Table 3.

Multiplicity of Loss, Subthemes, and Exemplar Excerpts From Selected Articles

Subtheme	Description	Exemplar Excerpts From Selected Articles
Uncertainty	Prognosis: not knowing whether individuals and families needed to prepare for death	“For SARS, death can hit suddenly. Families usually do not have the chance to hear the last words of patients or say their last words to patients.”8
	Information: uncertainty surrounding beliefs about the illness, including information provided by relevant authorities	“It is a poison brought by foreigners to divide us”9 “It is a disease brought by nongovernmental organisations (NGOs) in order to get more money”9
Disruption of connectiveness and autonomy	Multiple disruptions having an impact on the ability to “connect” and limiting choices	Physical barriers “ … because you just see people, through this mesh, or they have some kind of eye glass on their face, you only see a small part of a body”11 “They could not be near their loved ones, (or) touch them, (or) whisper to them. Everything had to be done through the cold glass panel.”8
		Psychosocial barriers “Family members … had to take care of children or elderly in their homes, or they were too afraid to come into the ETU, or they did not have money for transportation.”10 “I saw him walk out and sit in the common area and cry quietly to himself. Nobody was there to be with him.”8 “The subsequent isolation undermined their healing process and affected their ability to cope, as they received little support during their mourning and could not share their traumatic experiences.”10
		Loss of autonomy “The patient has no choice over where he dies or over who will be present when he dies.”8 “Going home to die was not possible for the majority of patients due to the difficulties in the discharge process.”8
		Interruption to usual rituals and practices “ … the rituals and funerals are either absent or shortened (when the body is abandoned or taken away rapidly to be buried in mass graves).”9 “In the Haitian culture and belief system, respect for the dead and ancestors are of tremendous importance, with consequences to individual and collective wellbeing.”9
		Loss of memorialization “When corpses were cremated, without funerals or formal burial, they did not even have a grave to visit.”10 “the usual processes for grieving become difficult … as there were no graves to visit or corpses were buried in unmarked graves or cremated without formal burial ceremony.”13
Factors influencing bereavement outcomes	Opportunities to promote social connections	“Designated meeting rooms with transparent dividers may allow visits of relatives inside the ETU.”10
	Respect for rituals in keeping with faith or culture	“The mourning tent placed inside the CTC allows family members to gather and say a last goodbye to their beloved ones.”9 “The possibility is also offered to the family to contact a religious leader of their choice, should they want a prayer or ritual to be organised before the body is transported and buried.”9
	Psychosocial support interventions	‘… psychosocial support interventions can play an important role in the response to such an epidemic.”9 “Support of family, friends, faith, and participation in a survivor's association were frequently mentioned coping strategies ….”10

ETU = Ebola Treatment Unit; CTC = Cholera Treatment Center.