anticipatory grief: recognition and coping
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JOURNAL OF PALLIATIVE MEDICINEVolume 11, Number 9, 2008© Mary Ann Liebert, Inc.DOI: 10.1089/jpm.2008.9824
Anticipatory Grief: Recognition and Coping
Jaimie L. Simon, M.S.W., L.C.S.W.
We often think grief refers only to the mourning that takes place after a death. However, grief can be more prolongedand can even occur before a person dies.
What is Anticipatory Grief?
• Anticipatory grief occurs before death, and is experienced by both the dying person and their loved ones. It is very sim-ilar to the grief that occurs after the actual death.
• Anticipatory grief can allow you to prepare for and develop coping skills for the life changes that will take place afterthe death of this important person.
• Despite your anticipatory grief experience, your grief after the death is not likely to be lessened.
What are the Symptoms of Anticipatory Grief?
• Symptoms of anticipatory grief can be physical, emotional, cognitive and/or spiritual, and are similar to grief responsesthat follow a death or significant loss.
• Physical symptoms can include sleep changes, headaches, nausea, fatigue, or appetite changes.• You may feel emotions such as denial/disbelief, worry/anxiety, fear, sadness, anger, helplessness, guilt, or simply over-
whelmed.• You might experience being disorganized, forgetful, confused, and/or have difficulty concentrating or making decisions.• Spiritual beliefs may change. You may be comforted by your faith or may feel angry with God. Family dynamics and
relationships, at work and elsewhere, can be affected as well. You might feel angry at others for not being as availableas you would like them to be.
• Emotional connections may be difficult. A prolonged dying process can sometimes result in an emotional distance thatcan cause feelings of guilt for the distance.
• If your loved one’s needs cannot be met at home, you may experience guilt associated with moving them to a care fa-cility.
How Can I Cope with Anticipatory Grief?
• Allow for your anticipatory grief. It is okay to take time for self-care, to cry, and to talk with others about your experi-ence.
• As a caregiver it can be important for you to find balance between the demands of care giving and the need for self-care.It is good to be aware of your own physical and emotional limitations and to ask for help from others. Family, friends,clergy, or other professionals can provide emotional support, as well as practical help with care giving needs.
• Take the opportunity to say good-bye and voice the unspoken or unexpressed. You might even involve the dying per-son in planning for the future. This could bring them a sense of comfort and reassurance that you will be okay after theydie.
The information and recommendations appearing on this page are appropriate in most instances, but are not a substitute for medicaldiagnosis. For specific information concerning your personal situation or medical condition, JPM suggests that you consult your physi-cian. This page may be photocopied noncommercially by physicians and other health care professionals to share with patients. Any otherprint or online reproduction is subject to approval by the publisher: Mary Ann Liebert, Inc. To purchase bulk reprints, call 914-740-2100.
JPM Patient InformationFeature Editor: Jocelyn White
References
1. Gates RA, Fink RM: Oncology Nursing Secrets 2001, 2nd ed.Philadelphia: Hanley & Belfus, 2001.
2. Kehl KA: Recognition and support of anticipatory mourning.J Hosp Palliat Nurs 2005;7:206–211.
3. Worden JW: Grief Counseling and Grief Therapy: A Handbook forthe Mental Health Practitioner, 2nd ed. New York: Springer,1991.
Address reprint requests to:Jaimie L. Simon, M.S.W.
Pathways Inpatient Palliative CareKaiser Permanente Hospice and Palliative Care
10180 SE Sunnyside RoadClackamas, OR 97015-9303
E-mail: [email protected]
JPM PATIENT INFORAMATION 1281