Traditionally, bereavement care for families of children who have died is provided for parents and siblings. Literature review revealed that grandparents' bereavement has barely been studied or reported. The aim of this study is to examine the special characteristics, needs, and grief coping strategies of this population. A qualitative case study of a group of grandparents of children who had died from oncological diseases was conducted. The group met for 9 months. The method of data collection was observation and recording. The group discussions raised a variety of themes, some common to other grief groups and some unique to grandparents. The themes unique to grandparents dealt with issues such as the legitimacy of their grief, their pained relationship with their children, and the specific meaning of this loss at old age. Based on our findings, a model of three concentric circles is suggested. (1) The personal level deals with effects on grief of advanced age, closeness to one's own death, and other losses in life. (2) The family circle focuses on the dynamics of the three-generation-family and the role of the grandparents. (3) The culture circle relates to the questions of the ''place'' of grandparents' bereavement: where, how, when, and with whom do grandparents experience and express their grief.

Our integrative model results in exposure of the majority of children with cancer to palliative care. For poor prognosis patients, palliative care is introduced early enough to allow gradual transition from symptom control after diagnosis to end of life care.

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