All hospices provide some form of bereavement care after a patient dies, but many families need help with anticipatory grief as well.

Chaplains and social workers, with support from the entire interdisciplinary team, are there to help patients and their families to navigate the emotions and struggles that often come with a loved one’s impending death.

Hospice News sat down with Brian Richards, a hospice chaplain and bereavement coordinator at Traditions Health in Wichita, Kansas, about the ways hospice teams can care for patients and families experiencing anticipatory grief.

What is anticipatory grief?

It’s the feelings of loss, grief and anxiety that happened before death when you know there’s a death coming. So it’s a cancer diagnosis that’s not treatable and death is in the near future. It’s coming on hospice, knowing a doctor says you have less than six months to live. So somehow it puts a proximity or inevitability of death right in focus.

What are some specific strategies that you use at Traditions to help families with anticipatory grief?

I think the main role as the chaplain in anticipatory grief is just the boldness, the willingness to step into the situation and acknowledge that death is imminent.

At Traditions, my first experience with our staff is that everyone is able to do that. It starts at admission, where we actually talk about having a hospice mindset, where we accept the prognosis and consider how we help people along the way.

It’s helping people realize that running to the emergency room might deal with a symptom, but it’s not going to prevent the outcome of death. So helping people recognize the journey is about acceptance. So our admissions team focuses on that. Our nurses, as they talk about it, do lots of education as far as what the next step of decline might look like, so families aren’t surprised.

It’s not comfortable, but we will help with the pain. We’ll help with management of pain and other symptoms. So care for anticipatory grief is built into hospice, with the acknowledgement and the training as death gets closer. How do we face this next step?

You’ve touched on this, but can you say more about the different roles of the interdisciplinary team when it comes to anticipatory grief?

Our nursing staff does the medical symptoms. So you’ll have shortness of breath; you’ll have increased secretions; you’ll have restlessness. Those are obvious signs that the nursing staff can say, “These are the symptoms of your illness that will, as progression goes on, increase or appear.” 

We have social workers that address anticipatory grief in the sense of: Is your will up to date? Do you have a mortuary? Do you have funeral plans? So they help with the very concrete, practical things that need to be dealt with that people, if they put off, are overwhelmed at the point of death.

We have the aides that are there, helping, assisting the nurses, but also making the patients comfortable and allowing family to have some relief from the constant care. It’s dealing with the very practical needs of the patient and the family to provide some comfort and strength for endurance, just for the long haul.

Then the chaplain on the spiritual side. Is there a need for reconciliation? Do they need help planning a funeral? Do they just need acknowledgement? This is somebody to sit with families in their tears.