Implementation and Delivery of a Comprehensive Bereavement Program in Pediatric Palliative Oncology

Background/Objectives: Bereavement care is widely endorsed as a standard of pediatric oncology and palliative care, yet it remains inconsistently implemented across pediatric oncology programs in the United States, and few programs have reported longitudinal delivery metrics. We aim to describe the iterative development and delivery of a multi-component bereavement program within an outpatient pediatric palliative oncology (PPO) program, characterize the population served, and benchmark delivery against national guidelines. Methods: This was a retrospective descriptive analysis of bereavement component delivery for PPO program patients who died between 2017 and 2026, using an iterative quality improvement framework. Program components (calls, condolence cards, packets, books) were tracked prospectively in a registry. Annual completion rates and timeliness were calculated for each family-facing component, and the cohort was characterized by demographic, clinical, and end-of-life variables. Data were reviewed for completeness at extraction; missing values were rare and are noted in the relevant tables. Results: A cohort of 403 deceased patients was included (41% Black, 15% Hispanic/Latino, 50% Medicaid-insured). The program evolved from informal bereavement phone calls (completion 74-81%) during 2017-2019 to a standardized, six-component program by 2020, reaching 93-100% annual delivery for most eligible components during 2022-2025. Early outreach occurred promptly (median 6 days after death for phone calls and condolence cards), and longer-term components were delivered within their intended windows. Conclusions: Comprehensive bereavement was developed over time without a fully formed infrastructure at initiation. This structured program began with one feasible, trackable activity and added components incrementally, achieving highly sustainable delivery that ultimately informed broader institutional practice.