The Clinical Guide to Supportive and Palliative Care for HIV/AIDS

A Clinical Guide to Supportive and Palliative Care for HIV/AIDS • Chapter 16: Grief and BereavementHealth care professionals can facilitate the anticipatory grief period by:• Identifying and legitimizing feelings of sadness, anger, guilt, and anxiety• 26 Encouraging picas expression of feelings in private, comfortable settings• Redefining terms related to expressions of grief (“lose control” or “breakdown” can be reframed into “emotional releases,” which are normal, expectedaspects of coping with stress and grief)• Enabling people to complete unfinished business• Encouraging people to live fully and enjoy life whenever and wherever theycan 10As people face their death, they want to know that they will be remembered and that their lifehad meaning. Engaging patients and caregivers in life review and memory work are effectiveinterventions in coping with anticipatory grief. 11 Zulli suggests religious rituals, meditation, useof photography and/or videos, and journeys (one last trip to a favorite place) as therapeutictools. 12FACTORS THAT AFFECT THE GRIEF PROCESS■ Several factors affect the length and intensity of the grief process. These may help or hinderthe bereaved move through the grief process. For those dealing with AIDS-related deaths, manyof the factors experienced indicate significant risks and often complicate the grief process,leading to potentially dangerous health outcomes.The Nature of the Relationship between the Deceased and the BereavedThis is a crucial factor during the grief process. Generally the greater the bond between thedeceased and the bereaved, the greater the grief experienced. The type of bond (parent, child,partner, sibling) does not necessarily indicate the intensity of grief; every relationship is unique.However, the death of a child is usually always considered a high risk for the bereaved parent(s). 2If there was an ambivalent or codependent relationship, this can also complicate the grief process,as the bereaved may face intensified emotional responses. 8For those dealing with AIDS-related deaths, another complicating factor is that often the relationshipmay be disenfranchised, or not socially recognized as a valid relationship for which togrieve. 13 These disenfranchised relationships can include the death of a partner, an ex-spouse, afriend or co-worker. Additionally, young children, the elderly, and the developmentally disabledare often considered unable to comprehend the loss, therefore unable to grieve. Anyone who isable to create a bond is able to grieve when that bond is threatened or broken. 13Often these disenfranchised grievers need additional support due to the risk factors experiencedduring their loss and yet are denied even general sympathy from society. Some are excludedfrom the postdeath rituals, denying them an opportunity to say goodbye to their lovedone and limiting the social support at a crucial time. 8XVIThe Manner of DeathThe perception of preventability of the death is a crucial factor that can complicate the griefprocess. For those grieving deaths from early in the AIDS pandemic, the fact that the loved onedid not live long enough to benefit from new treatments is difficult to reconcile. 7 And for thoseU.S. Department of Health and Human Services • Health Resources and Services Administration • HIV/AIDS Bureau 331