Fathers’ Perspectives of Bereavement Support

Abstract

Bereavement support is a required practice standard for comprehensive palliative care. However, research to guide supportive care for fathers who experience child loss is scarce. This article presents selected findings illuminating fathers’ need for support, which emerged from a phenomenological study describing fathers’ lived bereavement experience. Eleven participating fathers from the United States and Canada discussed their need for support, which was limited and difficult to access. They offered their perspectives of peer support groups and professional mental health counseling. Participants also provided their recommendations to help health professionals improve supportive care for bereaved fathers. Findings from this study advance the state of the science by incorporating fathers’ voices on what bereavement support was meaningful and important for them.

Keywords

bereaved parents bereavement coping/adaptation grief support groups

Bereavement support is a required practice standard for comprehensive pediatric palliative care (National Consensus Project for Quality Palliative Care, 2018, National Hospice and Palliative Care Organization, 2022). Yet, research remains insufficient to guide best practices that promote health and support bereaved parents’ well-being (Feudtner et al., 2019). According to Mulheron (2025), there is “a scarcity of research that incorporates bereaved people’s voices…without input from those living with grief, researchers cannot know what kinds of care models and interventions should be developed and studied” (para. 6). This is especially true for bereaved fathers since the majority of samples in bereavement research are comprised of mothers leading to significant underrepresentation of fathers (Dutta et al., 2019; Haylett & Tilley, 2021; McNeil et al., 2021; Postavaru et al., 2023).

Literature on men’s perspective of supportive bereavement care is sparse (Aho et al., 2011; Badenhorst et al., 2006; Schoonover et al., 2022). Bereavement support varies and is not always easily accessible (Lichtenthal et al., 2015; Morris & Block, 2015; Morris et al., 2019). Systematic reviews find few studies with methodological limitations, which make it difficult to draw meaningful conclusions on the effectiveness of support interventions (Ahluwalia et al., 2025; Ainscough et al., 2022; Endo et al., 2015; Rowa-Dewar, 2022).

In a scoping review of 52 studies exploring bereaved parents’ perceptions of helpful and unhelpful characteristics of informal support, Schoonover et al. (2022) identified only three articles focused solely on bereaved fathers. These articles generally found that bereaved fathers perceived peer support groups as helpful and fading social support unhelpful (Aho et al., 2009; Samuelsson et al., 2001; Wood & Milo, 2001). In a systematic review of 219 studies exploring interventions to improve care for bereaved people who experienced distinct types of loss, Ahluwalia et al. (2025) found moderate positive effects of psychotherapy and expert-facilitated support groups on grief symptoms. Few studies explored peer support interventions and consequential harms of interventions and Ahluwalia et al. (2025) concluded more research is needed.

Due to the shortage of targeted research on fathers, as opposed to mothers, experiencing loss, there is opportunity to better understand fathers’ perspectives of their bereavement support needs following a child’s death. Emerging from a larger phenomenological study which described fathers’ lived bereavement experience, an essential theme arose related to fathers’ need for a supportive community (Denhup, 2024a, 2024b). This article presents selected findings pertaining to that essential theme of bereaved fathers’ need for support.

Method

This qualitative study, grounded in Heideggerian hermeneutic phenomenology (Heidegger, 1962), aimed to describe and interpret the meaning of fathers’ lived experience of bereavement. The research question was: “What is the lived experience of bereavement among fathers who have experienced the death of a child?”. Phenomenology is the appropriate qualitative method to use when exploring the meaning of a phenomenon as it is experienced (Munhall, 2012). Phenomenology is used to understand people’s perspectives of their life experiences, uncover the essences of the experience, and ascertain the meaning of the experience in terms of what was experienced and how it was experienced (Doucette & Lane, 2025; Neubauer et al., 2019; Renjith et al., 2021).

Heidegger (1962) believed description and interpretation are necessary to understanding the meaning of people’s lived experiences. Consistent with ontological assumptions of interpretive phenomenology, lived experience contains multiple realities and is unique to every individual (Doucette & Lane, 2025; Heidegger, 1962). Heideggerian phenomenology seeks to understand what people experience in their daily lives, in their lifeworlds (Heidegger, 1962; Neubauer et al., 2019).

Heidegger (1962) does not provide specific methodological steps for researchers to conduct phenomenological research. Rather, he offers a philosophical perspective from which research methods could be derived. Thus, the researcher turned to van Manen’s (1997) method framed by Heideggerian philosophy. van Manen’s (1997) method consists of six research activities: (1) turn to the nature of lived experience and commit to a concern; (2) investigate the experience as it is lived; (3) reflect on essential themes that emerge from a three-fold approach to theme identification (wholistic reading, selective highlighting, detailed reading); (4) write and rewrite; (5) maintain a strong and orientated relation; and (6) balance the research while considering parts and whole.

The researcher plays a key role in any interpretive phenomenological inquiry (Neubauer et al., 2019). Heidegger (1962) presented the concept of the hermeneutic circle, whereby understanding arises in a circular fashion in which the researcher brings their own pre-understandings, or fore-conception, about a given phenomenon to the research; seeks to understand the phenomenon by making pre-understandings known; and studies the whole and parts of a phenomenon moving towards an interpretive understanding of lived experience (Earle, 2010; Koch, 1995; McConnell-Henry et al., 2009). The researcher’s lifeworld, including education, knowledge, and past experiences are valuable to the inquiry (Neubauer et al., 2019). Accordingly, the author provides this reflexivity statement: As a PhD-prepared advanced practice registered nurse (APRN), the author came to this research study because of her commitment to advance palliative care nursing science and education to improve quality outcomes and minimize suffering of patients and families. After nearly two decades of clinical nursing practice directly caring for children with serious illnesses and 17 years as an academic nurse educator teaching students to care for children and families, she has dedicated her program of research on bereavement and palliative care scholarship to improve outcomes and minimize suffering. The historical blind spot in nursing practice and education related to fathers’ bereavement, the gap in the literature on fathers’ bereavement, and comments from bereaved fathers, such as “you need to come talk to us”, motivated this authentic exploration of fathers’ lived experience. The author/researcher is not a bereaved parent, nor had any prior relationship with study participants. The author/researcher’s professional qualifications and experience conducting qualitative bereavement research enhance study rigor and trustworthiness of findings.

The researcher’s University granted IRB approval for this study (IRB protocol #3973). All participants provided written informed consent prior to participating in this research. Readers are referred to a prior publication (Denhup, 2024a) for a detailed explanation of the sample, data collection/analysis, and approaches used to ensure trustworthiness. A summary of which follows.

Sample

The researcher used purposive and snowball sampling to recruit a diverse cross-section of 11 fathers through various community-based peer support groups to holistically explore the essence of their bereavement experience. The majority were non-Hispanic/Latino white (10 white, 1 black), college-educated (3 with bachelors, 5 masters, 1 doctoral degree), married (10 married, 1 divorced) men, aged 30-70 (mean 50 years), of different faith/religious backgrounds (3 Jewish, 2 Christian, 1 Mormon, 5 Unaffiliated) from the United States and Canada. Each participant experienced a young child’s death at least one year prior to participation (range 1–22 years prior; mean 9 years prior). One of the 11 participants experienced the death of two children. Participants’ children (8 boys, 4 girls) ranged in age from stillborn-17 years of age at the time of death. The majority (n = 8) were illness-related deaths; six children had cancer and two infants had prematurity complications. One was stillborn at 38 weeks due to placental abruption. The three other children died following a sudden unexpected event; one adolescent with a long-stable cardiac history died during sleep, one child incurred an accidental injury during play, and one adolescent died in a motor vehicle accident. Six participants had surviving children (aged 7–38 years); five did not. All participants were receiving grief support through community-based bereavement peer support groups when interviews were conducted.

Data Collection and Analysis

The researcher engaged in deep phenomenological reflection, documented field notes, and wrote analytic memos while utilizing van Manen’s (1997) method, inclusive of its six research activities and three-fold thematic approach to uncover the essences of fathers’ lived bereavement experience.

