Death, Dying and Bereavement

Question 1

How has chronic illness changed over time?

Answer 1

Improvements in treatments and healthcare has have resulted in more people living with long term health conditions.

Question 2

What are the challenges to dealing with illness?

Answer 2

Adjusting to symptoms and disability Maintaining a reasonable emotional balance Preserving a satisfactory self-image and sense of competence Learning about symptoms, treatment procedures and selfmanagement Sustaining relationships with family and friends Forming and maintaining relationships with healthcare providers Preparing for an uncertain future

Question 3

Describe the self-regulatory model

Answer 3

STAGE 1: Interpretation

Representation of health threat - identity, cause, consequence, timeline, cure control

Emotional response to health threat - Fear, anxiety, depression

STAGE 2: COPING

STAGE 3: APPRAISAL

Question 4

What is the link between long term conditions and depression?

Answer 4

two to three times more likely to develop depression than the rest of the population.

People with three or more conditions are seven times more likely to have depression

Question 5

What is palliative care?

Answer 5

Founded on providing terminally ill people with compassionate care

Addressing medical, psychological, social and spiritual aspects of dying

Relieving/managing symptoms (e.g., pain, breathlessness) rather than curing disease

Collaborative approach with honest communication

Question 6

What are the 5 reactions to terminal illness in the Kubler-Ross theory?

Answer 6

1. Denial
2. Anger
3. Bargaining
4. Depression
5. Acceptance

Question 7

What is denial?

Answer 7

The person may think “This isn’t really happening”

They may lie about the situation and tell themselves that this is just temporary and everything will be back to normal soon

It is often used as a psychological defence in an attempt to cushion the impact of the source of grief

Question 8

What is anger?

Answer 8

● The person may think “why me?” or “how could God do this to me?”

● The person feels generalised rage at the World for allowing something like this to happen

● They feel isolated and furious that this is happening to them

● They think it’s unfair and may feel betrayed

● Outbursts of anger in unrelated situations can occur

Question 9

What is bargaining?

Answer 9

● The person thinks “If I do this, I can make it better, I can fix things.“

● One may feel guilt and feel it is their responsibility to fix the problems

● They make an attempt to strike bargains with God, spouses, HCPs e.g. “I’ll be a good person, if I get another chance”

Question 10

What is depression?

Answer 10

● The person thinks “my heart feels broken” or “this loss is really going to happen and it’s really sad”

● At this stage, the person is absorbed in the intense emotional pain that they feel from having their world come apart

● They can be overwhelmed with feelings of helplessness and sadness

● “Anticipatory grief”

Question 11

What is acceptance?

Answer 11

● The person thinks “this did occur, but I have great memories” or “it is sad but I have so much to live for and so many to love”

● The loss is accepted and we work on alternatives to coping with the loss and to minimise the loss

Question 12

Describe the embedded nature of stage theories

Answer 12

● Linear progression – gives a sense of conceptual order to a complex process – proving a degree of predictability & control

● An overwhelming cultural desire to “make sense” of the uncertain

● Developed at a time when limited literature on death & dying existed

● Applied to a number of different situations (including bereavement)

Question 13

What are some of the weaknesses with stage models?

Answer 13

● Stages are prescriptive and place patients in a passive role

● Do not account for variability in response (e.g., “people deal with things differently”)

● Focus on emotional responses and neglect cognitions and behaviour

● Fail to consider social, environmental or cultural factors (e.g., a patient in a positive and supportive environment is likely to exhibit very different stages than those who are not)

● Pathologise people who do not pass through stages

Question 14

What is the problem with pathologising in stage theories?

Answer 14

● Distress or depression is not inevitable: – Many people report significant and valuable changes from the experience of the illness (Weinman et al., 1999) – Some even report benefits (e.g., “Posttraumatic Growth” Tedeshi & Calhoun)

● “Acceptance” might not be achieved – Reaching a state of resolution may not be possible for some – Complex cognitive and emotional responses may continue to be present (Parkes & Weiss, 1983; Shadish et al., 1981)

● “Good” patients vs “Bad” patients (Taylor, 2006)

Question 15

What do we need to combine with long term conditions?

Answer 15

INDIVIDUAL AND HEALTHCARE perspectives

Question 16

What is bereavement?

Answer 16

refers to the situation of a person who has recently experienced the loss of someone significant in their lives through that person’s death

How we grieve is strongly influenced by cultural customs and norms

Perspectives include general stress and trauma theories, general theories of grief and models of coping which are specific to bereavement

Question 17

Summarise the dual process model of coping with bereavement (Stroebe & Schut 1999)

Answer 17

Everyday life expereince encompasses the whole of the diagram.

Catergories within everyday experience:

Loss-orientated - Grief work, intrusion of grief, relinquishing-continuing-relocating bonds/ties, denial/avoidance of restoration changes

Restoration orientated - attending to life changes, doing new things, distraction from grief, avoidance of grief, new roles/identities

Loss orientated and restoration interact and oscillate

Question 18

What is the duration and severity of bereavment dependent on?

Answer 18

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

● 85% of people will usually adjust by the second year of bereavement

Question 19

Summarise responses to bereavement (Bonanno & Kaltman, 2001)

Answer 19

Question 20

When is chronic grief likely to occurr?

Answer 20

– 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)

Question 21

How is chronic grief treated?

Answer 21

● Psychological interventions: – Little effect on mood, grief or physical symptoms – Some impact in high risk individuals such as those with existing mental health problems (Jordan & Neimeyer, 2003)

● Support appears to help bereaved people generally but does not buffer them against the grief (Stroebe et al., 2007)

● Suggests Bereavement is a process that most people will have to go through

● Support or intervention may be a comfort, but is unlikely to “solve” their grief

Question 22

How has understanding advancing of grief and grieving?

Answer 22

● Strobe and colleagues (2007) suggest:

– Further development of cross-cultural theoretical approaches

– Sound empirical testing

– More focussed efforts to better understand those who suffer extremely

– Continued development of effective psychological interventions to help support those who experience chronic grief