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Coping with Death and Dying

Bedside GriefAs a caregiver, coping with the idea of losing your loved one can be terrifying. A caregiver’s emotional well-being and quality of life drop dramatically when their loved one transitions from curative treatment (care that is focused on eliminating the cancer and curing the patient) to end-of-life care (care that is focused on providing pain relief and comfort for a terminally ill patient).1 Weitzner MA, McMillan SC, Jacobsen PB. Family caregiver quality of life: differences between curative and palliative cancer treatment settings. J Pain Symptom Manage. 1999;17(6):418-428. If your loved one’s cancer becomes incurable, expect the physical and emotional demands of the end-of-life phase of caregiving to be the most intense and exhausting part of the cancer journey.2 Cameron JI, Franche RL, Cheung AM, et al. Lifestyle interference and emotional distress in family caregivers of advanced cancer patients. Cancer. 2002;94(2):521-527.

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When your loved one’s condition progresses, hospice and palliative care may be given to make the patient as comfortable as possible for his or her remaining time. Palliative care programs have been shown to improve caregivers’ emotional states and overall well-being. Palliative care not only offers pain management and symptom control for your loved one, but it also provides emotional support to you and other family caregivers and provides you the opportunity to be involved in symptom management, communication and medical decision-making.3 Morrison RS, Meier DE. Clinical practice. Palliative care. N Engl J Med. 2004;350(25):2582-2590. Palliative care and hospice services can be given in a hospital setting, a nursing home, a dedicated hospice facility or in your home. Ask your oncology social worker for information and advice about your options and choose what suits your loved one’s and your family’s needs best.

Dealing with your emotions

When your loved one begins to receive hospice and palliative care, you may feel guilty or have feelings of helplessness or hopelessness. You will certainly grieve, and you may go through phases of denial, anger and panic. Watching a loved one fade away can also make you feel numb or disbelieving at times.

Over this period, you may have moments where you put the thought of your loved one’s approaching death out of your mind and focus on daily tasks. At other times, you may not be able to avoid sadness and grief. Your loved one is also likely to have powerful feelings of sadness, anger, frustration and loneliness.

To help you cope, try to stay busy by spending as much quality time as you can with your loved one while he or she is still conscious and communicative and by making necessary end-of-life arrangements. Help your loved one to communicate his or her wishes to the care team and complete legal arrangements. Be sure that the patient has granted power of attorney to you or another person who can make medical decisions on the patient’s behalf when your loved one can no longer do so. Encourage your loved one to also provide other documents as appropriate, such as a do-not-resuscitate (DNR) order or a living will, so that you do not have to worry about what he or she would have wanted when difficult decisions arise.

You might also help yourself and your loved one to cope with the intense emotions of the dying process by offering to record in writing, audio or video the dying person’s thoughts, memories and messages for others. Find out who, if anyone, the patient would like to see in his or her final days and manage visitors and visitation times so that you and your loved one are not too overwhelmed and you can take advantage of the patient’s “good” moments to see visitors. If your loved one would rather not have visitors, accept his or her wishes in this regard. You can offer to pass messages along to family and friends on the patient’s behalf.

Finally, if you and your loved one are religious people and praying helps you to find peace, make that a part of each day until the end. Invite your spiritual leader or members of your house of worship to be with you and your loved one if that will help ease your loved one’s passing. It is not uncommon for patients and caregivers to suffer a crisis of faith during the terminal phase of cancer, but even if that happens to you, you can still find comfort in your faith.

The grieving process

When your loved one passes away, you’ll likely go through a grieving process. Grieving involves feeling many different emotions over a period of time, all of which help you come to terms with your loss.

The first feelings of grieving usually include shock or numbness. When you become aware of how your life will be affected, other emotions start to surface such as anger, loneliness, disbelief or denial. These types of feelings can come and go over a long period of time. The final phase of grieving involves finding a way to come to terms with your loss.

Grieving can be a long and personal process. Nobody can tell you how you should react or what you should feel. However, here are some suggestions that may help you during the grieving period:

    • Be patient with yourself and the process. Accept that you need to experience your pain and emotions to heal in your own way.
    • Express your feelings, including letting yourself cry. Crying is not a sign of weakness when you are dealing with the loss of a loved one.
    • Try to avoid making any major life changes, such as moving or changing jobs, for the first year. This can allow you to keep your roots and a sense of security.
    • Eat well and exercise.
    • Avoid drinking too much alcohol or using drugs.
    • Forgive yourself for all the things you did or didn’t say or do. Compassion and forgiveness for yourself and others is an important part of healing.
    • Give yourself breaks from grief. It’s healthy to find distractions like going out to dinner or a movie.
    • Prepare for holidays, birthdays and anniversaries, knowing strong feelings may return.

 


References

1 Weitzner MA, McMillan SC, Jacobsen PB. Family caregiver quality of life: differences between curative and palliative cancer treatment settings. J Pain Symptom Manage. 1999;17(6):418-428.

2 Cameron JI, Franche RL, Cheung AM, et al. Lifestyle interference and emotional distress in family caregivers of advanced cancer patients. Cancer. 2002;94(2):521-527.

3 Morrison RS, Meier DE. Clinical practice. Palliative care. N Engl J Med. 2004;350(25):2582-2590.