Supporting Families Facing Loss: Anticipatory Grief Elizabeth A. Keene VP, Mission Effectiveness St....

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Transcript of Supporting Families Facing Loss: Anticipatory Grief Elizabeth A. Keene VP, Mission Effectiveness St....

  • Slide 1
  • Supporting Families Facing Loss: Anticipatory Grief Elizabeth A. Keene VP, Mission Effectiveness St. Marys Health System Lewiston, Maine ekeene@stmarysmaine.com
  • Slide 2
  • Definition of Terms Loss=Change=Grief Grief-the physical, psychological, spiritual, cognitive and behavioral responses to the (perceived) threat of a loss Mourning-the outward expression of grief Bereavement-the state of having suffered a loss
  • Slide 3
  • Anticipatory Grief (aka Anticipatory Mourning, Preparatory Grief) Response to awareness of a life-threatening or terminal illness in oneself or a significant other and the recognition of associated losses Rando, TA, ed. (2000) Clinical Dimensions of Anticipatory Mourning.
  • Slide 4
  • Anticipatory Grief Potential losses associated with illness: Loss of bodily function Loss of hopes, dreams Loss of employment/finances Loss of independence/control Loss of feeling of self-worth Loss of cognitive function Loss of role in family
  • Slide 5
  • Illness Trajectories
  • Slide 6
  • Cure /Life-prolonging Intent Palliative/ Comfort Intent Bereavement DEATHDEATH EVOLVING MODEL OF PALLIATIVE CARE
  • Slide 7
  • Mike Harlos MD, CCFP, FCFP Professor and Section Head, Palliative Medicine, University of Manitoba Medical Director, WRHA Palliative Care Medical Director, Pediatric Symptom Management Service
  • Slide 8
  • Anticipatory Grief Forewarning is not a sufficient condition for realistic anticipation! Misinterpretation- hydrological theory of grief Fulton, R. (2003) Anticipatory mourning: a critique of the concept. Mortality.
  • Slide 9
  • Supporting Families Facing Loss EASE Model Educate Assess Support Explore Needs/Strengths Carrington, NA, Bogetz, JF. (2004) Normal grief and bereavement: letters from home, Journal of Palliative Medicine. 7: 309-323.
  • Slide 10
  • The EASE Model: Educate Normalize grief as a natural response to loss Identify the range of typical responses Allow for individual differences
  • Slide 11
  • The EASE Model: Assess Physical health Emotional/mental health Spiritual needs/strengths Behavioral/social changes Loss history Risk for complicated grief
  • Slide 12
  • Assess What concerns you most right now? What brings you comfort? What does your experience look and feel like? With whom do you talk? What behavior changes are you seeing in your children?
  • Slide 13
  • Assess Emotional/Mental Health History of mental health issues Common response: inability to concentrate and/or forgetfulness (I feel like Im going crazy!) Roller coaster of emotions Hall, M and Irwin, M. (2001) Physiological indices of function in bereavement in Stroebe, MS et al. Handbook of Bereavement Research.
  • Slide 14
  • Assess Spiritual Needs/Strengths Religious or theological Providence, fate, Gods will Afterlife Suffering as redemptive Support of religious community Existential Meaning Purpose
  • Slide 15
  • Assess Behavioral/Social Changes Family Financial status/employment Impact on children in the family Loss History Previous losses, including non-deathrelated Recent secondary losses (financial, home) Disenfranchised (socially taboo) losses Cumulative losses Inability to grieve prior losses
  • Slide 16
  • Assessing for Risks of Complicated Grief Predictors Violence of the death Ability to make sense of the death (Post-death assessment): Length of time that symptoms have persisted Extent of interference in daily life Extreme isolation Abrupt major lifestyle changes Intensity of symptoms Suicidal ideation Severe depression
  • Slide 17
  • The EASE Model: Support Be present; be available Communication Need for short, frequent conversations Isolated incidents long remembered Realistic life expectancy
  • Slide 18
  • The EASE Model: Support Coping Problem-focused coping and positive reappraisal most effective strategies in maintaining positive affect Folkman, S. (2001) Revised coping theory and the process of bereavement, in Stroebe, MS et al. Handbook of Bereavement Research. Decision-making Goals of care Life review/legacy
  • Slide 19
  • The EASE Model: Explore Needs and Strengths Perception of support Family Community Communication Preference Education Preference Changes over time
  • Slide 20
  • Reflections by Mrs. Rose McCloskey