The researcher conducted conversational phone interviews privately with each participant on 1–2 occasions (1.15–3.35 h in length/participant, yielding 22 cumulative hours). After introductions to establish rapport and trust, the researcher asked participants: “Please tell me what it has been like for you since your child died”. The researcher probed with silence and neutral sounds, while moving the conversation along with such comments as “Go on”, “Please say more about what it was like for you”, and “Can you think of anything else that would help me to understand what it’s been like for you since your child died?”. The researcher transcribed each audio-recorded interview verbatim and reviewed them for accuracy. Several participants voluntarily shared songs, journal entries, and social media posts that they felt would help the researcher better understand their bereavement experience.

Trustworthiness

The criterion of credibility establishes a “match between the constructed realities of respondents (or stakeholders) and those realities as represented by the evaluator and attributed to various stakeholders” (Lincoln & Guba, 1989, p. 237). Multiple strategies, including prolonged engagement in the field, use of participants’ verbatim quotes, triangulation, and a member-checking process were used to ensure trustworthiness and credibility of this study’s findings.

During prolonged engagement in the field, the researcher was deeply immersed and engaged in phenomenological reflection and writing. Participants’ verbatim quotations were used to accurately capture what the fathers said. Triangulation was used to cross check data and identify findings that converged across time, space, and persons (Denzin, 1989; Kawar et al., 2024). Member-checking further validated credibility of findings. Using informal member-checks in real-time during interviews, the researcher reflected with the participants about what they said to confirm understanding. Participants had the opportunity to read the comprehensive analytic summary and provide feedback through a formal member-checking process, whereby the researcher asked participants “Does the summary resonate with you?” and “Do you see enough of your own experience in the summary that you think could be helpful for other fathers?”. Participants felt the summary deeply resonated with their experience; thus, no changes to the final representation of data were necessary.

Findings

A wholistic structure of the meaning of fathers’ lived bereavement experience emerged:

Bereavement is a life-long journey along which a father navigates through devastating and traumatic loss with great strength; has profound grief that mirrors the profound love he has for his child; chooses to live life with intention and engages in meaningful activities that create purpose aimed at honoring his child, continuing his child’s legacy, and using his own suffering for the good of others; is anchored by a continuing bond of love that fuels an ongoing relationship with his child; and needs a supportive community to sustain him as he travels down the healing road where it is possible to find faith, hope, and love while being forever transformed by loss. (Denhup, 2024a, p. 10)

This interpretive structure includes six essential themes; one of which pertains to fathers’ need for a supportive community. This essential theme includes the following subthemes: (a) fathers need support, (b) support is limited and difficult to access, (c) peer support, (d) support from professional mental health providers, and (e) participants’ recommendations to healthcare providers on how to best support fathers through their bereavement journey.

Participating fathers discussed their need for support and the challenges they faced. Participants shared their perspectives of peer support groups and professional mental health counseling. Participants provided their recommendations to help nurses and other health professionals improve supportive bereavement care, emphasizing what was meaningful and important for them.

Fathers Need Support

Participants discussed their need to express their grief within a supportive community; one which acknowledges fathers’ grief, bears witness to fathers’ grief, and holds a safe space for fathers to grief as they travel on their lifelong bereavement journey. Ryan explained: “Men need support. Men need venues in which to express their grief. It is really, really important to have your feelings, and express your feelings, and get them out of your system. Men need that support; whether that’s therapy, whether that’s peer groups, whether that’s counseling, or all the above. Somewhere where they can have their feelings, and where they can cry, and they can grieve, and they can tell their stories. That is the only thing that can help with healing over time is to be able to do that, to be able to grieve, and to be able to get it out of your system. That is tremendously important. Having somewhere where they can have the safe space to tell their story and can get their feelings out is huge. That is especially huge with men. Post- pandemic, I appreciate there is all this sensitivity about mental health but still we just deal with it so shabbily in the mainstream. It is really about yeah, go to a therapist, take some medication, feel better basically. And fine go to a therapist, but going to a therapist is only like an hour or two a week! There is the rest of the week that you have to deal with”.

Michael agreed that fathers need long-term support, stating: “Recognition of the severe effects that occur to parents, both male and female, [and] supports needed over a long period of time is an important acknowledgment in and of itself. Historically, that hasn’t been recognized as much in the psychological literature. I really strongly believe that setting time limits on proper healing is counterproductive. It really depends on what the person’s experience was in the relationship. The trauma effects magnify everything”.

Support is Limited and Difficult to Access

Participating fathers found bereavement support to be scarce and difficult to access. Eric stated, “There is a lot of support for women. My wife is in a lot of support groups that are women and then next to them, there is nothing for men. There is not enough!”. Michael stated: “I had a difficult time trying to find a grieving parents’ group. It was not easy to find!” Tim stated: “When I was initially going through everything, I didn’t come across a whole lot of resources about how men go through this.”

Matthew explained: “I had just started searching the internet, just everywhere. Going to bookstores, church libraries, anywhere I would think there would be a resource for it. It took a lot of deep diving to finally come across [a book for dads]. I did [a search] in Google. [I] would put information in there, and there would be medical journals or articles, and it would be gravitated towards the moms. Even when you put ‘grieving dads’, or ‘how to grieve as a dad’, or anything like that and it still would default back to mothers. Ten years later still, I look around and still don’t see much out there for dads”. The book that Matthew referred to, entitled Grieving Dads: To the Brink and Back (Farley, 2012), was a breakthrough for him. Matthew explained: “It really wasn’t until I read Kelly’s book on Grieving Dads: To the Brink and Back that I realized there are some fathers out there that went through the same things, especially Kelly himself. I ordered the book immediately [and] read through it a couple times. [I] actually reached out to him. That was really the first time in that process where there was that open ear and curiosity and really the want to help and [from someone who] went through the same thing I was [going through]. When I read the book, [I] felt better. I felt okay. I’m not alone. I can do better. That was the most bonding I had with anyone at that point. So, three years in and finally bonding with other dads. But three years later and [this is] still the only [book] one to deal with that topic”.

Steven stated: “How do you find these things? How do you curate these things? How do you know? You can’t go to everything, but you can’t google these things and easily find them. Nobody’s aggregating in a way that gives you all the information that you need on this journey, and it happens after death. Bereavement only happens after death”. Eric explained: “I know there are dads out there that are very vocal and come together, but there’s not the infrastructure in place to do it because there’s not organization to do it”.

Peer Support

Because supports were not readily available for participants, they spent significant time in frustration before finally stumbling upon a way to connect with other bereaved parents. Once they eventually did, they were finally able to start building a supportive community. It is telling that once a participant was able to make a connection, they were able to start building a supportive community. Participants discussed their experience with several types of peer support, including in-person support group meetings, virtual online support groups, social media/Facebook chats, newsletters, conferences, bereavement retreats, and individually on a 1:1 basis.

Frequency of Peer Support Varies

Daniel attended peer support group meetings regularly after Mateo died; every other week at first, then once a month. Steven attended an online support group once a month. Steven liked this because there are other fathers who were active in this small group. Steven explained: “There is a bunch of people I can call if I was ever in crisis, but it’s hard to find that. It’s a small group and it’s hard to find that. There is a bunch of dads in that small group, which is nice. You don’t find that necessarily anywhere else”. Steven also attended a virtual retreat held three hours per day for two days on a weekend, as well as in-person retreat for bereaved parents. About the bereavement retreat, Steven stated: “The retreat itself it was weird for us because we were there as parents without another child. Everybody else had other children there, and there’s a lot of children’s activities and all that. That was a little bit weird, but [my wife] and I can deal with it and face it”.

Adam went to a peer grief support group for a few months soon after Olivia died, and then stopped attending for a period when he decided to do individual counseling. Adam recently went back to regularly attending the peer grief support group because, as he explained: “I was getting to points where I was learning from my grief. I wanted to get out and talk to people more, and so that led me to the grief group. I’ve been going for about the last 5, 6 months”.

Nick attends two peer support groups, one with his wife and the other by himself. About the latter, Nick stated: “I still have my [support group] that’s all by myself. At first, I wanted [my wife] to come, but now there’s a piece that I’m actually fine with this one like being mine. I haven’t missed a single meeting. I love it”.

