Grief is a normal response to loss - any loss: a job, a limb, a life - that involves processes and tasks at emotional, cognitive and behavioral levels.
The initial shock of learning of impending or actual loss evolves into a process of creating a new relationship between the grieving person and the person (or object) of loss. Grief tends to be experienced in waves, triggered predictably by new losses (such as a loss of functional status) or unpredictably, by seemingly trivial events. Over time the intensity of these waves tends to decrease. Individuals progress through the grief process at different speeds. But, no progress, getting fixed in one phase of grief, can be cause for concern.
Anticipatory grief for patients involves reviewing one's life; for families/friends it means looking to a future without the dying person. Byock has suggested that patients and families may wish to say to each other, in some way, "Forgive me, I forgive you, thank you, I love you and good-bye."
People from different cultural backgrounds may differ in terms of how and what they want to say or do in preparation for death. Not knowing or acknowledging that a person is dying will likely delay or interfere with normal anticipatory grief. Grief reactions in dying patients may be confused with pain, depression, and even imminent death (e.g. social withdrawal may imply pain, depression, or anticipatory grief).
Neither pain nor depression are normal aspects of the dying experience, they should be carefully evaluated as both are treatable.
Grief tends to be experienced as sadness, whereas depression is associated with lack of self-worth. The question, "Are you sad or are you feeling depressed?" may help begin a dialog to help you distinguish between grief and clinical depression.
About 10-20% of the bereaved can experience a persistent or prolonged period of intense loss. There is deliberation about the diagnostic criteria for complicated grief and duration of symptoms. However, insecure attachment styles, weak parental bonding in childhood, childhood abuse and neglect, female gender, low perceived social support, supportive marital relationships, and low preparation for the loss are all felt to be risk factors.
Normal grieving is facilitated being honest and discussing prognosis, goals and treatment options. Pay attention, inspire a meaningful discussion. Ask, "How are you doing with this recent news?" “Are you scared?" "What is going through your mind?”
Ask for help – there are other health professionals available to help with grief.
Assess for and aggressively treat pain and depression
See reference for more information.
Adapted from Hallenbeck J. Grief and bereavement. Palliative Care Network of Wisconsin. Fast facts and concepts #32. Internet. Accessed on December 27, 2018.