Understanding bereavement: what every oncology practitioner should know

Death and dying are ever-present in the practice of oncology. Oncology clinic staff regularly encounter terminally ill patients and grieving family members and, therefore, are well positioned to identify and intervene on behalf of those at risk for extreme psychological distress. It is important for oncology providers to understand grief, the factors that heighten the risk for maladjustment to the loss, and how best to ease the emotional pain and suffering of bereaved family members. This article highlights models of grief that examine early relationships, relationships at the time of the loss, cognitive processes, and cultural practices. We also discuss special circumstances of grief such as the loss of a child or parent and grief in young adults. Risk factors for severe grief reactions, specifically prolonged grief disorder, are examined, as are the efficacy of various interventions, including staff support, psychodynamic therapy, cognitive-behavioral therapy, interpersonal therapy, group therapy, and Internet interventions. Overall, the literature on treatment for grief has demonstrated mixed results, but some therapies have shown promise in treating particularly distressed families and individuals. We discuss the clinical significance of grief and the importance of recognizing the unique factors which contribute to individuals' abilities to cope with loss.