Grief
After a death, how important is it for the family physician to maintain contact with the patient’s family?

A physician’s role in caring for family members is integral to providing care to the patient, and continues from diagnosis, through the disease trajectory, treatment, end-of-life care and bereavement. Understanding how family members grieve and what can help them is also important.

During the illness, the physician plays a key role in connecting the patient and family to services as required, such as home care and hospice palliative care. Hospice palliative care, in turn, helps with symptom management, and offers emotional and spiritual support to the terminally ill person and the family in bereavement. During this period of caregiving and anticipatory grief, the family receives needed support and establishes connections that often continue after the patient’s death.

Physicians can play an important role after a patient’s death by telephoning, arranging an office visit, or sending a card or information package to the family. These opportunities allow the physician to communicate basic information about the grief process, link family members to additional services and information, or provide contacts for local bereavement resources. Many hospice organizations have developed a card or information package that physicians can mail to the family.

If a physician has communicated with the family about grief resources after a patient’s death, this often encourages family members to seek help if needed and not feel alone in their grief. Knowing that such grief resources are available is especially important when the reality of the loss sets in, which often occurs about three months following the death. This often coincides with when friends, family and colleagues may (mistakenly) think that people should be “over it” and ready to move on.

A smaller percentage of individuals may experience complicated or more complex grief, the symptoms of which may not be evident for months or years following the death. It is important to keep in mind that in complicated grief, persistent longing for the deceased is both distressing and disruptive to daily functioning, and extends for longer than six months. Physicians should watch for the following symptoms which are disruptive in an individual’s life and may signal complicated grief:

  • having trouble accepting death;
  • being unable to trust others since the death;
  • harbouring excessive bitterness or anger about the death;
  • feeling uneasy about moving on with one’s life, such as forming new relationships;
  • feeling emotionally numb or detached from others since the death;
  • feeling life is empty or meaningless without the deceased;
  • feeling the future holds no meaning or prospect for fulfillment without the deceased; and
  • feeling agitated, jumpy or on edge since the death.

Understanding that bereavement care starts during the illness and caregiving period is important to a family. A family physician is in a key position to recognize those who may be at risk of developing complicated grief and connect them with additional help.

References

McGrath P, Holewa H, McNaught M. Surviving spousal bereavement: insights for GPs. Aust Fam Physician. 2010; 39(10): 7803.

Cairns M, Thompson M, Wainwright W. Transitions in Dying and Bereavement: A Psychosocial Guide for Hospice and Palliative Care. Health Professionals Press; 2003.