Chapter 1: Strategies for intervening in anticipatory grief and trauma

Preparing families for death

Additional Videos
What does death look like?(3:22)Video transcript
Talking about death (3:22)Video transcript

 “When working with families, we always try to use the most precise words possible. I‘ll often say that while things are looking good NOW, things remain critical and can change hour to hour. I encourage families to be cautiously optimistic while trying to prepare them that this might not go as well as any of us hope”. - ICU Physician.

Preparing for the possibility of death

There is a subtle balance between being realistic and not taking away hope. It’s good practice to start using words like ‘death’ and ‘dying’ when this is a possible outcome. By taking care to be sensitive and compassionate, you can speak about death and dying in a way that helps the family prepare for the likelihood of death and reduce the risk of traumatization.


Preparing for the certainty of death

While you may have a clear idea of what is going to happen, the family is confronting a new and life-altering experience and struggling with feelings of grief and trauma. A few things to consider when death is certain:

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Never make assumptions.

Never assume that families know that death will occur.   

Families may resist discontinuing treatments.

For many people, pursuing active treatment is an expression of love and ending it represents a betrayal.

Families may need to shift to a new reality.

This requires your clinical wisdom, patience, and ability to tolerate both anxiety and powerlessness.

Families may wonder about dying and death.

For many, the only time they have seen someone ‘die’ is on TV or in movies. Ask families if they want you to describe how this patient’s dying and death might look (e.g., what will occur when the breathing tube is removed).

Different cultures have different approaches.

Families may have specific cultural practices or rituals related to death.  Be open, respectfully curious, and willing to understand and respect their beliefs and values.  Remember that some cultures believe that the afterlife is impacted by the way that the person is treated as they are dying and how the body is handled after death.

Who wants and needs to be there at time of death.

Some family members will want to say goodbye before their loved one dies, whereas others may wish to not approach someone who is actively dying.  Some families may also want a religious or spiritual leader to be present.  Try to ensure that people who should and need to say goodbye have a chance to do so.

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By preparing families, you can give them a sense of what to expect and reduce their risk of further traumatization and bereavement difficulties.

It's our duty to be honest if there is little or no hope

Conversation Prompts

 Is there anything that you think your loved one would want us to be doing at this point”?

“Is there a religious leader or someone else from your spiritual community you’d like us to call at this time”?