Response to Gardiner C, and Ingelton C (2010) Commentary on Cronfalk BS, Ternestedt BM & Strang P (2010) Soft tissue massage: early intervention for relatives whose family members died in palliative cancer care. Journal of Clinical Nursing 19, 1040–1048

Authors


We agree with Gardiner and Ingleton’s (2010) remarks in their commentary of Cronfalk et al. (2010) that research in palliative care with postbereaved family members can be ethically sensitive and methodologically challenging. Gardiner and Ingleton (2010) emphasise the importance of procedure when sampling for participants in an already vulnerable group of individuals. In a study by Cherlin et al. (2007), approximately one-third of bereaved relatives sought bereavement support the first six months following the death of a family member. In Sweden, however, most structured bereavement support is offered 6–12 months following the loss of a family member. The difficulty in this study (Cronfalk et al. 2010) was therefore to foresee if bereaved relatives would participate, especially as the study involved massage, an uncommon support strategy.

We also agree with Gardiner and Ingleton (2010) on the importance of a rigorous research design and that this is imperative when seeking good evidence. In our study (Cronfalk et al. 2010), we discuss the limitations of the study design and are aware of the challenges this intervention study presents. As there is no previous experience of introducing bereaved relatives to massage, it would have been valuable to include a control group as we would then have been able to draw other conclusions. Nevertheless, the results presented in this study provide important information about a group of bereaved relatives and their need of support during the early grieving phase in Sweden.

Further in their commentary, Gardiner and Ingleton (2010) refer to the positive aspects of traditional support alternatives, such as group and individual counselling and telephone conversations. We agree with them that conversation serves a purposeful and meaningful help to many bereaved relatives (Gelfman et al. 2008). Even so, studies on bereavement support also show the need for diversity in upholding an individualised strategy (Valdimarsdóttir et al. 2005, Milberg et al. 2008). The results in the present study by Cronfalk et al. (2010) indicate a need for diversity in the support strategies offered to relatives within palliative care settings.

The massage provided in this study (Cronfalk et al. 2010) was shown to improve physical as well as emotional wellbeing during a vulnerable and frail phase of life. Gardiner and Ingleton (2010) question the reliability of the results concerning hope and comfort exemplified by one part of a quotation. This quotation ends with ‘... It was like grasping at straws, that`s what it was’. We argue that this is one way of experiencing hope and comfort.

Other quotations such as ‘She (the therapist had cared for him and now she care for me’ or ‘I almost longed for it (massage session). It started at the beginning of the week. It (the session) became like a sign- at a time when I had no power to think ahead...’ more explicitly clarify how hope and comfort was experienced. We argue that these results emphasise an important aspects of human life – that of feeling included and valued as a person.

We are planning to continue to explore the support needs amongst relatives during the early phase of bereavement and are currently scheduling a randomised multicenter study. This study will include varied support strategies including massage and adopt a qualitative and quantitative approach.

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