A comparative approach to end-of-life care and bereavement in France and sub-Saharan Africa

In this article, we examined the potential positive effect of end-of-life spousal assistance, communication and ritual acts on the process of adjustment to loss. Adopting a comparative transcultural approach, the study was conducted in France and Togo (West Africa), two cultural contexts differing in their approach to dying, death and bereavement. The two samples included a total of 235 bereaved spouses. Although the two samples were not homogeneous in terms of bereavement period, no significant differences were found in the level of complicated bereavement symptoms. However, the Togolese bereaved reported more perceived post-mourning growth, especially when the deceased died of old age. This post-mourning growth is also favoured by end-of-life communication with the dying person and the performance of ritual acts in support of the agony phase. In the French sample, post-mourning growth was experienced more by mourners who had had more intimate communication with their dying spouse. Our results clearly showed that assisting the dying without ritual support or communication was a risk factor associated with a difficult grieving process. These results clinically suggest promoting communication with the dying, symbolic ritual acts in end-of-life support and in particular in the assistance of relatives to the dying.