Understanding Bereavement: What Every Oncology Practitioner Should Know

Authors: Kacel, E. Gao, X., & Prigerson, H. G.

Published: J Support Oncol. 2011 ; 9(5): 172–180. doi:10.1016/j.suponc.2011.04.007.

Introduction:

Bereavement deserves special attention in oncology practices because of the frequency with which providers, patients, and their families encounter death. The biological, psychological, and socio-cultural demands of a potentially terminal illness such as cancer put all involved parties at risk for experiencing grief at many points throughout the continuum of care, both before and after death. Grief may develop before a death as patients and their families experience the loss of physical abilities and roles, activities, relationships, or a sense of a future (1). These losses may heighten a person’s sense of loneliness, fear, anger, sadness, helplessness, and hopelessness (2). Although grief typically decreases over time, the onset and expression of distress following a loss may vary among individuals, families, and cultures (3).

A vast body of research has examined grief in terms of risk factors, clinical presentations, and treatment options. In this literature, many terms have been employed to discuss these aspects of the experience of loss. Typically, “bereavement” refers to the death of a significant other (4, 5). Grief represents the psychological reaction to the death and has been described as a feeling of “wanting what you cannot have” (6). Grief encompasses the distress, including related feelings, cognitions, and behaviors which occur as a result of this loss (1, 5). Finally, “Prolonged Grief Disorder” (PGD) refers to a severe and protracted reaction to loss which manifests as extreme emotional distress and mental or functional impairment (7,8, 9). Due to the unique relationship that often exists between a patient, their family and the oncologist, providers have an opportunity to assist patients and families in adjusting to the many losses both will encounter. In particular, by encouraging the development of acceptance prior to the loss, providers may give family members a sense of predictability and comfort which helps them to understand the dying process and decreases their distress (1, 10-11). This paper is designed to address the practical needs of oncologists who are likely to encounter various presentations and morbid outcomes of grief and bereavement. We include a review of major theoretical models of grief, risk factors, clinical presentations (including pathological reactions), special circumstances, and conclude with a discussion of how oncology staff can best help patients and their family members by considering their losses holistically, in terms of their unique constellation of biological, psychological, and socio-cultural traits.