No abstract

In early 2013, an online survey of over 200 UK palliative care services published in the British Medical Journal found that most of these services were prioritizing 'community engagement' initiatives, most commonly adopting a 'compassionate community' model. Later this same year, a report released by the National Council for Palliative Care and the charity Murray Hall Community Trust, described the increasing uptake of compassionate communities by palliative care services in England. This review examines this new policy and practice development in British end-of-life care explaining its conceptual origins and describing its policy importance to current practice. Why services are increasingly turning to community partnerships and the reasons they believe that this approach might enhance the effectiveness and reach of their clinical work are described.

Our experiences of dying have been shaped by ancient ideas about death and social responsibility at the end of life. From Stone Age ideas about dying as otherworld journey to the contemporary Cosmopolitan Age of dying in nursing homes, Allan Kellehear takes the reader on a 2 million year journey of discovery that covers the major challenges we will all eventually face: anticipating, preparing, taming and timing for our eventual deaths. This book, first published in 2007, is a major review of the human and clinical sciences literature about human dying conduct. The historical approach of this book places our recent images of cancer dying and medical care in broader historical, epidemiological and global context. Professor Kellehear argues that we are witnessing a rise in shameful forms of dying. It is not cancer, heart disease or medical science that presents modern dying conduct with its greatest moral tests, but rather poverty, ageing and social exclusion.

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Aims:To determine who provides bereavement support in the community, what sources are perceived to be the most or least helpful and for what reason, and to identify the empirical elements for optimal support in developing any future compassionate communities approach in palliative care.Design:A population-based cross-sectional investigation of bereavement experiences. Sources of support (informal, community and professional) were categorised according to the Public Health Model of Bereavement Support; most helpful reasons were categorised using the Social Provisions Scale, and least helpful were analysed using inductive content analysis.Setting and participants:Bereaved people were recruited from databases of funeral providers in Australia via an anonymous postal survey (2013–2014).Results:In total, 678 bereaved people responded to the survey. The most frequently used sources of support were in the informal category such as family, friends and funeral providers. While the professional category sources were the least used, they had the highest proportions of perceived unhelpfulness whereas the lowest proportions of unhelpfulness were in the informal category. The functional types of helpful support were Attachment, Reliable Alliance, Social Integration and Guidance. The five themes for least helpful support were: Insensitivity, Absence of Anticipated Support, Poor Advice, Lack of Empathy and Systemic Hindrance.Conclusion:A public health approach, as exemplified by compassionate communities policies and practices, should be adopted to support the majority of bereaved people as much of this support is already provided in informal and other community settings by a range of people already involved in the everyday lives of those recently bereaved. This study has provided further support for the need to strengthen the compassionate communities approach, not only for end of life care for dying patients but also along the continuum of bereavement support.