Care of the family when the patient is dying

Families shoulder many burdens during terminal illness. Their needs grow and change as their loved one's illness progresses. We describe specific physician behaviors that can assist families in coping with terminal illness. Early in serious illness, there are the emotional burdens of learning of the illness and coming to accept a terminal diagnosis, of giving up hope of cure. As terminal illness progresses, patients often need family members to help refocus hope despite the inevitability of death. Patients and families need support, guidance, and encouragement to begin planning for many decisions. Although emotional burdens are felt by most family members, families who choose to have their loved one die at home take on enormous direct caregiving burdens as well. They need information and supplies, including specific teaching of caregiving skills and logistic support. After the death of the loved one, family members have bereavement needs that require ongoing support.