining communication with the child and emotional connection with the deceased parent is important for the surviving parent [27] , and support from healthcare professionals to facilitate family connections during the EOL period is considered necessary support for the family.
Healthcare professionals can convey various beneficial information and knowledge to the surviving parent regarding support for the child. However, without possessing this information or knowledge, they cannot provide support. Therefore, healthcare professionals need to understand the conflict between the desire to protect the child from the harsh reality of death and the need to prepare for the death of a partner [28] . They should support the surviving parent by providing necessary information and support, enabling the child to face the parent’s illness, and acquiring knowledge to meet the needs of the family.
4.2.3. Support Provided by Multidisciplinary Teams
Multi-disciplinary support overlaps with support for children, as children are sensitive to their surroundings and can perceive the situation of their parents, leading to increased anxiety when the truth is not communicated by the parent or single parent [21] . On the other hand, families also need to prepare themselves mentally for facing the harsh reality and may struggle with explaining the situation to their children [19] , thus necessitating specialized support from multiple disciplines to alleviate the distress of both children and families.
Furthermore, with the diversification of family needs, various types of support are provided. For bereaved families, repeated discussions about the deceased, death-related matters, and their own feelings after the loss, as well as receiving empathy, are important [29] . Additionally, recognizing the importance of family grief processes in daily life, play therapists and family therapists have found comprehensive grief support through play therapy (using play to facilitate children’s expression and exploration of their feelings, thoughts, and behaviors in a safe environment with a therapist) [30] and family therapy [31] . Therefore, collaboration with multiple disciplines, not limited to healthcare professionals such as doctors and nurses, is effective in addressing the diverse needs of families from specialized perspectives.
Moreover, the importance of continuous support for parent-child communication as support for families has been highlighted, underscoring the significance of support from community practitioners. They play a role in maintaining contact with families after parental bereavement, providing ongoing care [22] . They can respond promptly when families want to discuss matters related to their children or when families themselves seek support, contributing to a sense of reassurance for the families.
4.2.4. Support for Overcoming Grief
Support for overcoming grief overlaps with support for children. When children experience emotional instability, they may exhibit maladaptive behaviors at school [21] , highlighting the need for teachers to understand and support children’s grief in the school environment. Additionally, since children tend to believe they shouldn’t talk about the deceased parent [9] , creating an environment where families can openly discuss the deceased parent is considered necessary support for overcoming children’s grief. On the family side, single parents may be concerned about their child’s school situation, while bereaved families may find solace in sharing their feelings with others and gaining insights from those in similar situations [23] . Therefore, consulting with school counselors for single parents and providing information about support organizations to bereaved families by healthcare professionals can contribute to support for the remaining family members.
A common form of support for both children and families is peer support. Children reported gaining opportunities to express themselves and benefited from counseling through hearing the narratives of peers in similar situations [6] [24] . Similarly, families benefited from practical support provided in bereavement support groups centered on families and from the normalization of grief experiences through peer support, which promotes hope for the future [24] . Thus, peer support is considered important for supporting both children and families in overcoming grief.
Furthermore, it has been indicated that preparing children to share in the prognosis is necessary [32] . Since parents or single parent themselves may be struggling with grief while managing daily life, receiving support from healthcare professionals can help stabilize their mental and physical state, enabling them to support their children and facilitate explanations about the illness. However, there has been a lack of supportive care for children [32] , underscoring the importance for healthcare professionals to convey that they are available to address any concerns related to supporting children while simultaneously providing support to parents or single parents.
5. Limitations
The literature search engine used in this study was only Pub Med, so it cannot be considered a comprehensive review of all overseas journals. Additionally, it is necessary to understand the support for children and families, including papers by other healthcare professionals and non-healthcare professionals such as school counselors. By doing so, I believe we can examine nursing support for children and families from a broader perspective.
6. Implications
In this study, two overlapping categories were identified: “support involving multiple disciplines” and “support for overcoming grief”. Both children and families required involvement from multiple disciplines for specialized support before and after bereavement. Additionally, for overcoming grief, the involvement of peer support was deemed necessary. Therefore, even after parental bereavement, continued support such as peer support and support groups is suggested to be crucial for the subsequent adaptation of families to their daily lives. On the other hand, there is a need for promoting system development to enhance understanding and support systems for bereaved families in Japan. Furthermore, continuous communication involving multiple disciplines was deemed necessary for supporting children who have experienced parental bereavement and their families.
7. Conclusion
Support for children who have experienced parental bereavement and their families requires open communication, which influences their adaptation to daily life afterward. Furthermore, involvement from multiple disciplines plays a crucial role in providing specialized support to address the diverse needs of children and families, facilitating the process of overcoming grief. Additionally, it has been evident that support systems for bereaved families implemented overseas are effective in supporting children and families. In Japan, there is a need to establish support systems that include children as part of family support. To address this need, there is a challenge in nursing support to provide opportunities for learning about the necessity of such support and to establish systems that enable interdisciplinary collaboration in clinical practice.
Funding
This study was conducted as part of the research funded by the SGH Foundation for Cancer Nursing Research, a public interest corporation, during the 4th SGH Cancer Nursing Research Grant.