1. EPEC ( modified by Dr Sutton 2013) LOSS/GRIEF/BEREAVEMENT EPEC ( modified by Dr Sutton 2013) LOSS/GRIEF/BEREAVEMENT The Project to Educate Physicians on End-of-Life Care (EPEC) Supported by the American Medical Association and the Robert Wood Johnson Foundation

2. Objectives Identify, manage initial grief reactions

3. Loss, grief with life- threatening illness... Highly vulnerable patient Losses for patient –function / control / independence –image of self / sense of dignity –relationships –sense of future

4. ... Loss, grief with life- threatening illness Confronting end of life for patient and family –high emotions –multiple coping responses

5. Normal grief for survivors Physical –hollowness in stomach, tightness in chest, heart palpitations Emotional –numbness, relief, sadness, fear, anger, guilt Cognitive –disbelief, confusion, inability to concentrate

6. Complicated grief... Chronic grief –normal grief reactions over very long periods of time Delayed grief –normal grief reactions are suppressed or postponed

7. ... Complicated grief Exaggerated grief –self-destructive behaviors eg, suicide Masked grief –unaware that behaviors are a result of the loss

8. Tasks of the grieving 1. Accept the reality of the loss 2. Experience the pain caused by the loss 3. Adjust to the new environment after the loss 4. Rebuild a new life

9. Assessment of grief Repeated assessments –anticipated, actual losses –emotional responses –coping strategies role of religion Interdisciplinary team assessment, monitoring

10. Grief management If coping strategies appropriate –monitor –support counseling rituals If inappropriate, potentially harmful –rapid, skilled assessment, intervention

11. Loss, Grief, Bereavement Summary Loss, Grief, Bereavement Summary