Observations Regarding Anticipated Grief

1. Observations Regarding Anticipated Grief Tom Saunders, M. Div, Chaplain Please complete general and pre-session surveys before the presentation http://streaming.biocom.arizona.edu/event/?id=24072 ¡Vida! Educational Series

2. Educational Objectives • Define anticipatory grief. • Explain at least two different phases of grief. • Be able to use two methods for dealing with anticipatory grief.

3. What is Anticipatory Grief? Anticipatory grief is grief that is experienced prior to a significant loss. One could say that anticipatory grief can be a grief of preparation. Preparation for the patient who has a terminal illness and preparation for the family and other persons in the life of the patient.

4. What is Anticipatory Grief? This means that anticipatory grief can be a reality for the patient, the family, caregivers, friends and even the professionals who care for the patient. Anyone emotionally associated with the patient can also experience this type of grief.

6. Definition of Terminal Illness (The Spanish Society of Palliative Care) The fundamental elements of terminal illnesses are:1. The presence of an advanced,  progressive and incurable illness2. The lack of a reasonable response to specific treatment3. The presence of numerous problems or intense symptoms that are multiple, multifactorial, and changing

7. Definition of Terminal Illness cont. The fundamental elements of terminal illnesses are:4. Large emotional impact on the patient, family, and treatment team related explicitly or not to with the presence of death5. Prognosis of six months or less.

8. What is Anticipatory Grief Psychiatrists Dr. Carmen Rosales Herrera and Dr. Mary Sol Olmeda explain that anticipatory grief, as a phenomenon of scientific study, began with soldiers during the second world war. More recent studies have included research regarding the parents of children with terminal illnesses.

9. Other Conditions and Illnesses Although the focus of this presentation is about anticipatory grief experienced in the environment of hospice and palliative care, there are other conditions and illnesses that can be the cause of anticipatory grief.

10. The Symptoms of Anticipatory Grief The symptoms of anticipatory grief can be the same symptoms one experiences with regular grief.

11. The Various Dimensions of Life According to the Hospice Foundation of America, grief affects us in various dimensions of life: • Physically • Emotionally • Spiritually

12. Emotional Symptoms of Grief • Stress • Depression • Sadness • Anger • Crying • Indecision or confusion • Temporary changes in personality

13. Spiritual Characteristics of Anticipatory Grief • Questioning one’s faith • Bargaining with God • Searching for miracles or other special religious beliefs to cure the illness

14. Spiritual Care of Patients and Families In our spiritual care of patients and families, we never criticize the faith they express. We can talk about the reality of the situation, but faith is an expression of hope, and we want to encourage hope in every individual.

16. Classic Phases or Stages of Grief By Dr. Elizabeth Kubler Ross • Denial • Anger • Bargaining • Depression • Acceptance • Hope

17. As the patient can pass through these phases during a terminal illness, the patient’s caregivers can also.

19. It’s important to know that one may not experience these phases. There is not a fixed sequence in passing through these phases. One might experience some of all of these phases at various times during the course of anticipatory grief or regular grief.

20. It is said that this is a less dramatic grief because one has more time to put his or her feelings in order. Also it provides time to take care of issues like insurance, inheritances, and other paperwork. At times there is a sense of relief after the death of one’s loved one when anticipatory grief has been experiences. José María Romera

21. Anticipatory Grief can be a motivation for important conversations with the patient. Dr. Ira Byock In his book The Four Things That Matter Most talks of what we can be saying to our loved ones during the course of a terminal illness.Forgive me -- I forgive you Thank you I love you Good bye

22. Methods for Dealing with Anticipatory Grief Support groups (self care/ caregiver groups) Spiritual support from clergy/ pastoral counselor Support from a religious community Emotional support from a psychologist, social worker, or other professional Exercise Support from family and friends Appropriate rest

23. The Work of Expressing Grief Dr. Alan Wolfelt talks about the work of expressing grief. He and other experts in the area of grief speak of the needs to express grief in various ways that work for the individual.

