Bereavement and grief

Normal grief

Normal reaction to loss (bereavement)
Sadness more specific to thoughts of the deceased
“Waves” of grief at reminders
Self-esteem usually preserved
Functional decline less severe
Thoughts of dying involve wish to join the deceased; active suicidality uncommon
Intensity decreases over time
Illusions or hallucinations of the deceased (considered normal if the individual does not believe that they are real)
- This is normal in children. Children under age 6 do not understand the finality of death and may believe that it is temporary or reversible.

Definition: a mental disorder characterized by an unusually prolonged period of grief and/or mourning (lasting at least 12 months in adults and 6 months in children) resulting in severe distress and functional impairment.

The SPIKES protocol is a set of recommendations to help practitioners communicate bad news to patients.

S - Setting: Private room, sit down, no interruptions.
P - Perception: “What have you been told so far?” or “What is your understanding of the situation?”
I - Invitation: “Would you like me to explain the results now?”
K - Knowledge: Give a “warning shot” (“I’m afraid the news is not good.”). Use simple, direct language. Avoid jargon.
E - Empathy: Identify and acknowledge the patient’s emotions (“I can see this is upsetting.”). Listen and be silent.
S - Strategy/Summary: Create a clear plan for next steps. Reassure the patient they will not be abandoned. Schedule follow-up.