Facilitating grief in seriously ill patients
Task	How to do this
Reflect	Reflecting or mirroring the patient's feeling by naming and summarizing the underlying emotion in a safe and gentle way
	Example: If the patient says, “Why did I to get this horrible disease?” respond with “I can see that you are angry”.
Empathize	Empathy is defined as the intellectual identification with or vicarious experiencing of the feelings, thoughts, or attitudes of another.
	Example: “It must be really hard for a very independent person like you to accept help. I really admire how gracious you are being about this.”
Lead	Guided questions can help facilitate the grief process.
	Example: “As you looking ahead and planning for the time ahead, what concerns you the most?”
Improvise	A grieving patient's mood often fluctuates over time. Sometimes, the patient may be full of hope and optimism and manifest restoration oriented grief. At others, the patient may be sorrowful and manifest loss oriented grief. It is important to first gauge the patient's current mood and offer support that is congruent to the current emotional state of the patient. Some patients may want to process their grief by recounting their past or recent experiences and active listening is helpful in these situations. Others may want just a quiet and supportive presence and prefer to remain in companionable silence. To note, patients may suddenly change coping strategies, which requires flexibility on the part of the clinician to be able to respond appropriately.
Educate	Explain to the patient that grief ebbs and flows. Ensure that the patient and family understand that people grieve in different ways and that anger, yearning, sadness are all common manifestations of grief. Similarly, family members may manifest their anticipatory grief as anxiety or anger towards the patient. Identifying, validating and channeling constructive outlets for anger helps decrease conflicts between patients and their families.
Validate the Experience	Many patients often report that they feel like they are on an emotional roller-coaster as they struggle to cope with the serious illness. Validate the normalcy of the experience and support them through the process. Example: “It seems to me you are responding normally to a very difficult situation” or “These mood swings are very common when coping with a serious illness”
Recall	Many patients who are seriously ill often do a life review and reflect on their past accomplishments and disappointments. Clinicians can help by asking about personal accomplishments, special stories or legacies that patients may wish to hand down to future generations.