Overview of included empiric articles relating to grief and bereavement of family/friends
| Beuthin et al, 202123 | Canada | Qualitative (semistructured interviews) | 9 bereaved family and friends (average 15 months; range 4–36 months) | All caucasian, middle to older-aged women | Euthanasia | Explore bereavement experiences | Grief-bereavement is an extended period that includes predeath to the present MAiD/certainty of death creates ‘parade of lasts’ |
| Brown et al, 2020a(25) | Canada | Qualitative (semistructured interviews) | 5 patients, 11 family members, 14 HCP | 100% Caucasian; 77% female; ages >40 | Euthanasia | Explore patient, family, HCP experiences with MAID | Care considerations in four domains: Emotional (unique facets associated with MAID) Physical (eligibility, location, procedural) Spiritual (honouring choice, acknowledging loss) Relational (supporting the circle of support) |
| Brown et al, 2020b(24) | Canada | Qualitative (semistructured interviews) | 5 patients, 11 family members, 14 HCP | All Caucasian; 77% female; ages>40 | Euthanasia | Explore perspectives on MAiD access and care delivery | Care pathway has ambiguity, causing gaps in knowledge, participation, institutional supports Quality improvement processes are needed to improve legal barriers and clarify HCP roles |
| Frolic et al, 202026 | Canada | Qualitative (semi-structured interviews) | 16 family members (“months after MAiD”) | 56% female | Euthanasia | Understand Hamilton MAiD programme and MAiD legacy impact | Four domains of opposing tensions: Autonomy/ambivalence Time as gift/burden Decreased suffering/time Individual’s legacy/family’s bereavement |
| Gamondi et al, 201537 | Switzerland | Qualitative (semistructured interviews) | 11 bereaved family members (median 24 months; range 12–72 months) | 54% female | Assisted suicide | Explore family involvement in decision-making and subsequent bereavement | All described moral dilemmas during decision-making Barriers causing isolation stem from concerns from stigma and secrecy |
| Ganzini et al, 200942 | US | Quantitative (validated scales or questionnaires) | Family members of those who received MAiD (n=95) and those who did not (n=63) (range 4–36 months) | MAiD group: 100% Caucasian; 69% Female; Mean age 60.9 Comparator: 97% Caucasian; 79% Female; Mean age 60.1 | Assisted suicide | Compare grief symptoms and mental health of family caregivers between those who received MAiD and not | No differences between groups in measures of prolonged grief (2% vs 0%) or depression symptoms (11% vs 14%), or mental health service use (44% vs 52%) Quality of life in last 7 days rated higher by family for those who received MAiD (4.2 vs 2.9, p=0.03) |
| Hales et al, 201927 | Canada | Mixed-methods (focus groups, unstructured conversations, survey) | 11 bereaved family members | NS | Euthanasia | Understand perspectives, identify improvement | There should be improvements to the process, clarifications to the scheduling and 10-day period of reflection Burden associated with patient privacy, clinician objective, lack of bereavement resources following MAiD |
| Ho et al, 2020 | Canada | Qualitative (semistructured interviews) | 26 HCPs | 88% female; 46% nurses, 27% physicians, 19% social workers, 8% spiritual health | Euthanasia | Explore HCPs challenges and resource recommendations | There are inadequate psychological and professional support for family/friends. Resources are needed to ease family distress regardless of whether patients receive MAiD |
| Hashemi et al, 20216 | Canada | Mixed-methods (semistructured interviews, validated questionnaires) | 13 caregivers of home MAiD (average 18 months; range 10–28 months) | 100% Caucasian; 69% female; mean age 60.1 | Euthanasia | Explore quality of bereavement for home MAID | MAiD was easier to accept, family/friends accepted and ready for death All participates had positive experience, and none suffered from complicated grief (IES-R mean=9.2 and BGQ mean=2.1) |
| Holmes et al, 201828 | Canada | Qualitative (semistructured interviews) | 18 family or friends (before and after MAiD) | NS | Euthanasia | Explore bereavement experiences | Planned death day is odd, although often peaceful, with valued time to say goodbye |
| Laperle et al, 202134 | Canada | Qualitative (semistructured interviews) | Bereaved family members, 8 after euthanasia, 8 after natural death (range 6–48 months) | 75% female; mean age 49.4 | Euthanasia | Offer insights into the relational landscape of bereavement experienced in anticipated death Draft an interpretive model of grief | The bereaved are active agents who co-construct their experience with their social environment Bereaved family experience four landscapes: I feel open and visited I feel far away, along with the deceased I feel besieged I feel I am expanding and invested with a message |