24. The Work of Expressing Grief • Recognize anticipated grief • Journal your grief • Draw/ paint your grief (other art forms) • Pray your grief • Eulogize your loved one • Create ceremonies for the expression of anticipatory grief • Express your anticipated grief in your own way

25. Case Studies • Patients • Caregivers • Family members

26. Conclusions & Observations from Hospice Anticipatory grief is common. Anticipatory grief can open up other parallel grief; one can recognize a constellation of losses. There is support to deal with the effects of anticipated grief, such as for regular grief Anticipatory grief is a grief of preparation and can help us regarding future losses.

27. Bibliography • About.com. (2009, March 16). Anticipatory grief - explanation of anticipatory grief. About Palliative Care - Hospice and Palliative Care. Retrieved July 19, 2012, from http://dying.about.com/od/thegrievingprocess/a/anticip_grief.htm • Ayudando en el duelo anticipado | Calcetines del revés. (2012, March 24). Calcetines del revés | Así estamos ahora, como calcetines dados la vuelta. Somos nosotros, pero no somos los mismos. Esta es nuestra lucha por encontrar una nueva manera de vivir sin los seres amados que nos faltan.. Retrieved July 19, 2012, from http://calcetinreves.wordpress.com/2012/03/24/el-duelo-anticipado/ • Byock, I. (2004). The four things that matter most: a book about living. New York: Free Press. • Clínica Alemana de Santiago S.A. - Chile. (n.d.). Clínica Alemana de Santiago S.A. - Chile. Retrieved July 3, 2012, from http://www.alemana.cl/reader/alemana/pub/v03/S9701Articulos/S0101200612/news13667.html;jsessionid=HcQ1QLwLQK0mYLWgW63z9pr3kqGgBWnV2H5LKNlvRpv9tn113mLk!577850547!NONE

28. Bibliography Etapas descritas por la Dra. E. Kubler Ross que pueden aplicarse al duels. (n.d.). Renacer. Retrieved July 18, 2012, from www.renacerbuenosaires.org/ar/etapas.htm Kramer, H., & Kramer, K. (1993). Conversations at midnight: coming to terms with dying and death. New York: W. Morrow and Co.. Romera, J. M. (n.d.). El duelo anticipatorio. hoy.es. HOY Extremadura a diario con noticias y última hora del periódico y la edición digital. Retrieved July 4, 2012, from http://www.hoy.es/20090302/sociedad/duelo-anticipatorio-20090302.html Herrera, C. R., & Olmeda, M. S. (2001). El duelo anticipatorio. psiquiatria.com. Retrieved July 4, 2012, from www.psiquiatria.com/bibliopsiquis/bitstream/10401/1811/1/interpsiquis_2001_2478.pdf

29. Bibliography Hospice Foundation of America. " Comprendiendo el Duelo - YouTube ."YouTube - Broadcast Yourself. . N.p., n.d. Web. 13 July 2012. <http://www.youtube.com/watch?v=8sTaMp_PC80&feature=related>. SECPAL / Guía CP/ Definición de enfermedad terminal: características. (n.d.). SECPAL. Sociedad Española de Cuidados Paliativos.. Retrieved July 19, 2012, from http://www.secpal.com/guiacp/index.php?acc=dos Stamateas, B. (n.d.). Duelo por la muerte de un familiar- Por Bernardo Stamateas en Canal 26 - YouTube . YouTube - Broadcast Yourself. . Retrieved July 19, 2012, from http://www.youtube.com/watch?v=rah5gaD7jWk&feature=related Wolfelt, A. (2007). Living in the shadow of the ghosts of grief: step into the light. Fort Collins, CO: Companion Press.

31. Educational Series Please complete the satisfaction and post-session surveys after viewing the presentation go to: http://streaming.biocom.arizona.edu/event/?id=24072 Thank you!