Presentation Title

Observations Regarding
Anticipated Grief
Tom Saunders, M. Div, Chaplain
Please complete general and pre-session surveys
before the presentation
¡Vida! Educational Series
Educational Objectives
• Define anticipatory grief.
• Explain at least two different phases of
Be able to use two methods for dealing
with anticipatory grief.
What is Anticipatory Grief?
Anticipatory grief is grief that is
experienced prior to a significant
loss. One could say that anticipatory
grief can be a grief of preparation.
Preparation for the patient who has a
terminal illness and preparation for
the family and other persons in the
life of the patient.
What is Anticipatory Grief?
This means that anticipatory grief can
be a reality for the patient, the family,
caregivers, friends and even the
professionals who care for the patient.
Anyone emotionally associated with
the patient can also experience this
type of grief.
Definition of Terminal Illness
The fundamental elements of terminal
illnesses are:
1. The presence of an advanced, progressive
and incurable illness
2. The lack of a reasonable response to
specific treatment
3. The presence of numerous problems or
intense symptoms that are multiple,
multifactorial, and changing
(The Spanish Society of Palliative Care)
Definition of Terminal Illness
The fundamental elements of terminal
illnesses are:
4. Large emotional impact on the
patient, family, and treatment team
related explicitly or not to with the
presence of death
5. Prognosis of six months or less.
What is Anticipatory Grief
Psychiatrists Dr. Carmen Rosales
Herrera and Dr. Mary Sol Olmeda
explain that anticipatory grief, as a
phenomenon of scientific study, began
with soldiers during the second world
war. More recent studies have included
research regarding the parents of
children with terminal illnesses.
Conditions and Illnesses
Although the focus of this presentation
is about anticipatory grief experienced
in the environment of hospice and
palliative care, there are other
conditions and illnesses that can be
the cause of anticipatory grief.
The Symptoms
Anticipatory Grief
The symptoms of anticipatory grief can
be the same symptoms one
experiences with regular grief.
The Various Dimensions of Life
According to the Hospice Foundation of
America, grief affects us in various
dimensions of life:
• Physically
• Emotionally
• Spiritually
Emotional Symptoms of Grief
Indecision or confusion
Temporary changes in personality
Spiritual Characteristics of
Anticipatory Grief
• Questioning one’s faith
• Bargaining with God
• Searching for miracles or other special
religious beliefs to cure the illness
Spiritual Care of
Patients and Families
In our spiritual care of patients and
families, we never criticize the faith
they express.
We can talk about the reality of the
situation, but faith is an expression of
hope, and we want to encourage hope
in every individual.
Classic Phases or Stages of
By Dr. Elizabeth Kubler Ross
As the patient can pass through
these phases during a terminal
illness, the patient’s caregivers
can also.
It’s important to know that one may not
experience these phases.
There is not a fixed sequence in passing
through these phases.
One might experience some of all of
these phases at various times during
the course of anticipatory grief or
regular grief.
It is said that this is a less dramatic grief
because one has more time to put his or
her feelings in order. Also it provides time
to take care of issues like insurance,
inheritances, and other paperwork. At
times there is a sense of relief after the
death of one’s loved one when anticipatory
grief has been experiences.
José María Romera
Anticipatory Grief can be a motivation
for important conversations with the patient.
Dr. Ira Byock In his book The Four Things
That Matter Most talks of what we can be
saying to our loved ones during the course of
a terminal illness.
Forgive me -- I forgive you
Thank you
I love you
Good bye
Methods for Dealing with
Anticipatory Grief
• Support groups (self care/ caregiver groups)
• Spiritual support from clergy/ pastoral
• Support from a religious community
• Emotional support from a psychologist,
social worker, or other professional
• Exercise
• Support from family and friends
Appropriate rest
The Work of Expressing Grief
Dr. Alan Wolfelt talks about the work of
expressing grief. He and other experts
in the area of grief speak of the needs
to express grief in various ways that
work for the individual.
The Work of Expressing Grief
Recognize anticipated grief
Journal your grief
Draw/ paint your grief (other art forms)
Pray your grief
Eulogize your loved one
Create ceremonies for the expression
of anticipatory grief
• Express your anticipated grief in your
own way
Case Studies
• Patients
• Caregivers
• Family members
Conclusions & Observations
from Hospice
• Anticipatory grief is common.
• Anticipatory grief can open up other parallel
grief; one can recognize a constellation of
• There is support to deal with the effects of
anticipated grief, such as for regular grief
• Anticipatory grief is a grief of preparation
and can help us regarding future losses.
• (2009, March 16). Anticipatory grief - explanation of anticipatory
grief. About Palliative Care - Hospice and Palliative Care. Retrieved July 19,
2012, from
Ayudando en el duelo anticipado | Calcetines del revés. (2012, March 24).
Calcetines del revés | Así estamos ahora, como calcetines dados la vuelta.
Somos nosotros, pero no somos los mismos. Esta es nuestra lucha por
encontrar una nueva manera de vivir sin los seres amados que nos faltan..
Retrieved July 19, 2012, from
Byock, I. (2004). The four things that matter most: a book about living. New
York: Free Press.
Clínica Alemana de Santiago S.A. - Chile. (n.d.). Clínica Alemana de
Santiago S.A. - Chile. Retrieved July 3, 2012, from
Etapas descritas por la Dra. E. Kubler Ross que pueden aplicarse al duels.
(n.d.). Renacer. Retrieved July 18, 2012, from
Kramer, H., & Kramer, K. (1993). Conversations at midnight: coming to
terms with dying and death. New York: W. Morrow and Co..
Romera, J. M. (n.d.). El duelo anticipatorio. HOY Extremadura a
diario con noticias y última hora del periódico y la edición digital. Retrieved
July 4, 2012, from
Herrera, C. R., & Olmeda, M. S. (2001). El duelo anticipatorio. Retrieved July 4, 2012, from
Hospice Foundation of America. " Comprendiendo el Duelo - YouTube
."YouTube - Broadcast Yourself. . N.p., n.d. Web. 13 July 2012.
SECPAL / Guía CP/ Definición de enfermedad terminal: características.
(n.d.). SECPAL. Sociedad Española de Cuidados Paliativos.. Retrieved July
19, 2012, from
Stamateas, B. (n.d.). Duelo por la muerte de un familiar- Por Bernardo
Stamateas en Canal 26 - YouTube . YouTube - Broadcast Yourself. .
Retrieved July 19, 2012, from
Wolfelt, A. (2007). Living in the shadow of the ghosts of grief: step into the
light. Fort Collins, CO: Companion Press.
Educational Series
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