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Take-Home Messages for the Oncology Practitioner

Understanding Bereavement: What Every Oncology Practitioner Should Know

Links:

PDF OF ARTICLE: Recognizing Grief in Oncology Patients and Their Caregivers

Judith Lacey MD, FAChPM 

Article Outline

• References

Health-care professionals should recognize that grief may present in a variety of forms and at various times during a patient's illness and beyond.

—Kacel, Gao, and Prigerson, “Understanding Bereavement: What Every Oncology Practitioner Should Know”

Recognizing and addressing the psychological distress of patients and their families often falls to the oncologist. We know that up to 50% of patients with cancer have identifiable psychiatric disorders, such as anxiety, depression, delirium, and demoralization.^[1] But when it comes to patient grief, how do we diagnose this and differentiate it from other complaints? Which patients are more susceptible? How do we identify the family with anticipatory grief or at risk of prolonged grief disorder (PGD)? Are there interventions during the course of the illness trajectory that can improve the well-being of both patient and family? This article provides an overview of what the oncologist should know about bereavement.

As clinicians working with patients with advanced cancer, we are aware that many of our patients do not want to be perceived as a burden to their family and want to know that their family members and loved ones are supported. Patients wish to ensure that the impact of their disease and dying will not result in long-term emotional, social, or physical family member morbidity. Identifying family members' psychosocial and coping concerns is therefore an integral part of patient care.^[2]

As people live longer with a diagnosis of incurable cancer and all its uncertainty, researchers remind us to consider anticipatory grief. Both patient and family can be grieving - a process that may begin at any time from the moment of a cancer diagnosis. Cultural background, personality, past history, and family function contribute to how one grieves. In a recent publication in Death Studies, the complex nature of grief in the patient with advanced cancer is explored further, recognizing the overlap of symptoms with major depression.^[3] The interesting question is whether interventions introduced for the advanced cancer patient to address existential and psychosocial distress may also be useful for the grieving patient.

From Kacel, Gao, and Prigerson's article we have learned that clinicians have the opportunity to aid in reducing postloss and potentially pre-loss suffering. We need to identify those patients and family members who are at risk of developing PGD, think about the possibility of anticipatory grief, refer those requiring intervention, and refer early to palliative care (hospice) as it improves bereavement outcome. We need to be aware of the significant positive impact good patient–doctor, parent–doctor, and family–doctor communication can have on reducing PGD and long-term morbidity.