Need for Pre-Bereavement Peer Support

Some participants whose child’s death was cancer-related identified a need for peer support prior to their child’s death when they were experiencing anticipatory grief. For example, Steven needed support when he was experiencing anticipatory guidance before Jeremy’s death due to osteosarcoma. Peer support was only available to Steven after Jeremy died, not before when he needed it. Steven stated: “People just don’t understand the need to get support before grief is happening, before the child passes away. You need support then. It’s not that just you grieve after. People don’t understand that, and don’t realize that. I also looked for other dads to talk to. What is this like? How do you deal with this? How do you face this? What do you do with it? How does it feel? What do you do at the funeral? All those questions I had. I couldn’t find anybody. There was actually some people, but nobody would really help me the way I wanted to. I wanted a friend, a peer to go through it. Not really having that support from somebody who could really talk to me about it was really tough! I had a therapist and that was good, but he lost his wife to cancer. He wasn’t a bereaved dad. There wasn’t anybody to really talk with and commiserate. It just really doesn’t exist. I just struggled to find somebody to identify with. There are no pre-bereavement groups. There are only bereavement groups”. Kevin also sought out peer support prior to his child’s death due to osteosarcoma. Unlike Steven, Kevin attended a peer support group that his wife recommended. Kevin shared: “It’s kind of unusual, but I actually went to one meeting when Mason was in his terminal diagnosis. Went out for about 2 h one night because my wife recommended it. I went to that one meeting. It was a little bit of a shock for some people that my child was still living, but they all understood because they were all on the other side of the fence. And sure enough, about two months after Mason died, we started going to the monthly meetings”. Kevin continued to attend in-person peer support group meetings monthly for the first 10 years of his bereavement journey.

Need to Explore Different Types of Peer Support

Some participating fathers felt a need to explore different types of peer support offered by different organizations before they chose the one that was most helpful for them. For example, Daniel sought out peer support through in-person meetings and conferences that were offered by different organizations before he decided to stay with one organization. Daniel explained: “I went to several conferences. You’ll find people going back and forth between groups. They both service the same community. It’s just their model is different. [One is] more business model, and [the other] is more of a volunteer donations model”.

Some participants found peer support through a particular organization to be more helpful than others because it closely aligned with their personal spiritual beliefs. For example, James explained: “This organization really clicked. There are probably thousands of others, but [this organization] really clicked for me because it aligned with the beliefs that I had, and it lets me continue my relationship with my daughter”. About his peer support group, Ryan explained: “They focus on more of a spiritual aspect. They have belief in afterlife. If you’re not open to that, which I am, but if you’re not open to that then that’s not going to work for you”.

Some participants found peer support amongst other parents who experienced the same type of child loss to be most helpful. Steven explained it was most helpful to attend a peer support group for parents who experience a child’s cancer-related death, as opposed to a sudden loss stating: “After [Jeremy] passed, I started to seek out bereavement groups. [I] found [one] that didn’t really help me because there wasn’t really anyone who lost a child to cancer. There were people who lost their kids to accidents, like someone had their kid fall. Some had their kid die from drug overdoses. One kid had a boulder fall on him and crush him. These are all horrible things, but they are different because they didn’t have anticipatory grief. I didn’t find that very meaningful”. Similarly, Eric found peer support with other parents who had a similar child loss experience to be most helpful and explained: “Where I find comfort with other people who lost a child is when it was to cancer. I could wear their shoes, and vice versa”.

Peer Support Benefits and Disadvantages

Participating fathers discussed their perceptions of peer support benefits, which included receiving support from other parents who share the lived child-loss bereavement experience, feeling understood, finding companionship and forming meaningful relationships, learning from other parents, and supporting other parents. Examples of peer support benefits are presented in Table 1 below.

Table 1.

Peer Support Benefits

Benefits	Illustrating Examples
Shared child-loss experience	James: “If I had to name one thing that was more beneficial than anything else is finding a peer group with people who have gone through similar circumstances, especially the people who are farther ahead. Because when I was six months in, I was looking at people who were five years in and they look like they’re happy. Maybe it’s just them; maybe they’re just a weirdo. There were several people that were there, and I was like well maybe it’s possible. I would just encourage them to try to find people that have been through what they’re going through.” Ryan: “It’s just so meaningful to me to meet someone who’s been through the same experience as me. Those kinds of experiences have been really helpful. Having support and being able to connect with community is huge for men. That’s probably my biggest message.” Tim: “I just went to one of the bereaved parents’ group four months ago, which is wild being in there because I am the youngest person in there. I’ve been at this the longest of everybody that’s in there. What prompted it was I realized that this is really important to me. I’ve been at this a while and maybe I can shed some perspective on some things and handling stuff wrong or right, so I’ll give it a shot. It’s been nice because people there are so sweet and they are understanding. You hate to see other people hurting like that in the same way, but there is this certain level of comfort or strength that comes from being around other people that have a similar experience.”
Feeling understood	Michael: “They all get it! Every single one of those people in that room get it. Group therapy really does matter. Because they’re all like, ‘Yeah, yeah you walk into a Walmart and there’s the stuff! Their favorite thing!’ They totally get it. That was helpful. It was just nice to know there were people who understood; but, it’s a horrible club to belong to. Avoid it at all cost. It’s not an experience you want to have, but you don’t get to pick and choose. It just comes at you. But the people were great! I felt like the people really, really understood.” Kevin: When you meet other bereaved parents, it’s very helpful. I recommend that. Sometimes it’s in-person meetings, and sometimes it’s safer on facebook pages where you don’t have to go into a meeting and prepare yourself physically. You can just send a confidential message back and forth. When someone is in the middle of their grief and bereavement process, they’re saying ‘What is this for other people? Where can I get some help? This is horrible what I’m feeling and does this go on forever?’ Those things show up on the facebook pages. Communicating with other parents who have had the same kind of experience is fundamental to any process of returning to some level of reasonable function. I would recommend to bereaved parents that it is essential that they communicate with other bereaved parents. It’s extremely helpful. In some ways it brings a little bit of relief. It doesn’t change the situation but when you learn about the different struggles of other parents and the commonality of feelings, you don’t feel quite as alone. Keep communicating with other bereaved parents because after a while you get to the point you begin to help them, which is really hard to understand when you’re in the middle of your grief. Communicate with other people who had the same experience.” Steven: “[The] first time I went I’m like, ‘These are my people’. Everything I would say or do, they got. They understood. It’s always been helpful to get the nods and all that. It definitely felt like home. It was great to just talk to people and have that common understanding. When you start talking and someone says, ‘Yep, I get it.’ These people understand this like nobody else can. I’ve met a lot of bereaved parents. We all just walk in and boom! Instantly, it’s calming. We’re friends for life now because we get it, and understand it, and we know what to say, and we know that they understand it. It’s all a little bit different for everybody, but it’s that common experience that helps so much. Just having dads with the common experience is a big deal! Just identify, and share that, and have that network of people that you can talk with. Having the opportunity to share what we were doing, that’s great! Just having dads with the common experience is a big deal! I met another dad who lost his daughter, who was the same age as Jeremy, at the same time as Jeremy. She didn’t die of cancer; she was in a car accident. He hasn’t had another dad to talk to, a peer, someone who he can just say a few words or just give a look and know that the other guy gets it. As he talked to me, I think he realized that he found someone where it’s ok to cry, it’s ok to complain, or just feel lost or lonely. Just having someone there who understands is valuable.” Eric: “It was helpful to talk with another father who was feeling my pain, and understands me, and I understand him.” Ryan: “I was going [to] a fundraising organization. They have a walk every year. There’s a lot of community. I find it really hard, but I go anyways. This fellow who was there, [he was] a big guy, who was pretty burly and really [a] nice guy. It turns out he had lost his son less than a year before. He just said to me at one point, really quietly, ‘Can you look at the pictures on your phone?’. It took me a minute to figure out what he was talking about. He said ‘Oh, I can’t really look at the pictures. I can’t look at the pictures”. I was like, ‘Yeah, I get it. Yeah, I understand’ and we had a moment. We talked. [I said] ‘Do you have support? Are you going to a therapist? Great, great you’re going to therapy. Excellent, you’re just going need to do that to have your feelings in a supportive way’. I felt really good. I gave this guy some support. I just realized here he was and I’m someone he can really talk to, another man. That is what men need, to be able to talk to other men, particularly bereaved parents.” Nick: “It’s just listening to other people’s stories and feeling like you’re not alone with the situation and feeling like other people, and being able to help other people too. I enjoy that a lot. We don’t know each other at all, but we’ve got this connection that really makes you feel that you really know them. You can say stuff that would sound crazy to most people. They’re like, ‘That’s totally normal’. Like there’s people who are buying christmas presents for their kids who are deceased, or decorating trees for them, or other stuff that seems crazy in a way. When you’re with other parents who are also doing the same thing, you’re like yeah this isn’t crazy. This is what we do for our kids or about our kids. I don’t think people necessarily judge it; maybe it’s my perception that they would if I told them. I don’t think the world would judge me to say ‘Hey I just spent $100 on christmas presents for Jack, what am I going to do with those’. I think they’d understand, but when you’re with other parents who do the exact same thing it’s more connected about it. They’re going to do [it too]. They’re totally going to know where you’re coming from.”
Companionship and meaningful relationships	Daniel: “We all enjoyed each other’s company so much. It’s the most wonderful group of people that you’re sorry to meet for the reason you’re meeting them. There would be breakout sessions that you could go to if you wanted to, or just sit and talk to people. I met a lot of people that I’m still friends with. When you meet another bereaved parent, there’s an immediate connection.” Steven: “Those people are definitely my friends. It was so good to be with those people.” Ryan: “People form really deep and meaningful relationships through that. Find your support groups wherever you can find them.” Kevin: “I met a lot of parents. I’m still good friends with a couple. It’s quite a journey when you meet people like that. Meet other parents, communicate, and just talk.”
Learning from other parents	Adam: “When I go to the grief group, I’m reminded of like, ‘Oh my gosh, you can lose a child that way?’. People do. Oh my god, I’m sitting next to someone who lost their child 15 years ago and they still appear as very crippled. They need medication to get through days. It’s not to comparison shop and make myself better, but it just reminds me ‘Oh my gosh, the effect that this still has on any one of us’. It makes me feel like ‘gosh!’. It opens your eyes. Just when you think you have something figured out, there’s another opportunity to learn from it. It opens my eyes all the time to how this can affect people. I always have to stop myself before I make too many big assumptions. You hear stories. There’s all this different perspective out there. We have a lot of similarities, and there’s just always something else to learn.” Steven: “[There] was a dad I finally connected with to understand what the experience was like. He was a great friend and mentor. I know a whole range of dads that are anywhere from a year out to 14 years out. Everybody has something to add. It was a great opportunity to instantly connect with other families that lived through the same hell we did and came out the other side, all a bit empty, but also stronger.”
Supporting other parents	Daniel: “It’s not so much for me anymore. It’s for the people who are coming. I don’t feel like I need a support group. It’s more to show and talk with people, and listen to their stories, and if nothing else show them that you can get through this.”

