Sometimes if the dying patient is too ill, the family may move from the bedside back into a family room, separate from the patient. It is always important in this therapy that achievable goals are targeted, sometimes modest ones for poorly functioning families, as the work is, of necessity, time-limited. Nonetheless, considerable benefits can still flow from the open communication that is involved. He highlighted the opportunity that palliative care services have to identify those family members at increased risk of poor bereavement outcome, and thus intervene preventively. Whenever there is a perception that death has been untimely or in some way shocking in its nature, the relationship with the deceased either ambivalent or overly dependent, the bereaved psychiatrically vulnerable because of a past history of such disorder, the family dysfunctional leaving the carer isolated or unsupported, or a cumulative build up of stressful loss events has occurred, then the palliative care team should maintain supportive followup.
Early referral is recommended if concern develops.
Ongoing family work with those recognized to be at increased risk provides a useful model to accomplish this. Grief work as a therapy has been mostly individually-directed and focused on the bonds of attachment to the deceased. In contrast, this model is family focused. It particularly promotes meaningful family relationships, a notion that is akin to enhancing socialization to counter loneliness in the bereaved. The family group is generally the most important source of social support, and therefore an obvious means of comfort for the bereaved.