title: The bereavement experiences of lesbian, gay, bisexual and/or trans* people who have lost a partner: A systematic review, thematic synthesis and modelling of the literature.
abstract: Socially excluded populations have poorer access to care; however, little attention has been paid to lesbian, gay, bisexual and/or trans* people. Lesbian, gay, bisexual and/or trans* people are at increased risk of certain life-limiting illnesses and may not receive the care and support they need at the end of life and into bereavement.
  
  
  
  To identify and appraise the evidence of the bereavement experiences of lesbian, gay, bisexual and/or trans* people who have lost a partner and develop an explanatory model of lesbian, gay, bisexual and/or trans* partner bereavement.
  
  
  
  Systematic review (in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines) and thematic synthesis with assessment of reporting and rigour. Quantitative or qualitative articles reporting bereavement experiences of lesbian, gay, bisexual and/or trans* partners were included, excluding articles reporting multiple losses in the context of HIV or AIDS.
  
  
  
  PsycINFO, MEDLINE, Web of Science, Scopus, Cochrane Library. Inclusion dates: database inception - 30 April 2015.
  
  
  
  A total of 23 articles reporting on 13 studies were identified. Studies described universal experiences of the pain of losing a partner; however, additional barriers and stressors were reported for lesbian, gay, bisexual and/or trans* people, including homophobia, failure to acknowledge the relationship, additional legal and financial issues and the 'shadow' of HIV or AIDS. A novel model was developed to explain how the experience for lesbian, gay, bisexual and/or trans* people is shaped by whether the relationship was disclosed and acknowledged in life and into bereavement and how this impacts upon needs and access to care.
  
  
  
  There is a need for healthcare providers to avoid hetero-normative assumptions; be mindful of additional stressors in bereavement for lesbian, gay, bisexual and/or trans* people; and consider additional sources of support to deliver individualised holistic care.
authors.affiliation: King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, UK Katherine.Bristowe@kcl.ac.uk.
authors.forename: Katherine
authors.initials: K
authors.lastname: Bristowe
authors.affiliation: Department of Palliative Care, King's College Hospital NHS Foundation Trust, London, UK.
authors.forename: Steve
authors.initials: S
authors.lastname: Marshall
authors.affiliation: King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy & Rehabilitation, London, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Harding
mesh_terms: D000223:Adaptation, Psychological; D001601:Bereavement; D005260:Female; D006117:Grief; D006801:Humans; D008297:Male; D012747:Sexual Partners / Q000523:psychology*; D000072339:Sexual and Gender Minorities / Q000523:psychology*
keywords: Lesbian; bereavement; bisexual; death; gay; partner; transgender