Participating fathers also discussed disadvantages of peer support groups. One being that it is mothers who attend primarily. When fathers do attend, they are less likely to be actively engaged. Additionally, exposure to other bereaved parents with intense grief adds to fathers’ own distress. Examples of peer support disadvantages are presented in Table 2 below.

Table 2.

Peer Support Disadvantages

Disadvantages	Illustrating Examples
Mothers primarily attend; when fathers do attend, they are less likely to be actively engaged	James: “In my organization, we find [it] is 88% women. We’ve had one conference. I think it was at least 80% women, and most of the guys were dragged by their wives.” Eric: “There I am. The lone guy talking with the girls, like I’m one of the girls. Dads are not very active. They have a facebook group [for dads]. I was like, ‘Oh wow, a facebook group for (dads). That’s pretty cool. Let me going to go in there: Hi everybody’. Nobody responds. Guys don’t want to deal with it.” Ryan: “In any of the groups that I’ve been in they’re like, ‘Yeah, we need a men’s group’. Women are naturally encouraged to go formally to an emotionally supportive community, and men are much less so. I’m not talking about just like going drinking with your buddies. That’s one of the biggest things I think men really need.” Adam: “There are so few men. When they do come in, the woman does all the talking and the man just sits there. I’m like, what the hell?! I notice that in my grief group when men are there, it’s just crazy to me how we have such a hard time talking about this. I remember the first meeting I went to there was a guy across the room. We’re the only two men, and there was like 22 people. I’m going ‘Okay, cool! There’s another guy!’ But he was in a different space. He was there with his wife. I learned through [the] small groups (that) they haven’t talked to anyone in six months. And I’m going like, what?!!? So, I had to pull back. I just said hi. He clearly didn’t want to talk to me. I was thinking, this is weird. Okay, I’ll give him his space. Then I go to the second meeting. There’s myself and two other men, but they were there with their wives and the men wouldn’t talk. I’m saying, what the hell? The wife would tell the whole story of how the child died and how she feels. While [the mother] introduced them when we went around the circle at the start of the meeting, [the father] wouldn’t talk. He just looked down. Then when I walked over to him and introduced myself, he immediately started talking about one of his biggest pains. He said, ‘I’m at a point where I’m just not going to talk about this to anybody. I’m not going to bring it up. I bring it up, and it brings down the room. I wreck conversations. I just decided I’m not going to bring it up ever again. I’m not going to talk to anyone anymore’. I said, ‘Well, actually it’s interesting that you say that. I read this book [written by] Ivan Maisel. He was an ESPN reporter, and he lost his son to suicide [in] 2015. He has a very good perspective on how he gave himself permission to not feel shame about talking about his son’s death. When he goes into these situations and conversations, he developed a script for himself. He says that he’s not afraid to say it. If a conversation steers itself in that direction, say it! Don’t worry about their feelings. You have to be able to get it out of you’. So, I was just explaining that to him. I wasn’t counseling him in that way, but I was just explaining it about the book. We kinda connected. I realized, I completely understand that pain. An interesting thing came up in my therapy session. The therapist [said] ‘Why do you think it is women dominated and the men don’t talk? Why are the women doing the talking?’. I said ‘I believe it’s because women just keep talking. They don’t stop’. I know this is an overgeneralization, but I started to test it with my wife. We’re pretty open communicators. I recognized too that it always starts with how is her day going and she can dump for an hour! And I’m just like listening and listening. I realized about half way through, I want her to stop! I don’t have the heart to tell her to stop. I finally just told her one day, ‘If you wonder sometimes why maybe I’m not expressing myself, it’s because you don’t shut up!’ It’s nothing personal, but now it seems to play out in the grief group too. I’m just staring at these men and I can just see their pain! [I see] their red face. They’re staring looking at their feet. They’re uncomfortable! And I just want to freakin shoot them and say ‘freakin say something, because I’m about to!’ I don’t believe this is like, ‘Oh, women are doing all this wrong’. No, not at all. These are just observations more than anything, out of my curiosity. When I brought this up to [my wife] she was like, ‘You know, you’re right! You are totally right! You are absolutely right’. We had a really bonding over it. I now think about it this way. I’m a guy. I say a little, but then we move on. Then we’re in a grief group and I’m supposed to share my feelings with a bunch of women. That bunch of women are speaking for the men. I can understand why a lot of men are like, ‘Just screw it! I’m not saying a thing’ and literally you can see their pain. You could literally see the pain eating them and you want to pull it out of them. I think if they just had like an absolute meltdown right now and tears, that would really benefit them. This is my assumption. I’m not gonna judge the other guys because I’m right there with you. But at some point, I think you can just see the pain in your fellow man. Listen man, I can see your pain and we got to get this shit out of us.”
Exposure to other bereaved parents with intense grief can intensify fathers’ distress	Ryan: “There is support for bereaved parents, but the thing is the support is basically peer support. It’s by people who can be pretty wounded themselves. There’s not really much guidance going on. They are peer run organizations. They are full of people who are just trying to piece things together themselves. They don’t really know how to moderate meetings, but it’s good that they’re there. I know of other people for who it is like a complete lifeline because they got nowhere else to go, no one else to help them. Some parents find it immensely helpful, and I can see that. People are just trying to just survive and hold on. That can be very difficult to be around. Peer support groups can be really amazing, or they can intensify your distress. One of the things that intensified my distress was being around people who were really distressed, like open wounds of grieving. That’s where also a ton of online stuff like facebook, where there are all these groups, and you can join these groups. I don’t go to those personally or very much, or I join them and go in occasionally. I’m very, very careful about which ones I spend any time in. It’s just like there’s just a whole bunch of people who are just so wounded and so bleeding that it can be really painful to be around. There are all these people, like a room full of pain. I’m very empathic and sensitive to that. Someone [else] might not be, but for me it was difficult especially when there’s not much moderation and people are just dominating [the conversation] using those formats to do their therapy. It’s like vomiting a lot of emotions. It can be pretty overwhelming.” Steven: “I also found that a lot of people in the group were letting grief crush them. [For example, they said] ‘I’ve been in this group for 30 years. I haven’t left the house. I can’t do anything’. I didn’t find that helpful, so I stopped going to that”. Eric: “A grief retreat is put on by my organization. I’m a little done with them because it’s been two years already. I don’t need to. I feel like that’s for within the first 18 months. I think it’s good. I think after that it’s not going to do anything for me. I’m already dealing with my own grief. I don’t need somebody else’s problems on me like that magnitude. They’re heavy. They’re heavy. They’re heavy”

