Grief comes into each of our lives at different times and for different reasons. We may instinctively grieve the loss of a person we love, but can also feel profound, life-changing emotions related to the loss of a job, a relationship, a pet, a home, even a dream.

While some grief feels normal, there are several types of bereavement and the changes to our emotional, spiritual, physical, and cognitive experiences can sometimes be unexpected. In hospice, we often deal with a specific type of grief described as being anticipatory. Anticipatory grief occurs when a person is ill for an extended period of time and the feelings of loss one expects to feel after the death happen while the person is still living. Anticipatory grief can be felt by the person who is ill as well as by loved ones.

John Monnin, a bereavement counselor at Crossroads Hospice in Cleveland, is experienced in walking with people through their grief journeys and has seen anticipatory grief firsthand. “Anticipatory grief is just as it sounds — anticipating a loss in advance, but not wanting to do so,” Monnin says. “An individual may experience overwhelming waves of sadness and deep feelings of helplessness as they wait for a death to occur. It’s important to recognize and acknowledge that it’s normal to feel this way when a person is terminally ill.”

How can you tell if a person is dealing with anticipatory grief? Most often this is occurring when the loss is imminent but there is a struggle to come to terms with it. “The signs might be bouts of sobbing, restlessness, constant worry, and even a preoccupation over the patient’s welfare when they are in the care of others,” explains Monnin. Some signs may not be as noticeable to others, such as anxiety or sleeplessness. “There are a lot of factors at play. Grieving is an individual experience and there are no absolutes.”

Walking the Journey with the Patient

If you think a patient is dealing with anticipatory grief, what can you do? Healthcare professionals can, and should, play an important role in helping patients and families cope. Active listening is vital, advises Monnin. “Some people just need to talk. Being able to listen and being truly present in the conversation is tremendously helpful.”

It’s also important to help a patient or family member identify their emotions. “Remind them what they feel is what they should be feeling,” says Monnin. “Make sure they understand this is a stage they are going through and they won’t stay there for the rest of their lives.” It is also good to remind that even though grief may be experienced before the loss, this does not necessarily mean there will be reduced grief after the loss.

Some people need permission to experience feelings of grief. Caregivers especially are under a lot of pressure and may feel if they grieve it is a sign of weakness. By explaining that what they are going through is normal, and giving them permission to feel and express their feelings in a healthy way, often leads to a much-needed sense of relief.

Other helpful suggestions:

• Help people identify their support systems. Remind the person he or she is not alone. Ask who they can turn to whether that is a friend, spiritual advisor, or family member. Make suggestions to help them round out their circle of care. Also let them know you are there as a source of support as well.

• Discuss constructive ways to handle grief for adults and children. Look for signs of depression, anger, anxiety. Remind that being angry is allowed and that there are constructive ways to alleviate the emotions (suggest punching a pillow or doing some sort of physical work or exercise).

• Ask them how they’re doing….and ask frequently. Are they sleeping (too little, too much, or at all)? Are they eating healthy foods? Are they exercising? Conversely, are they overindulging in things such as drugs or alcohol? Caregivers often need to be reminded to be kind to, and patient with, themselves.

• Don’t forget about spirituality. Some people are better able to cope through spiritual expression. Encourage the person to continue to reach out to their higher power and recognize this important connection in the midst of their heartbreak.

• Be mindful that other healthcare professionals, your colleagues, may be experiencing anticipatory grief, too. Many hospice workers, for instance, become especially close to patients and may also need support.

People struggling with anticipatory grief may need to be reminded that feeling a sense of loss doesn’t mean they are giving up. In fact, this period allows people to make the most of the remaining time. “Say the ‘thank you’…share memories and love. Make new memories,” reminds Monnin. “Maybe say the apologies, too.”

Grief is a normal part of life and it should be recognized and managed in productive ways. Working with patients and family members as a team can be an effective way to help those experiencing anticipatory grief better manage their loss journey through to recovery.

To learn more about the grief support program at Crossroads Hospice, please contact us at 888-564-3405 or visit our website.