Bereavement care: A practical approach

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Bereavement careA practical approach

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• Pgomutbu_at_med.cmu.ac.thHandout download
  http//portal.in.th/suandokpal

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??????????? Bereavement care

• 1. Definition
• 2. Theorical models (selected) of Bereavement
  and grief
• 3. Practical approach

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We are talking about natural experience

• Anything that you have.you can lost
• Anything that you are attached to.. you can be
  separated from
• Anything you lovecan be taken away from you.
• Yes, if you really have nothing to lose,
• you have nothing kalish,
  (1985)

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Definitions
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Bereavement ?? ??? ??????

• Period after a loss during which grief is
  experienced and mourning occurs

Grief ????

• Reacting to the loss.
• Experienced as a mental, physical, social, or
  emotional reaction.

Mourning ??? ????

• External or public display of grief
• eg. funeral, ritual.

US National Cancer Institute .
http//www.cancer.gov
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Anticipatory grief

• A grief reaction that occurs before the loss
• Can be felt by the patients themselves
  Allows for absorbing the reality of the loss
  gradually over time. Golden period for
  end of life discussion

US National Cancer Institute .
Complicated grief

• Chronical high level of grief that unlikely to
  resolved naturally.

Zhang et al. JPM, 2006
Oxford handbook of palliative care,2009
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Bereavement and Grief ??? Wound healing

• Loss injury
• Bereavement Wound healing period
• Grief Inflamation reaction
• Complicated grief ?

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Complicated grief ?????

1. 50
2. 30
3. 10
4. lt 1

C. Uncomplicated grief 80-90 (Prigerson HG,
Bereavement care.2004)
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Diagnosis complicated grief
Fixed attachment with death one
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Risk factor of poor grief outcomes
Circumstantial - Untimely death ( eg.Sudden death, death in childhood) - Long term care ( eg. Demantia)
Personal - History of multiple losses- Insecurity childhood attachment - Dependent relationship- Ambivalent relationship- Hidden grief expression - Lack of resilience
Social - Lack of social support- Lack of mourning Oxford handbook of palliative care,2009
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Depression
PTSD
GriefAll about death one
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Selected theorical models
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Dual process model of coping with Brereavement (
Strobe and Schut, 1999)
Relentless -gtInhibited, Delatyed grief
Relentless -gt PTSD
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Growing around grief ( Tonkins,1996)
New concept
Old concept
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Practical approach
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Primary prevention

• End of life care discussion during the
  Anticipatory grief
• Itself does not predict better bereavement
  outcome
• Time for family to complete unfinished business
  with the dying person

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Effective bereavement care

• Secondary prevention
• High risk to complicated grief
• Individual treatment module

Margaret Stroebe et al, Lancet 2007 370 196073
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  ?????????? ) ?? High risk complicate grief
  family ??? ????????????????????????????...

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• 1 ????? ??? 6 ?????
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B. 1 ????? ??? 6 ?????
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13-18 ????? ??????????????? poor grief outcomes
MDD, PTSD
1- 2 ???????? Mourning ?????
Zhang et.al. Journal of Palliative medicine
5,2006 1188-1203
High level of grief at 6 months post loss predict
poor grief outcomes at 13-23 month and unlikely
to resolved naturally.
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Professional grief

• Percepion Family is angry with them
• Guilt unable to prevent the death.
• Competency Dont know what to do/say

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What we can do

• Clarify information the cause of death
• Encouraging them to express feeling about the
  deceasedeg. A letter / telephone of condolence
• Empathy Tolerate silences
• Being thereas a healer
• 
  Pigerson HG et al. JAMA 2861369-1376

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Take home message

• Grief is itself a medicine
• 
  ( Green J,1992)

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The power of Being there
The Doctor" by Luke Fildes,1981