Disadvantages

Illustrating Examples

Mothers primarily attend; when fathers do attend, they are less likely to be actively engaged

James: “In my organization, we find [it] is 88% women. We’ve had one conference. I think it was at least 80% women, and most of the guys were dragged by their wives.”
Eric: “There I am. The lone guy talking with the girls, like I’m one of the girls. Dads are not very active. They have a facebook group [for dads]. I was like, ‘Oh wow, a facebook group for (dads). That’s pretty cool. Let me going to go in there: Hi everybody’. Nobody responds. Guys don’t want to deal with it.”
Ryan: “In any of the groups that I’ve been in they’re like, ‘Yeah, we need a men’s group’. Women are naturally encouraged to go formally to an emotionally supportive community, and men are much less so. I’m not talking about just like going drinking with your buddies. That’s one of the biggest things I think men really need.”
Adam: “There are so few men. When they do come in, the woman does all the talking and the man just sits there. I’m like, what the hell?! I notice that in my grief group when men are there, it’s just crazy to me how we have such a hard time talking about this. I remember the first meeting I went to there was a guy across the room. We’re the only two men, and there was like 22 people. I’m going ‘Okay, cool! There’s another guy!’ But he was in a different space. He was there with his wife. I learned through [the] small groups (that) they haven’t talked to anyone in six months. And I’m going like, what?!!? So, I had to pull back. I just said hi. He clearly didn’t want to talk to me. I was thinking, this is weird. Okay, I’ll give him his space. Then I go to the second meeting. There’s myself and two other men, but they were there with their wives and the men wouldn’t talk. I’m saying, what the hell? The wife would tell the whole story of how the child died and how she feels. While [the mother] introduced them when we went around the circle at the start of the meeting, [the father] wouldn’t talk. He just looked down. Then when I walked over to him and introduced myself, he immediately started talking about one of his biggest pains. He said, ‘I’m at a point where I’m just not going to talk about this to anybody. I’m not going to bring it up. I bring it up, and it brings down the room. I wreck conversations. I just decided I’m not going to bring it up ever again. I’m not going to talk to anyone anymore’. I said, ‘Well, actually it’s interesting that you say that. I read this book [written by] Ivan Maisel. He was an ESPN reporter, and he lost his son to suicide [in] 2015. He has a very good perspective on how he gave himself permission to not feel shame about talking about his son’s death. When he goes into these situations and conversations, he developed a script for himself. He says that he’s not afraid to say it. If a conversation steers itself in that direction, say it! Don’t worry about their feelings. You have to be able to get it out of you’. So, I was just explaining that to him. I wasn’t counseling him in that way, but I was just explaining it about the book. We kinda connected. I realized, I completely understand that pain. An interesting thing came up in my therapy session. The therapist [said] ‘Why do you think it is women dominated and the men don’t talk? Why are the women doing the talking?’. I said ‘I believe it’s because women just keep talking. They don’t stop’. I know this is an overgeneralization, but I started to test it with my wife. We’re pretty open communicators. I recognized too that it always starts with how is her day going and she can dump for an hour! And I’m just like listening and listening. I realized about half way through, I want her to stop! I don’t have the heart to tell her to stop. I finally just told her one day, ‘If you wonder sometimes why maybe I’m not expressing myself, it’s because you don’t shut up!’ It’s nothing personal, but now it seems to play out in the grief group too. I’m just staring at these men and I can just see their pain! [I see] their red face. They’re staring looking at their feet. They’re uncomfortable! And I just want to freakin shoot them and say ‘freakin say something, because I’m about to!’ I don’t believe this is like, ‘Oh, women are doing all this wrong’. No, not at all. These are just observations more than anything, out of my curiosity. When I brought this up to [my wife] she was like, ‘You know, you’re right! You are totally right! You are absolutely right’. We had a really bonding over it. I now think about it this way. I’m a guy. I say a little, but then we move on. Then we’re in a grief group and I’m supposed to share my feelings with a bunch of women. That bunch of women are speaking for the men. I can understand why a lot of men are like, ‘Just screw it! I’m not saying a thing’ and literally you can see their pain. You could literally see the pain eating them and you want to pull it out of them. I think if they just had like an absolute meltdown right now and tears, that would really benefit them. This is my assumption. I’m not gonna judge the other guys because I’m right there with you. But at some point, I think you can just see the pain in your fellow man. Listen man, I can see your pain and we got to get this shit out of us.”

Exposure to other bereaved parents with intense grief can intensify fathers’ distress

Ryan: “There is support for bereaved parents, but the thing is the support is basically peer support. It’s by people who can be pretty wounded themselves. There’s not really much guidance going on. They are peer run organizations. They are full of people who are just trying to piece things together themselves. They don’t really know how to moderate meetings, but it’s good that they’re there. I know of other people for who it is like a complete lifeline because they got nowhere else to go, no one else to help them. Some parents find it immensely helpful, and I can see that. People are just trying to just survive and hold on. That can be very difficult to be around. Peer support groups can be really amazing, or they can intensify your distress. One of the things that intensified my distress was being around people who were really distressed, like open wounds of grieving. That’s where also a ton of online stuff like facebook, where there are all these groups, and you can join these groups. I don’t go to those personally or very much, or I join them and go in occasionally. I’m very, very careful about which ones I spend any time in. It’s just like there’s just a whole bunch of people who are just so wounded and so bleeding that it can be really painful to be around. There are all these people, like a room full of pain. I’m very empathic and sensitive to that. Someone [else] might not be, but for me it was difficult especially when there’s not much moderation and people are just dominating [the conversation] using those formats to do their therapy. It’s like vomiting a lot of emotions. It can be pretty overwhelming.”
Steven: “I also found that a lot of people in the group were letting grief crush them. [For example, they said] ‘I’ve been in this group for 30 years. I haven’t left the house. I can’t do anything’. I didn’t find that helpful, so I stopped going to that”.
Eric: “A grief retreat is put on by my organization. I’m a little done with them because it’s been two years already. I don’t need to. I feel like that’s for within the first 18 months. I think it’s good. I think after that it’s not going to do anything for me. I’m already dealing with my own grief. I don’t need somebody else’s problems on me like that magnitude. They’re heavy. They’re heavy. They’re heavy”

Helpful and Unhelpful Peer Support Group Activities

Participants also shared examples of helpful and unhelpful peer support group activities. Helpful peer support group activities included an informational newsletter and a symbolic butterfly release. For example, Michael found his peer support group’s informational newsletter helpful because it provided anticipatory guidance about how to navigate holidays that trigger grief intensity. Michael stated, “They put out a newsletter that was so right on target. Here’s what you need to know. Here’s what you need to do for your holidays. Newsletters [are] very, very helpful”. Tim found a butterfly release to be helpful, stating: “When you don’t have your kids to hold on to or [you can’t] create new things together, something symbolic like a butterfly release that can actually be really helpful”.

Other participants did not find specific group activities helpful, such as reading grief literature, yoga, or creative art projects. For example, Steven shared: “I don’t really personally prescribe to all the different bereavement exercises. I’m not really a big fan of like exercises, like do this reading or whatever. That’s not my thing. That works for some people. I do meditate; but, like music or yoga or art projects, I don’t really see dads doing a lot of that”.

In addition to peer support groups, some participating fathers shared their perspective of professional mental health counseling as another component of a supportive community.

Support from Professional Mental Health Providers

Some participants sought support from professional mental health providers. The amount of professional support varied, from a short-term temporary basis to more sustained long-term support. Some participants perceived professional support to be helpful, while others did not perceive it to be helpful. A few examples follow to illustrate the contrasting individual perspectives of professional support.

