key: cord-0704177-gl7dgh2y authors: Muturi, Ivy; Freeman, Shannon; Banner, Davina title: Reply to: Comment on: Virtual funerals: A feasible and safer option during the COVID‐19 pandemic date: 2021-02-21 journal: J Am Geriatr Soc DOI: 10.1111/jgs.17042 sha: ae1cd41defe38805114bdb50474d3cfed6663a4f doc_id: 704177 cord_uid: gl7dgh2y This letter comments on the letter by Fredrick Sherman. To the Editor: Dr. Fredrick T. Sherman's commentary discussing the long-standing approaches that physicians have, and still use, to express their condolences and pay their respects to the bereaved is an important topic that can expand on the points discussed in our article, Virtual Funerals: A Feasible and Safer Option During the COVID-19 Pandemic. 1,2 While our article focused principally around the use of virtual platforms for mourners to host safe services during the COVID-19 pandemic, we agree with Sherman that physicians play a vital role in supporting patients and families during death and bereavement, both in-person and virtually. We emphasize that physicians-as members of the healthcare team working with interdisciplinary professionals-shoulder the responsibility in providing patients and their families with information about the growing range of end-of-life options, including virtual funerals. Information surrounding virtual funerals during the COVID-19 is scarce and widely dispersed across the internet. While scanning predominantly gray literature, our goal was to answer the following questions: How do virtual funerals work? Which platforms are often used? How many guests can attend? How much will it cost? How is information kept secure? How do those attending the funeral adhere to infection prevention guidelines? What are the experiences of previous hosts? The burden associated with planning a funeral, burial, memorial, or celebration of life is often carried by those closest to the deceased. Under normal circumstances, ceremonies would take place in a traditional manner, allowing family members, friends, and others to gather in mourning. However, the ongoing pandemic has forced many to adapt their practices to adhere to COVID-19 restrictions for physical distancing and to further consider the health and safety of themselves and those in their community. Our commentary highlighted the changing nature of grieving practices within the context of a global pandemic. 2 Not being able to say goodbye to a dying loved one, feeling unprepared for a death, and experiencing lower levels of social connection are just a few ways in which the pandemic has caused many to experience complicated grieving processes. 3 The term disenfranchised grief, is defined as grief that "goes unacknowledged or unvalidated by social norms." 4 In the context of COVID-19, disenfranchised grief "can occur when families are unable to grieve with normal practices of social support and rituals" and can also "occur when an individual does not follow social/mandated "rules" and becomes infected or spreads the illness." 3 Healthcare professionals should not shy away from discussing memorial plans, as well as health and safety considerations of COVID-19, during advance care planning with the patients and individuals close to them (e.g., family and close friends). Providing information regarding memorial services during the COVID-19 pandemic should be considered an important part in assisting individuals with managing grief. Healthcare providers and interdisciplinary professionals can play important roles following a loss, including, gatekeeper, messenger, and counselor. Healthcare providers in particular build strong connections with patients and their families and those connections are not lost following a death. Bereavement follow-up is a practice that may be carried out by physicians as well as by other members of the care team such as: social workers, bereavement support workers and nurses. Healthcare professionals are positioned to provide vital support to those affected by the patients' death which can include offering words or gestures of condolence. This support may be particularly important for those experiencing a complicated loss during the pandemic. 3 The pandemic has called on individuals, healthcare professionals, and those working in death services to adapt their usual practices. An interdisciplinary approach to grief support can similarly be beneficial in coordinating access to a wide range of resources, including information about hosting virtual funerals, accessing grief support services, and identifying when to seek ongoing help in the event of complex grief. Informing patients and their families about the accessibility and feasibility of virtual funerals is just one of many ways in which professionals can help support the bereaved. While many bereavement support activities have been offered traditionally in person, virtual options to connect with loved ones following a death, such as a virtual visit from a family physician, are too opportunities that warrant exploration. Further research is needed to assess how healthcare professionals can adapt their current approaches to meet the needs of those who have experienced loss during the pandemic, including exploring how physicians, other healthcare providers, and interdisciplinary professionals may best provide support and services. Comment on virtual funerals: a feasible and safer option during the COVID-19 pandemic Virtual funerals: a feasible and safer option during the COVID-19 pandemic Grief during the COVID-19 pandemic: considerations for palliative care providers Disenfranchised grief: when no one seems to understand your loss The authors have no conflict of interest. All authors contributed to writing of this letter.