A concept developed by Kubler Ross to identify the emotional responses of the terminally ill patients or their near relatives. Idea, is to adopt appropriate behavior to handle these sensitive situations.

1. ‘Loss and Grief’: Emotional
Experiences by Terminally Ill Patients
Col Zulfiquer Ahmed Amin
M Phil, MPH, PGD (Health Economics), MBBS
Armed Forces Medical Institute (AFMI)

2. When someone is identified to have terminal illness or anyone
near relative is detected to have critical conditions; we experience
certain emotional responses, which are unique in nature. This
emotional responses need delicate handling; otherwise may lead
to dangerous or embarrassing consequences. It is not rare to
experience suicidal tendencies or professional are being harassed
either by the patients or their near-relatives with terminal
condition, arising from misunderstanding and inappropriate
handling of normal psychological responses.

3. The Kübler-Ross model, otherwise known as the five stages of
grief, postulates a series of emotions experienced by terminally
ill patients prior to death, or people presented by the loss of a
loved one.
The model was first introduced by Swiss psychiatrist Elizabeth
Kubler Ross in 1969. Motivated by the lack of instruction in
Medical Schools on the subject of death and dying, Kübler-Ross
examined death and those faced with it at the University of
Chicago Medical School and hypothesized this concept.

4. The stages, popularly known by the acronym
DABDA, include:
Stages of death and dying

5. ‘Denial’ – The first reaction is denial. Many contemporary
psychoanalysts treat denial as the first stage of a coping cycle. If
you were diagnosed with a deadly disease, you might believe the
news is incorrect – a mistake must have occurred somewhere in
the lab–they mixed up your blood work with someone else. If you
receive news on the death of a loved one, perhaps you cling to a
false hope that they identified the wrong person. In the denial
stage, you are not living in ‘actual reality,’ rather, you are living in a
‘preferable’ reality. Interestingly, it is denial and shock that help
you cope and survive the grief event. Denial aids in pacing your
feelings of grief. Instead of becoming completely overwhelmed
with grief, we deny it, do not accept it, and stagger its full impact
on us at one time.

6. ‘Anger’ – As the masking effects of ‘denial’ begins to wear, reality
and its pain emerge. Once you start to live in ‘actual’ reality again
and not in ‘preferable’ reality, anger might start to set in. The
intense emotion is deflected from our vulnerable core, redirected
and expressed instead as anger. The anger may be aimed at
inanimate objects, complete strangers, friends or family.
This is a common stage to think “why me?” and “life’s not fair!” You
might look to blame others for the cause of your grief and also may
redirect your anger to close friends and family. You find it
incomprehensible of how something like this could happen to you.
If you are strong in faith, you might start to question your belief in
God. “Where is God? Why didn’t he protect me?”
The doctor who diagnosed the illness and was unable to cure the
disease might become a convenient target.

7. ‘Bargaining’ – The normal reaction to feelings of helplessness and
vulnerability is often a need to regain control through a series of “If
only” statements, such as:
If only we had sought medical attention sooner…
If only we got a second opinion from another doctor…
If only we had tried to be a better person toward them…
This is an attempt to bargain.
Secretly, we may make a deal with God or our higher power in an
attempt to postpone the inevitable, and the accompanying pain.
This is a weaker line of defense to protect us from the painful
reality. For instance: "I'd give anything to have him back." Or: "If
only he'd come back to life, I'd promise to be a better person!"

8. ‘Depression’ – "I'm so sad, why bother with anything?"; "I'm going
to die soon, so what's the point?"; "I miss my loved one, why go
on?“
During the fourth stage, the individual despairs at the recognition
of their mortality. In this state, the individual may become silent,
refuse visitors and spend much of the time mournful and sullen. It
is our quiet preparation to separate and to bid our loved one
farewell. Someone might even experience suicidal thoughts –
thinking “what’s the point of going on?”

9. ‘Acceptance’: The last stage of grief identified by Kübler-Ross is
acceptance. Not in the sense that “it’s okay my husband died”
rather, “my husband died, but I’m going to be okay.” In this stage,
your emotions may begin to stabilize. You re-enter reality. You
come to terms with the fact that the “new” reality is that your
partner is never coming back – or that you are going to succumb
to your illness and die soon – and you’re okay with that.
In this last stage, individuals embrace mortality or inevitable
future, or that of a loved one, or other tragic event. This phase is
marked by withdrawal and calm. The dignity and grace shown by
our dying loved ones may well be their last gift to us.

13. -Help patient and family to be aware of emotions they may
encounter in the grief process
-Encourage patient and or family to express their feelings
-Encourage healthy coping mechanisms such as exercising or
gardening
-Identify changes in behavior, communication, mood, eating and
sleeping pattern
-Identify those with poor coping mechanisms- May need grief
counseling or antidepressant treatment.
Role of healthcare worker

14. Images of five stages of ‘Loss and Grief’