Nick attempted to seek professional grief counseling from a therapist; however, none of the therapists to whom he was referred followed up with him. Nick explained: “I tried to get a therapist after I called many. I was referred to many, but none of them called me back. They didn’t call me back. I called my primary care physician to get referrals, and they referred me to them. I called them and left messages and called them and left messages. I guess it’s not meant to be.”

Eric did not perceive professional support from a therapist to be helpful, stating: “I had done some therapy and then I quit it because they don’t get me. I’m just talking, talking, talking. I’ve talked enough. I was out of breath at that point. I don’t know what kind of support I could get on a daily basis. It’s not like there’s a daily support that I need. It’s not like I’m going to go for dialysis or something. It’s not like there’s a magic pill that you could take to cure you. There is Xanax or drugs of that sort, but that doesn’t cure you. All that does is just mask it.”

Ryan perceived professional support to be helpful as he, recalled his therapist’s explanation of therapy: “He said, ‘Having those feelings and really consciously reaching out and sitting with them is like you’re dipping your finger into boiling water. Your hand is in that boiling water anyways, so you might as well notice it and have it in a controlled way through therapy.” Ryan’s therapy included talk therapy, emotional freedom technique (EFT), and eye movement desensitization and reprocessing (EMDR), about which he says: “It’s been completely life saving for me”. Ryan also received professional support from a hospice bereavement counselor for two years after Mia’s death. Although this was helpful, Ryan felt two years was not long enough stating: “Having a bereavement counselor for two years who came over to our house every week and was there for us was amazing, but honestly, two years isn’t that long. It was really helpful to have the bereavement counselor”.

Adam shared his perception of professional support he received from a grief counselor, stating: “I think I had expectations that there should be some rapid realization or understanding of why [Olivia died]. At one of my last visits with the counselor it was like 2, 3 months out and then I pulled the plug on it because I [was thinking] ‘I’ve got to focus on work. My wife and I are doing okay. It’s hard. I don’t think I’m getting anything out of this’. I was a little frustrated, but not angry. I think I had expectations that I was supposed to have some epiphany to understand the why behind this already, and here its 2, 3 months out. [The counselor] told me blankly during one of my visits: ‘That is not to come. It may not come for a long time. It’s way, way too early’. I was thinking ‘Oh, he’s just a lazy ass. He doesn’t want to do anything’. That’s where I was at the time, and [now] it’s almost the 6-year point. It was early and things needed to play out more [in] those early months”. Adam’s perception of counseling changed when he resumed professional support two years later, for as he explained: “I realized that counselor was pivotal. He helped sort out a lot of files in my mental cabinet, things that he pointed out. He said, ‘Your daughter’s life was not that 11 months [of cancer]. You had almost nine years with her. There was a lot more to it. If you reduce her life to those 11 months, you sort of reduce her. Even in those 11 months, there were times where you laughed’.” Adam also shared that the counselor helped to reframe his thinking about hope, explaining: “[The counselor said] ‘You had hope’. ‘Hope is a powerful thing.’ I learned not to be angry about hope. I was able to start to shift. I was able to shape a different perspective. He recognized how arrogant was I that I would outlive my daughter. I think that just because I gave birth to her, and that the doctor said she was beautiful, and everything was great, you just live under the assumption that that’s how it will play out. I was able to work through that. I was able to see the death more broadly”.

Steven received professional support from a therapist before and after Jeremy died. Steven shared: “Thank God I found my therapist who said ‘It’s okay. This is what you have. This is how you should feel. What you’re doing is totally fine’ and validating that. It’s hard for men to want to engage with a therapist, who might not necessarily be a male. To find somebody who takes your insurance and is available is really hard. I didn’t know that he had lost his wife to cancer. He didn’t tell me that till later, but just having had that experience made it so much easier for him to share advice of common things”.

Recommendations from Participants to Health Professionals

Participants voluntarily suggested eight recommendations, which they believed would help nurses and other professionals improve supportive care for bereaved fathers in the future. Their recommendations included the following: (1) connect fathers with peer support groups and professional mental health providers before and after loss; (2) help fathers make memories; (3) provide fathers with time, privacy, and choices; (4) provide fathers with compassionate guidance and resources for managing logistical matters after a child’s death; (5) attend the child’s wake, funeral and/or memorial service; (6) maintain contact and follow-up with fathers - do not abandon fathers; (7) assess men’s loss history and bereavement; and (8) conduct follow-up wellness visits to assess fathers’ wellbeing. Examples of participants’ recommendations are presented in Table 3 below.

Table 3.