| Laperle et al, 202235 | Canada | Mixed-methods (semistructured interviews, questionnaires) | Bereaved, 25 after MAiD, 36 after death with palliative care (average 11.8 months) | 85% female; mean age 16 | Euthanasia | Describe the grief experiences of individuals who have lost a loved one through MAid or natural death | No differences between groups in measures of prolonged grief disorder (Prolonged Grief-13) or psychopathological symptomatology of grief (Revised Grief Experience Inventory) Neither MAiD or death with palliative care favour prolonged grief; although there may be less social stigma in Quebec, Canada |
| Oczkowski et al, 202130 | Canada | Qualitative (semi-structured interviews) | 20 HCPs | 45% female | Euthanasia | Describe HCP perspectives, identify successes and suggestions | Need for centralised portal to cover technical and logistics Emotional support for patients and families before, during and after through SW, spiritual care |
| Philippkowskil et al, 2020 | Australia | Quantitative (validated scales) | 164 adults randomised to read one of four vignettes | 79% female | Assisted suicide | Investigate the cause of death and age of the deceased on emotional responses to the bereaved, desire for social distance, and grief expectations | The age of death affected grief experiences The mode of death did not affect grief experiences (p=0.33) |
| Pronk et al, 202141 | Netherlands | Qualitative (semistructured interviews) | 12 family/friends of individuals with mental illness who requested or received MAiD | 50% female | Euthanasia (lethal prescription or injestion) | Examine experiences of relatives of patients that requested MAiD due to mental illness | When patients with mental health request MAiD, family/friends generally feel ambivalence. Family/friends more strongly want to be involved in decision-making and have their views heard by HCPs and the patient. |
| Schutt, 201131 | Canada | Qualitative (semistructured interviews) | seven bereaved family members | 100% Caucasian; 57% female | Euthanasia | Explore insights from family members’ experience of MAiD | Procedural aspect of MAID augmented perception of biomedical process Should be presented with palliative philosophy |
| Smolej et al, 202236 | Canada | Qualitative (semistructured interviews) | eleven caregivers of individuals who requested or received MAiD | 91% female; average age 54.5 | Euthanasia | Explore the experiences and support needs of family caregivers who are or have provided care peri-MAiD | |
| Srinivasan, 201943 | USA | Qualitative (interviews) | 22 bereaved family members (‘bereaved within 3 years’) | 100% Caucasian; 68% female; age range 61–80 | Assisted suicide | Explore bereavement experiences | Themes identified with assisted death: General grief reactions Anticipatory grief Sense of control Level of agreement with assisted death Grief expression and stigma |
| Swarte et al, 200340 | Netherlands | Quantitative (validated questionnaires) | Bereaved family and friends of terminally ill patients with cancer who received MAiD (n=189) and those who did not (n=316) | MAiD group: 54% female; mean age=48 Comparator: 58% female; mean age=49 | Euthanasia (lethal prescription or injestion) | Assess how euthanasia affects grief of family and friends | Bereaved family and friends of those who died by euthanasia had less traumatic grief symptoms (adjusted difference −5.29 (95% CI −8.44 to −2.15)), less current feeling of grief (adjusted difference 2.93 (0.85 to 5.01)); and less post-traumatic stress reactions (adjusted difference −2.79 (-5.33 to -0.25)) |
| Trouton et al, 202029 | Canada | Quantitative (survey) | 18 physicians who provided MAID | NS | Euthanasia | Explore physician practices for bereavement support to patients | Importance of bereavement support recognised (72.2%), but physicians do not have time or resources to provide support Bereavement following MAID is unique due to unfamiliarity and potential for stigma |
| Wagner et al, 2011 | Switzerland | Quantitative (validated questionnaires) | 85 relatives or friends (mean 20 months) | 56% female; mean age=60.15 | Assisted suicide | Examine the effects of perceived social acknowledgement on symptoms of post-traumatic stress and complicated grief | General disapproval, rather than family disapproval or recognition, were correlated with PTSD (rs=0.50=0.56) and complicated grief scores (rs=0.63–0.71) |
| Wagner et al, 2012 | Switzerland | Quantitative (validated questionnaires) | 85 relatives or friends (mean 19 months) | 56% female; mean age=60.15 | Assisted suicide | Examine the impact of witnessing assisted suicide on mental health | Compared with general Swiss population, survey found slightly higher rates of PTSD (13%) and depression (16%) Rates of complicated grief were comparable (4.9%) |
BGQ, Brief Grief Questionnaire; HCP, healthcare professional; IES-R, Impact of Event Scale - Revised; MAiD, medical assistance in dying; NS, not significant; PTSD, post-traumatic stress disorder; SW, social work.