Bereavement care in general practice: a cluster-randomized clinical trial.

BACKGROUND: The loss of a loved person may lead to complicated grief (CG). General practitioners (GPs) consider bereavement care to be important but find training for this task to be insufficient. We hypothesized that improvement in skills that facilitate early identification of CG and enhance GPs' clinical care may reduce adverse health outcomes. Aim. To test whether implementation of a bereavement management program in general practice could improve the GPs' ability to identify CG and provide clinical care.

DESIGN: A cluster-randomized controlled trial allocating GPs and their listed patients suffering from bereavement to either a intervention or a control group.

SETTING: Close relatives of patients who had died from cancer in Denmark were recruited (N = 402).

METHOD: The primary outcomes were defined as the bereaved relatives' score on the Beck's Depression Inventory II and the Inventory of Complicated Grief-Revised (ICG-R), the GP's clinical assessment of the relative's grief reaction and the relative's number of contacts with general practice.

RESULTS: Larger improvements in ICG-R scores were found in the intervention group than in the control group. In the intervention group, patients exhibiting CG symptoms were more likely to receive supportive care and to be referred to mental health practitioners, whereas GP's in the control group more often prescribed psychotropic drugs for patients with symptoms of CG. The GP's ability to identify CG at 13 months did not seem to be better in the intervention group than in the control group.

CONCLUSION: While only statistically near significant, we found some indications of an effect of the intervention compared with usual care. Our results underscore the need for improving GPs' clinical skills in identifying patients with CG.