Participants’ Recommendations to Health Professionals

Recommendations	Illustrating Examples
Connect fathers with support, including peer support groups and professional mental health providers before and after loss	Michael: “It would be very helpful to connect them to people like these grieving parent groups. I had a difficult time trying to find a grieving parents’ group. It was not easy to find! So, facilitating that could be helpful for parents. It might not hurt to have somebody who could go with them because it just shakes you up! You’re not okay after you leave one of those things. It stirs the pot. Those resources are really helpful. Some counseling could help. People might need an antidepressant.” Ryan: “I think any parent, but especially dads who are less likely to have support, need to have some support that is put right in front of them. They may not want to, but they should at least know it’s there. They should be told: ‘By the way, you should really, really, really think about going to a counselor or maybe that’s just talking to your pastor, but something’. Especially men need to know. It would really be in your best interest if you did not do this by yourself. You need community. You need professional support, [and] peer support is huge, and family support if you can get it”. Start by saying, ‘Are in you therapy? Do you have access to a grief counselor? I highly recommend that you find ways to work on your emotions. Do you have a therapist? Have you been to a therapist? Have you thought about going to a therapist?’ A list of resources would be really helpful because that’s something that’s pretty minimal for the nurses because [they] aren’t grief counselors. [Nurses are] busy dealing with people who are still here. Even to have something that’s printed out, like a handbook, that could be given to people and say ‘Here. Here’s your list of resources’. It’s essentially just telling [fathers] ‘You’re really going to need some support. You need it now. You’re going to need it in the future. Whatever that looks like to you, I encourage you to seek it out. Start with your community. If you belong to a faith community, talk to your pastor, talk to your Rabbi, start there. Go meet [and] see if they can connect you with other people. If you don’t have a community, find a community. That can be online. You’re going to need it’. People are going do better if they have access to those resources. I think absolutely that should be encouraged especially with child loss. Having peers to talk to should be heavily encouraged.” Steven: A nurse could be a facilitator and lead that actual support. Say, ‘Hey, I recognize this might be something you might want to check out’ [and] talk about the importance of it and getting it and providing connection and guidance. That’s absolutely critical to have nurses be able to recognize that and take action. The nurse may recognize something and give you a pamphlet, right? [And] I’m like, ‘Okay, that’s pretty with some words. That’s wonderful. I’m going to leave this here on the chair, or I’m going to leave it in the car, or I’m going to throw it out. I gotta deal with getting my kid in the wheelchair, waiting for the pain meds, or whatever else is going on’. So the next step is for that nurse is to say, ‘Hey, I’m happy to reach out to this organization on your behalf. Would you want me too? It’s going beyond just [giving] the pamphlet. It’s the repeated nature of it. Because you give them a pamphlet once and they’re like, ‘Yeah, whatever like a set of instructions like yeah I’ll throw those away’. Hopefully that nurse sees that family again and recognizes something and says, ‘Hey, I’m not trying to tell you what to do but something you may find helpful is finding somebody who can talk with you about this and has gone through this. Check this out’. To be able to actually make that actual connection there and doing it. The biggest barrier they’re going to find in getting that peer support is getting parents to raise their hand and acknowledging their child is late-stage cancer and acknowledging [it]. That’s gonna be really tough. But having nurses trained in that and understanding that is going to be incredibly valuable. If the nurse understands it better, they can recognize it and be proactive about it. If there was somebody who would connect me to a peer support organization that would be incredible. I would see my doctor more frequently because I was concerned about my health and if I fell apart that’s a problem. He prescribed me antidepressants and sleeping pills. He knew I was getting good mental health care. He would have definitely referred me to somebody, but the onus of responsibility falls on me to be able to do that. For the dad to break through the stigma of seeing a therapist is hard, but it doesn’t mean you shouldn’t try.”
Help fathers to make memories	Tim: “Everybody there were really prepared for it. They gave us a disposable camera which I thought was the most insane thing at the time! I was like “No, I don’t want to. It’s weird. You’re going to take pictures of me holding my passed away dead daughter?’ I did it. I am so thankful I did. They all encouraged it saying ‘down the road people are happy to have this’. They were right. I’m really glad we did it. They took pictures of her. Even if a dad were to say, ‘I don’t want to do this’, encourage them to do it. They will regret not having that time. Just encourage them, not push it, but encourage it. It’s important.” Adam: “We had time after she died. I can remember the six-hour window after. I vacillated between the pain and the quiet; the eerie quiet in the room. The hospital was fantastic. They let us stay with her. They’re like, whatever you need. You need to sit here for a day, you got it. Whatever you need, whenever you’re ready to go. I was kind of hopping around. I found a little bit of comfort in gathering up some of her things and taking it out to the car, just getting out of the room for a second and coming back. We had those moments with her. During that time, [her brother] shaved her face. We changed her clothes [and] made sure she was clean. You always say as a human being you spend time learning how to live, and then you’re faced with the opposite of that. And now, I can look at that experience. This is an absolute moment of healing that really has something beautiful to it. Thankfully, I can see it. It is maybe that tiny little kick start to healing that I’m seeing. And the family’s together, because we’ll always be together. You see it differently.” Matthew: “When I called the hospital to check on paperwork, I wanted the medical files. I was met with more hostility than anything because how dare I ask for his medical files?! I fought for several months to gain those files from the hospital. I don’t know if they saw it as an insult or that I was coming after them, but it was almost like Fort Knox trying to get my own child’s medical records. When I finally did, not that I understood any of it, but I just wanted to be able to go through my son’s files. I was reaching for as much as I could get of him, as many memories as I could with the little time I had with him for a week”… “There was a group; they weren’t affiliated with the hospital. They just happened to be there on that day [and] checked in with the NICU unit. They had gotten his prints, and taken a picture, and got a little bear that was with him in the NICU unit. It looked like the biggest bear in the world next to him, but it fits in the palm of my hand. They sent that to me in a care box. That’s all that ever came. I thank them tremendously for that. I’m grateful that they were there that day.”
Provide fathers with time, privacy, and choices	Tim: “They gave us some time with her until she started to feel cold. One of the best things that I’m most thankful for when it comes to the immediate needs that the nurses provided was providing space and time with her afterwards.” Nick: “We were in the ICU at the time, so they quartered it off so no other patients could see him being moved from his room to the elevator to the morgue. They gave us as much time as we wanted with him. They told us that they would clean up the room and send anything to us. They said, ‘If it’s easier for you, you can pack up the room [or] we’ll just pack up the room and send stuff to you’. And so that’s what we did.”
Provide fathers with compassionate guidance and resources for managing logistical matters in the immediate aftermath of a child’s death	Michael: “It’s very, very difficult. I’m trying to do all these logistical things and I was already decimated. I had to tell my children what happened. I had to set up a funeral. I had to put together pictures of my son for the funeral. I had to write a talk. I spoke about my son’s life. It was a lovely talk actually. I had to design a headstone for my son. This is all I had to do. The whole thing just landed right here on these two shoulders. I was in charge of having to put together everything. It wrecked me. It was too soon. It was just too much too soon, but you don’t get an option when somebody dies. You have to pull a lot of stuff together. It would be great if they could develop resources to help [fathers] figure out how to do the funeral. I had an above average ability to be able to pull all that together. I think it’s a very challenging task. You only get one shot at it, and there’s no practice attempts. There’s just so much involved. You’re overwhelmed! You can’t even function. You can’t even think straight. The [hospital] billing department could say, ‘Hey look, this person just had a child die. We’re asking a grieving person to shuckle up I don’t know how much cash and they may not have it. That would be something for political advocacy; maybe there could be a special fund to help people with funeral and burial costs.” Matthew: “They called in a chaplain. The nurse sat there just to check the heart beat every so often to make sure everything was going okay. The chaplain and the nurse just sat there silent, while my wife and I were wailing and carrying on just having the worst moment of our lives. I don’t blame the nurse or the chaplain at all, but there was this just kind of sterile lack of empathy. It’s kind of their job to be like that so I don’t have any grievances towards that, but I mean you could fake a little compassion rather than just sit there like you’re just waiting for a bus or something. It was like it was another day at the office. Like, okay, this is kind of going on right now, lunch time is in an hour, and they sat there the whole time. When the nurse finally took the last check with the stethoscope [she] said ‘There’s no heartbeat. I’m going to take him away now and we’ll prep him for the mortuary service, and we will bring you a temporary death certificate for you to have with your files’. You know, five days ago I was given a birth certificate and now I’m getting a death certificate in one week! The delivery of both was just so foreign. There was no empathy. I was just like ‘What the hell?’. We just walked out with our heads down, trying to hold in tears, down the hospital corridor without our son. I had to sit in the car and try to keep myself together to try to drive home. A few days later we went to the mortuary service. I know that’s completely their job is to be a wall. They live and breathe that world, so I don’t blame them one bit for not having that empathy or show they care. I wasn’t expecting that at all in that building. I expected it everywhere else, but that was the one spot I knew it wasn’t coming. We had to choose an urn. It was so weird having to pay money for an urn to have the ashes of our son in. No one really helped me with that expectation and how it’s going to happen. The funeral director was just doing his job. I wasn’t expecting anything there.”
Attend the child’s wake, funeral, and/or memorial service	Tim: “The NICU nurses at that hospital were the greatest group of people that maybe I’ve ever been around. They were wonderful. A lot of them came to his funeral.” Nick: “One of the things that we just loved about the nurses so much that worked with him is they took such good care of him. He had this team of four nurses who came to his wake. They came together.”
Maintain contact and follow-up with fathers - do not abandon fathers	Eric: “Since Connor’s passing, we have seen our lead doctor. We had spent some time with him and he follows [us on facebook]. He calls us occasionally. I don’t bother him because he’s a busy man. How we talk is he follows us on facebook, he likes and loves on facebook. That’s how I know he’s there. He reaches out on his birthday.” Tim: “The nurses will still message me. They’ll say, ‘There are certain kids that just stay with us and so do their parents’, or I just see them on facebook that’s totally unrelated. One of them will comment and joke and laugh about something, and then she’ll follow it up with a message like, ‘Are you okay? I still think about Declan. I still think about you’.” Ryan: “One of the things that happens with bereavement, and one of the worst things was and this is just the way it is, we spend a year and half at hospice and we got to know the social worker really well [and] the chaplain. We got to know everyone really well. About three weeks after Mia dies, the social worker comes over and she’s with their bereavement person. And the social worker said, ‘I’m going now, and you have this new person’. That’s the way it is. That was really hard. The bereavement person was wonderful. We stayed in touch with her for two years. That’s part of the hospice thing which is amazing just to get that, but it doesn’t make up for that loss. Basically, you can’t call them anymore because they now need to go deal with the parents whose kids are still alive. Like the social worker, she’s gotta go somewhere else. It’s a loss.” Matthew: “[I heard] nothing from the hospital and after I got those [medical] records, I never heard a single thing from the doctors or anyone.”
Assess men’s loss history and bereavement	Nick: “Any time I’ve gone, my doctor really has not addressed it, the bereavement piece, at all. The nurses seem like they’re not sure what to say or what to do, like just feeling uncomfortable. What I found is they don’t really know what to do with me. You can tell there’s a shift. They’re more uncomfortable than I am. And it could be my imagination, but there was this one time when I felt like the nurse was really uncomfortable and just wanted to really hurriedly just wanted to get out of the room after she realized that my son had passed away.” Matthew: “I talked about it one time, and got that same sterile response of ‘Ah, sorry to hear that’ and on with the visit, and it was never discussed again. Whenever you go see a new doctor, you fill out all that history and for what? Most of the time it doesn’t do anything. They’re not checking on you or checking on past history. They’ll ask if you’re depressed. They do ask some psychological questions and some wellbeing questions, but not have you ever had a loss. That could probably help them more than have you ever felt depressed; that’s a blanket statement.”
Conduct follow-up wellness visits to assess fathers’ well-being (e.g. mental and physical health screenings, assessment of sleep and rest, anticipatory guidance)	Michael: I think follow-up visits from a social worker or a nurse who could over the course of several months just to make sure everybody is okay. Just to follow-up, that would be a brilliant idea. Nurses can facilitate some follow-up visits just to ensure the people’s physical health is okay. Your immune system is gonna take a whack. It’s really gonna get whacked pretty hard. That could make a difference. I don’t think I slept for days. Maybe even a prescription sleeping medication might not be a bad idea; something to just prescribe so you can get some rest. That did not help my immune system, for sure. [Guidance for holidays] it helps to have that! How are you going to handle the holidays? That’s something nurses could do.”

