Lecture 8: Bereavement Flashcards by Ellie Cheney

What is bad news to a patient?

Likely to drastically alter patient’s view of his/her future

Causes cognitive, behavioral, or emotional deficit in person.

Decreased hope of patient or family’s quality of life.

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What is the MUM effect?

Reluctance to give bad news to patients/families.

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Do patients and families want to hear bad news usually?

Yes ):

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What is the SPIKES protocol?

Setup
Perception
Invitation
Knowledge
Empathize
Summarize and Strategize

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What is Setup in SPIKES?

Comfortable environment
Who else does the patient want there?
Time management

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What is Perception in SPIKES?

What does the patient/family already know?
Opportunity to correct misunderstandings
Gauging pt’s level of readiness to discuss diagnosis

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What is Invitation in SPIKES?

How much does the patient want to know?
Is there anyone the patient would like to know, or to use as a liaison?
If he or she feels that “ignorance is bliss”?

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What is Knowledge in SPIKES?

Impart knowledge about condition
Do not minimize severity of situation

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What is Empathize in SPIKES?

Acknowledge patient/family emotions
Sample remarks to show empathy

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What is Summarize/Strategize in SPIKES?

Summarize information given
Strategize next steps

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What are some emotions patients feel when given bad news?

Fear
Anger
Sadness
Shame
Relief

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What is death?

Cessation of vital functions.

IRREVERSIBLE cessation of all functions, INCLUDING BRAIN

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What is dying?

Process of losing vital functions.

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What are some signs of impending death?

Decreased bodily functions
Bedbound/profound weakness
Emotional distance, decreased conversation
Cool/mottled extremities, death rattle.

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What is bereavement?

Reaction to the loss of a close relationship.

State of being deprived of someone by death.

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What is grief?

Emotional response caused by loss of a close relationship.

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What is mourning?

The psychological process by which the bereaved person undoes his or her bonds to the decreased and settles with his or her personal grief.

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What are the 5 stages of a patient’s reaction to impending death?

Shock and Denial
Anger
Bargaining
Depression
Acceptance

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What occurs in shock and denial?

Dazed patient, may refuse diagnosis.
The common defense mechanism is that patients will try to rationalize their overwhelming emotions.

How should a clinician approach a patient in the shock and denial stage?

Respectfully but directly.

Reassure them they will not be abandoned.

What occurs in the anger stage?

Denial wears off, but patient is still angry and not ready to accept reality.

Displacement of anger may occur.

Patients often ask “Why me?” during this stage.

How should a clinician approach a patient in the anger stage?

DON’T TAKE IT PERSONALLY.
Be empathetic and NON-defensive with patients.

What occurs in the bargaining stage?

Patients may attempt to negotiate.

How should a clinician approach a patient in the bargaining stage?

You will take care of patient to the best of your ability.
Participate as partners.

What occurs in the depression stage?

Clinical signs of depression may manifest. Practical (sadness, costs of burial, who will take care of family, etc...) Preparation (mentally accepting the upcoming separation)

How should a clinician approach a patient in the depression stage?

Support and empathy! Distinguish between sadness and major depressive disorder. If it is MDD, you can treat it.

What occurs in the acceptance stage?

Patient realizes death is inevitable and accepts it. Patients can resolve their feelings ideally. Not every patient makes it here ):

How should a clinician approach a patient in the acceptance stage?

Spend time with patients. Offer spiritual support

How is a kid's attitude towards death?

<5 = separation similar to sleep 5-10 = developing sense of mortality and often fear that parents will die ): 9-10 = recognize they can die too, and by puberty, they usually recognize it as universal and inevitable.

What is essential for a child to have if they are hospitalized?

A consistently present, trusted person.

How do adolescents often approach death?

Understand its inevitable and final. Fear loss of control, being imperfect, or being different.

What are the two attitudes the elderly tend to have as they approach death?

Integrity/legacy Despair

How does grief normally present?

Immediately following death Can occur weeks following death Can occur in waves.

What are some normal behaviors of people grieving?

Searching behaviors = hallucinations/sense of the deceased's presence. Somatic complaints: Sleepless, agitation, etc... Self-reproach Social withdrawal Linkage object investment Identification phenomena

What is identification phenomena?

Taking on the qualities, mannerisms, or characteristics of the decreased person.

How long does grief traditionally last?

6mo to 1 yr. 6 mo should hopefully start showing improvement.

What can grief turn into?

Chronic depression Complicated grief

What is survivor guilt?

Occurs in people who feel relieved that they were not the one to die, but the persistent feeling starts eating away at them. Often presents as difficulty establishing new intimate relationships from fear of betraying the deceased.

What is uncomplicated bereavement?

Describes symptoms of grief following the loss of a loved one. Symptoms are often characteristic of MDD episode.

What is prolonged grief disorder?

Death of someone close at least 1 yr ago. Causes intense yearning/longing or preoccupation almost everyday. Patient has significant distress or impaired functioning. Patients response exceeds social/cultural/religious norms. Symptoms not due to a different psychiatric disorder.

How many criteria do you need to meet for prolonged grief disorder?

What are the treatment options for prolonged grief disorder?

Psychotherapy (Preferred), such as CBT, behavioral activation, or exposure therapy. Pharmacotherapy: antidepressants preferred if used.

What are the medical sequelae of bereavement?

Higher rates of mortality (esp. in older men) Higher rates of morbidity/healthcare costs (esp. HTN and CHF) Higher rates of alcohol, tobacco, and sedative usage. Higher rates of impaired immune function.

In terms of mood disturbances, what are the key differences between grief and depression?

Depression typically has minor fluctuations in mood. Grief is waves, so fluctuations are common.

In terms of shame and guilt, what are the key differences between grief and depression?

Depression typically has the fundamental belief that oneself is wicked/worthless. Grief is usually about not having done enough for the deceased before death.

In terms of SI, what are the key differences between grief and depression?

Depression typically threatens SI more often. Grief claims life is unbearable, but generally do not wish to actually die.