3b) Death, Dying + Bereavement Flashcards
Key concepts
- Kubler-Ross’s stage theory of adjustment (basic outline)
- Five myths of coping with loss (Wortman & Silver 1989)
- Illness Representations – Leventhal (5 dimensions)
- Death and dying: Define key psychological factors in palliative care; critique the utility of stages of grief models
- Coping with illness: explain how adjusting thoughts or behaviour can reduce the effects of an illness or procedure; define different coping responses and how to improve their effectiveness
What are some challenges of living with an illness
- Adjusting to symptoms/ disability
- Maintaining a reasonable emotional balance
- Preserving a satisfactory self-image and sense of competence
Learning about symptoms, treatment procedures and self-management
Sustaining relationships with family and friends
Forming and maintaining relationships with healthcare providers
Preparing for an uncertain future
Describe the self regulatory model. (Leventhal, 1993)
three main stages of adaptation to illness
1 - “interpretation”
(the patient’s attempts to make sense of their perceived symptoms);
2 - “coping” (adaptive + maladaptive ways of dealing with the problem to regain a sense of balance)
–> maladapting = denial (e.g drink more)
3- “appraisal” (assessment of how successful/or not the coping stage has been).
model = “self-regulatory” because these three components interrelate in order to maintain a state of equilibrium (i.e., health).
BUT with terminal illness –> ability to return to health is not possible and coping becomes more about the psychological response to the inevitability of death and dying.
what are some Psychological impact of Long-term conditions
- 2/3 x more likely to get depression
- mental problem –> increases risk of CHD/ mortality
What is narrative based medicine? Greenhalgh & Hurwitz, 1998):
emphasis is on listening to people’s narratives and using these to improve clinical care
Loss of:
- physical ability
- identity
- occupational goals
- hope
–> underlies + associates with many mental health problems
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- Explain Kubler-Ross’s stage theory of adjustment (basic outline)
explains reactions to terminal illness:
- Denial
- -> psychological defense - Anger
- -> “why me?”
- -> feeling of unfairness / isolation - Bargaining
- -> “if i can do this, i can make it better and fix things” - Depression
- -> intense emotional pain
- -> overwhelmed in helplessness + sadness - Acceptance
- -> loss is accepted –> work on alternatives to coping w + minimizing loss
- Five myths of coping with loss (Wortman & Silver 1989)
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Note: majority of people prefer to die at home
Higginson et al., 2013
Gomes et al., 2013
recommendation =
- boost palliative care
- patients who want to die at home should be offered home palliative care (Gomes et al., 2013)
what are the weaknesses of the stage theories?
i.e weakness of Kubler-Ross’s stage theory
- Stages place patients in a passive role
- Doesn’t look at variability in response (e.g., “people deal with things differently”)
- Focus on emotional responses and neglect cognitions and behaviour
- Fails to consider social, environmental / cultural factors
- Pathologise people who do not pass through stages
Define bereavement
situation of a person who has recently experienced the loss of someone significant in their lives through that person’s death
Describe the stress theories of bereavement
- stress + coping w bereavement = dynamic process
Orientation toward loss:
Preoccupation
Think and yearn for the person lost
Seeking out places as reminders or searching for the person
Orientation toward restoration: Adjustments to lifestyle Coping with day-to-day life Building a new identity Distracting away from painful thoughts
The duration and severity of a person’s grief may depend on:
The duration and severity of a person’s grief may depend on:
- How attached they were to the deceased person
- The circumstances of death and the situation of loss
- How much time they had to work through anticipatory mourning
Responses to bereavement (Bonanno & Kaltman, 2001)
- in 1st year of bereavement –> most people are under common grief
- -> then goes onto either minimal grief or chronic grief
what is chronic grief?
when is it more likely to occur?
- more severely affected
- associated with worsening mental health
More likely to occur if:
- The death was sudden or unexpected
- The deceased was a child
- There was a high level of dependency in the relationship
- The bereaved person has a history of psychological problems, poor support and additional stresses (e.g., financial)
