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Bereavement care: A practical approach

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Title: Bereavement care: A practical approach


1
Bereavement care A practical approach
  • ??.????? ????????? ????????????????????????
  • Pgomutbu_at_med.cmu.ac.th Handout download
    http//portal.in.th/suandokpal

2
??????????? Bereavement care
  • 1. Definition
  • 2. Theorical models (selected) of Bereavement
    and grief
  • 3. Practical approach

3
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  • ???????????
    ??????????? (
    ???????????? ) (
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    ????? ???????
    ?????????????

4
We are talking about natural experience
  • Anything that you have.you can lost
  • Anything that you are attached to.. you can be
    separated from
  • Anything you lovecan be taken away from you.
  • Yes, if you really have nothing to lose,
  • you have nothing kalish,
    (1985)

5
Definitions
6
Bereavement ?? ??? ??????
  • Period after a loss during which grief is
    experienced and mourning occurs

Grief ????
  • Reacting to the loss.
  • Experienced as a mental, physical, social, or
    emotional reaction.

Mourning ??? ????
  • External or public display of grief
  • eg. funeral, ritual.

US National Cancer Institute .
http//www.cancer.gov
7
Anticipatory grief
  • A grief reaction that occurs before the loss
  • Can be felt by the patients themselves
    Allows for absorbing the reality of the loss
    gradually over time. Golden period for
    end of life discussion

US National Cancer Institute .
Complicated grief
  • Chronical high level of grief that unlikely to
    resolved naturally.

Zhang et al. JPM, 2006
Oxford handbook of palliative care,2009
8
Bereavement and Grief ??? Wound healing
  • Loss injury
  • Bereavement Wound healing period
  • Grief Inflamation reaction
  • Complicated grief ?

9
Complicated grief ?????
  1. 50
  2. 30
  3. 10
  4. lt 1

C. Uncomplicated grief 80-90 (Prigerson HG,
Bereavement care.2004)
10
Diagnosis complicated grief
Fixed attachment with death one
11
Risk factor of poor grief outcomes
Circumstantial - Untimely death ( eg.Sudden death, death in childhood) - Long term care ( eg. Demantia)
Personal - History of multiple losses - Insecurity childhood attachment - Dependent relationship - Ambivalent relationship - Hidden grief expression - Lack of resilience
Social - Lack of social support - Lack of mourning Oxford handbook of palliative care,2009
12
Depression
PTSD
Grief All about death one
13
Selected theorical models
14
Dual process model of coping with Brereavement (
Strobe and Schut, 1999)
Relentless -gt Inhibited, Delatyed grief
Relentless -gt PTSD
15
Growing around grief ( Tonkins,1996)
New concept
Old concept
16
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    .?????????????????? ?????????????. .
    .???????????? ....

17
Practical approach
18
Primary prevention
  • End of life care discussion during the
    Anticipatory grief
  • Itself does not predict better bereavement
    outcome
  • Time for family to complete unfinished business
    with the dying person

19
Effective bereavement care
  • Secondary prevention
  • High risk to complicated grief
  • Individual treatment module

Margaret Stroebe et al, Lancet 2007 370 196073
20
  • ????????????????????????????? ( ???? ???????? ,
    ?????????? ) ?? High risk complicate grief
    family ??? ????????????????????????????...
  • 1 ??? ??? 1 ?????
  • 1 ??????? ??? 3 ?????
  • 1 ????? ??? 6 ?????
  • 1 ??????? ??? 3 ??

B. 1 ????? ??? 6 ?????
21
13-18 ????? ??????????????? poor grief outcomes
MDD, PTSD
1- 2 ???????? Mourning ?????
Zhang et.al. Journal of Palliative medicine
5,2006 1188-1203
High level of grief at 6 months post loss predict
poor grief outcomes at 13-23 month and unlikely
to resolved naturally.
22
Professional grief
  • Percepion Family is angry with them
  • Guilt unable to prevent the death.
  • Competency Dont know what to do/say

23
What we can do
  • Clarify information the cause of death
  • Encouraging them to express feeling about the
    deceased eg. A letter / telephone of condolence
  • Empathy Tolerate silences
  • Being thereas a healer

  • Pigerson HG et al. JAMA 2861369-1376

24
Take home message
  • Grief is itself a medicine

  • ( Green J,1992)

25
The power of Being there
The Doctor" by Luke Fildes,1981
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