Curbside Consultation

Helping Patients Cope with Grief

 

Am Fam Physician. 2019 Jul 1;100(1):54-56.

Case Scenario

A 56-year-old patient recently came in for a six-month follow-up for some well-controlled medical conditions. He has been my patient for more than 20 years and has generally been upbeat at his visits. Over the past few years, he has shared freely about his wife's battle with metastatic colon cancer. When asked how he was handling her declining health, he typically responded, “I'm hanging in there.” At this visit, the veneer of keeping things together had vanished. He shared through teary eyes that his wife had died about a month ago. He was visibly upset, barely made eye contact, and spoke with a shaky voice. He tried to maintain his composure, but emotions got the better of him. I offered comfort and condolences as best I could; however, I didn't believe that I helped much. Other than referring him for grief counseling, what are some recommendations for busy primary care physicians when helping grieving patients?

Commentary

The loss of a loved one, especially a spouse or a child, is perhaps one of the most difficult events a person will experience in a lifetime. The resulting grief can be overwhelming and incapacitating for a time. Family physicians can be sources of comfort to those who grieve the loss of someone close to them.

The knowledge of several terms is useful when helping a patient who is facing the experience of a loss or who has experienced a loss (Table 1). Individuals caring for a loved one often feel anticipatory grief, bereavement, grief, mourning, and, in extreme circumstances, complicated grief.1,2

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TABLE 1.

Description of Grief-Related Terms

TermFeaturesDuration

Anticipatory grief

Mourning loss of health in a loved one; worry about what life will be like without that person

Can last for years depending on the health status of the loved one

Bereavement

Experiencing a loss

Often overlaps with grief

Grief

Internal manifestation of loss (e.g., sadness, loneliness, crying, insomnia, lack of self-care, yearning)

Frequently lasts up to one year

Mourning

Personal or public way to grieve (e.g., funerals, wakes)

Months to years

Complicated grief

Abnormally long, protracted, disabling grief

Can last for years

TABLE 1.

Description of Grief-Related Terms

TermFeaturesDuration

Anticipatory grief

Mourning loss of health in a loved one; worry about what life will be like without that person

Can last for years depending on the health status of the loved one

Bereavement

Experiencing a loss

Often overlaps with grief

Grief

Internal manifestation of loss (e.g., sadness, loneliness, crying, insomnia, lack of self-care, yearning)

Frequently lasts up to one year

Mourning

Personal or public way to grieve (e.g., funerals, wakes)

Months to years

Complicated grief

Abnormally long, protracted, disabling grief

Can last for years

Bereavement, grief, and mourning are all normal experiences. Symptoms of grief can include sadness, loneliness, yearning for the deceased, insomnia, crying, relief, anger, and social withdrawal.3 The intensity of these symptoms lessens with time, and most people are over the worst of it after one to two years. For many people, grief is a process that includes different emotions of varying intensities along the way. For others, grief occurs in stages, although this is not a universally accepted paradigm.4,5

Little well-designed research exists to support any bereavement interventions,6,7 which include individual and group counseling through mental health or palliative care services. Even less is known about the role of primary care physicians in addressing bereavement.8 Given the lack of guidance from reliable evidence, most reviews recommend tailoring the intervention to the cues and perceived needs of the bereaved. Most of the time, those without underlying mental disorders do not require any specific treatment, such as medication or grief counseling.9 Early intervention is not recommended because it may interfere with the grieving process.7 Patients with extended grief or grief complicated by depression may receive greater benefit from counseling.7 Family physicians might consider the following steps to support their bereaved patients.

Schedule a Dedicated Visit. Address anticipatory grief in detail by scheduling a separate, dedicated visit. It can be helpful to discuss the grieving process at this time. During anticipatory or actual grieving, patients may find it helpful to have someone else state some of the emotions they are experiencing, and they may appreciate their physician's support.

Provide Support. Responding to patients' cues can provide appropriate support after a loss. Kind, compassionate words spoken with empathy go a long way in comforting someone in the midst of loss. A short phone call a couple days after the visit to check in or a personal note can be of tremendous comfort.1 An appropriately timed visit with the patient after spousal death can be helpful. Patients can be reassured that their

Address correspondence to Stephen T. Dudley, DVM, MD, at stdudley@uw.edu. Reprints are not available from the author.

Author disclosure: No relevant financial affiliations.

References

show all references

1. Parkes CM. Bereavement in adult life. BMJ. 1998;316(7134):856–859....

2. Shear MK. Clinical practice. Complicated grief. N Engl J Med. 2015;372(2):153–160.

3. Zisook S, Shear K. Grief and bereavement: what psychiatrists need to know. World Psychiatry. 2009;8(2):67–74.

4. Weiner JS. The stage theory of grief. JAMA. 2007;297(24):2692–2694.

5. Maciejewski PK, Zhang B, Block SD, Prigerson HG. An empirical examination of the stage theory of grief [published correction appears in JAMA. 2007;297(20):2200]. JAMA. 2007;297(7):716–723.

6. Stroebe M, Schut H, Stroebe W. Health outcomes of bereavement. Lancet. 2007;370(9603):1960–1973.

7. Schut H, Stroebe MS. Interventions to enhance adaptation to bereavement. J Palliat Med. 2005;8(suppl 1):S140–S147.

8. Nagraj S, Barclay S. Bereavement care in primary care: a systematic literature review and narrative synthesis. Br J Gen Pract. 2011;61(582):e42–e48.

9. Shear MK, Reynolds CF, Simon NM, Zisook S. Grief and bereavement in adults: clinical features (login required). Updated January 25, 2018. https://www.uptodate.com/contents/grief-and-bereavement-in-adults-clinical-features. Accessed April 18, 2019.

10. National Cancer Institute. Grief, bereavement, and coping with loss (PDQ)—health professional version. Updated April 20, 2017. https://www.cancer.gov/about-cancer/advanced-cancer/caregivers/planning/bereavement-pdq. Accessed April 18, 2019.

11. Buckley T, Stannard A, Bartrop R, et al. Effect of early bereavement on heart rate and heart rate variability. Am J Cardiol. 2012;110(9):1378–1383.

12. Carey IM, Shah SM, DeWilde S, Harris T, Victor CR, Cook DG. Increased risk of acute cardiovascular events after partner bereavement: a matched cohort study. JAMA Intern Med. 2014;174(4):598–605.

13. Grimby A, Johansson AK. Factors related to alcohol and drug consumption in Swedish widows. Am J Hosp Palliat Care. 2009;26(1):8–12.

14. Riley SG, Pettus KI, Abel J. The buddy group—peer support for the bereaved. London J Prim Care (Abingdon). 2018;10(3):68–70.

Case scenarios are written to express typical situations that family physicians may encounter; authors remain anonymous. Send scenarios to afpjournal@aafp.org. Materials are edited to retain confidentiality.

This series is coordinated by Caroline Wellbery, MD, Associate Deputy Editor.

A collection of Curbside Consultation published in AFP is available at https://www.aafp.org/afp/curbside.

Please send scenarios to Caroline Wellbery, MD, at afpjournal@aafp.org. Materials are edited to retain confidentiality.

 

 

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