With an altruistic aim, participants offered their recommendations to help health professionals improve supportive care for bereaved fathers. It was their belief that implementing their suggested recommendations could be helpful for other bereaved fathers. Kevin urged all health professionals to “Listen. Pay attention. Learn. Show compassion. That’s what the world needs”.

Discussion/Implications

By applying interpretive phenomenology using van Manen’s (1997) method, this study provides one interpretation of fathers’ lived bereavement experience associated with child loss. This exploration broadens understanding of the meaning that fathers attribute to their bereavement experience. Understanding meaning can help health professionals gain new appreciation of and learn from fathers’ bereavement experience as they strive to positively influence person-centered supportive bereavement care.

Eleven fathers provided rich descriptions of their lived bereavement experience, articulating their need for a supportive community. However, they had difficulty finding and obtaining support. Literature suggests that societal stereotypes of masculinity and expectations of men’s grief expression, coupled with a general lack of social recognition of men’s grief and ensuing needs create stigma (McKenzie et al., 2022; Obst et al., 2020, 2021; Zinner, 2000). This, in turn, may negatively impact support-seeking and fathers’ overall bereavement experience. Additionally, studies suggest societal expectations and sociocultural patterns of fathers’ role as primary provider for the family, such as caring for and working to financially support their family, may influence grieving (Alam et al., 2012; Arach et al., 2022; Cook, 1988; Denhup, 2024a; Donovan et al., 2021; Grout & Romanoff, 2000; McNeil et al., 2021; Obst et al., 2020; Olson-Garriott et al., 2015). Scholars propose that gender does not determine the way people grieve, but rather that grieving styles are influenced by a myriad of factors, including gender, culture, socialization, temperament, and developmental experiences (Doka and Martin; 2021; Martin & Doka, 2011). Further, the societal assumptions may contribute to sparse accessible support infrastructure as participants themselves identified a lack thereof. There is opportunity to enhance the supportive infrastructure and curate existing support venues which health professionals can then provide to fathers. For example, nurses could compile a list of peer support groups for fathers who are experiencing anticipatory grief before and grief after their child’s death. By proactively providing contact information for and facilitating connections with peer support groups, nurses could relieve the burden placed on fathers to search for support themselves.

Findings reaffirm literature indicating fathers view peer support groups favorably (Aho et al., 2011; Samuelsson et al., 2001; Schoonover et al., 2022; Wood & Milo, 2001). Participants in this study perceived peer support groups to be beneficial because they received support directly from other parents with a shared child-loss experience. They felt understood. They found companionship and formed meaningful relationships with peers. They learned from other parents and were able to support other parents in return.

Findings expand understanding of peer support groups. While participants noted several advantages, they also identified disadvantages including the fact that it is primarily mothers who attend, fathers are less actively engaged when they do attend, and exposure to other bereaved parents who are grieving can intensify fathers’ distress. This aligns with literature suggesting peer support groups that are not facilitated by expert health professionals have unintended consequences, including negative experiences of group participation being emotionally draining, reemphasis on what was lost, feeling like an outsider when other stories are perceived as worse than the participant, and other members talking too much, being negative, or giving advice (Ahluwalia et al., 2025).

Participating fathers also shared their individual perceptions of professional support they received from mental health providers. Professional support was perceived as helpful for some participants, while not helpful for others. Some literature suggests bereaved fathers perceive professional support to be insufficient and provided by uninterested health professionals (Aho et al., 2009, 2011; McCreight, 2004; Wood & Milo, 2001). The contrasting perceptions about professional support among the participating fathers in this study make it difficult to draw inferences and limit generalizability. Future research is exploring fathers’ perceptions of professional support from mental health providers would be beneficial.

This study also generated insight into participating fathers’ recommendations to health professionals, based upon what was meaningful and important to them. While care must be taken to not broadly generalize participants’ recommendations to other populations, health professionals can reflect upon these and consider how they might apply when supporting fathers in their clinical practice setting.

Strengths and Limitations

This study has strengths and limitations that warrant consideration. This study provides one interpretation of the meaning of fathers’ lived experience of bereavement, as richly described by 11 participants to address a gap due to underrepresentation of fathers in the literature. Participants validated the study’s findings through a member-checking process; this is a noted strength. However, as is true of all hermeneutic research, there may be other plausible interpretations (Van Manen, 1997). Findings are representative of the participants, which limits generalizability to other populations of bereaved fathers.

Eleven participants reflected upon their lived experience at one point in time. The study did not aim to explore fathers’ perceptions of bereavement support specifically. Rather, participants’ need for a supportive community emerged as an essential theme of their bereavement experience. Future studies investigating fathers’ perceptions of bereavement support effectiveness, both peer support groups and professional support, is warranted.

As is typical of qualitative research (Kawar et al., 2024), the sample was small but adequate to achieve data saturation. The sample was homogeneous, with the majority being white, college-educated, married men from Western culture who actively participated in peer support groups. The study would have benefited from a greater representation of fathers from diverse racial, cultural, and socio-economic backgrounds. The study would have also benefited from fathers who do not participate in support groups. At the time of their interview, these well-educated men had support systems in place to help them grieve. It is possible that the bereavement experience and associated grief could be different for fathers who do not have the means nor access to peer support groups and/or professional support. While there are advantages to recruiting participants from support groups, including that participants have already begun to tell their stories to others, are likely personally invested in the research topic, and likely to find the research topic to be of importance (Cacciatore et al., 2013), doing so excludes fathers who are not in support groups from research studies. This is an underrepresented population of bereaved fathers that warrants further exploration. Further, cultural norms can influence perspectives of death and grief expression (Aeschlimann et al., 2024). Thus, further research exploring bereavement as it is lived by culturally diverse fathers and to explore culturally sensitive support needs is warranted. Support needs of marginalized and underrepresented fathers remain unknown. Future studies should investigate the support needs of fathers from minority ethnic backgrounds, fathers of low socioeconomic status, non-married fathers, fathers in the LGBTQIA + community, as well as fathers of adult children. It is likely such lifeworld factors could influence the meaning of their lived bereavement experience and how they grieve as a bereaved father.

The sample was also heterogeneous with regards to participants’ faith/religion, time since child’s death, and cause of child’s death. Studies suggest grief is experienced differently depending on factors, such as time post loss and death circumstances (Alam et al., 2012; Champion & Kilcullen, 2023; Lichtenthal et al., 2013; McNeil et al., 2021; Meij et al., 2008; Morris & Block, 2012; Prigerson et al., 2009). In this study which explored the phenomenon of bereavement, the nature of the lived bereavement experience with essential themes resonated with each participant regardless of the cause of their child’s death or length of time post loss. This unique triangulation is a noted strength.

Conclusion

By sharing what was meaningful and important to them, participating fathers hoped health professionals could learn from them and thought their input could be helpful for other fathers who experience child loss. This input from bereaved fathers who are living with grief helps to address Mulheron’s (2025) call for research that includes the voices and input of bereaved people. While more targeted research is needed for bereaved fathers, including greater diversity among participants and viewpoints during their grief and bereavement journey, this study amplifies fathers’ voice in the literature, deepens understanding of the nature of fathers’ lived bereavement experience, and illuminates fathers’ perceived needs for a supportive community.

Footnotes

ORCID iD

Christine Denhup

Informed Consent

All participants provided written informed consent prior to participating to conduct and publish the research.

Ethical Considerations

Fairfield University approved the study via expedited review (3973) on 5/4/2022.

Funding

The author received no financial support for the research, authorship, and/or publication of this article.

Declaration of Conflicting Interests

The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

It is not possible to share data because it could identify research participants.*

Author Biography

Dr. Christine Denhup is an Associate Professor of Nursing at Fairfield University. Dr. Denhup has practiced as a pediatric nurse, pediatric oncology clinical nurse specialist, and academic nurse educator during her nursing career. Her scholarship focuses on pediatric palliative care and bereavement.

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