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Recognizing Grief in Oncology Patients and Their Caregivers

Understanding Bereavement: What Every Oncology Practitioner Should Know

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PDF OF ARTICLE: Take-Home Messages for the Oncology Practitioner

doi:10.1016/j.suponc.2011.04.008

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Noreen Carrington LMFT, FT, Charles F. von Gunten MD, PhD 

[Author vitae]

Article Outline

• What Every Oncology Practitioner Should Know
• Grief in the Oncology Practitioner
• References

Kacel and colleagues provide an exhaustive review of bereavement theory and practice.^[1] However, as a consequence of the depth and structure, readers might miss the “take-home” messages that every oncology practitioner should know. In addition, every oncology practitioner needs to be able to recognize the grief responses in oncology practitioners themselves.

What Every Oncology Practitioner Should Know

Every oncology practitioner, whether physician, nurse, pharmacist, radiation technician, or medical or clerical assistant, needs to know that grief is normal. Grief includes the emotional, physical, cognitive, and spiritual responses to loss. It is as normal as the flash of blood when starting an intravenous line or the pain of a bone marrow biopsy.

The manifestations of grief—what one is likely to see in the office or in the hospital—are varied: Crying, anger, emotional numbness, behaving as if nothing has changed are all common. The most important thing to know is that these relate to grief. People are not trying to be difficult; they are not borderline or dysfunctional. Eighty percent of the bereaved will get through it without professional help.^[2] Most people do cope. While they may never feel “the same” as before, they will adapt to a new normal and carry on productive lives.

The response to grief from the oncology practitioner for those 80% should be the human response. The development of new skills beyond that of the average caring health professional is not needed. When someone is crying, stop talking, sit down, and listen. When someone is angry, stop talking, sit down, and listen. When a survivor of a patient who died tearfully says that he or she hears the person’s voice or experiences a yearning for the presence of the deceased, sit down and listen. We are always surprised when it is the reception clerk in a busy oncology practice who seems the most skillful when confronted with a patient or family member expressing strong emotion. We speculate that it is because he or she has not unlearned the compassionate human responses that well-socialized adults demonstrate in such situations. We also observe that the expression of any strong emotion tends to upset oncology professionals, and those professionals tend to give the nonverbal signal to the person expressing the strong emotion to STOP IT!

For the 20% of patients or family members whose grief is associated with difficult adaptation, referral for specialized treatment is appropriate. There is no evidence that therapy from a psychiatrist versus a psychologist versus a social worker versus a marriage and family therapist is better or worse. The oncology practitioner needs to know what is available in his or her environment and to use it.