Grief Response of Patients Diagnosed With Cancer

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Theories, concepts and ideas on grief

The loss of a loved one often causes grief and depression to those who were close to the deceased. Even with the knowledge of knowing that death is a part of growth, the thought of death scare many people. This knowledge of knowing that we will one day lose a close relative is always present with us. According to Kubler-Ross (2008), this knowledge creates anxiety from an early stage in life. This occurs as early as in childhood.

The beginning of anticipatory grief begins when as children, we realize that we will all die or lose a loved one at some point in life (Kubler-Ross, 2008). This should prepare us for the loss that we are anticipating to experience later in life. This anxiety though never quite prepares us for the real experience of losing those that we love. Anticipated grief heightens when those that we love get the diagnosis of terminal illnesses such as cancer.

Anticipatory grief does not prepare people for the actual grief, nor does it make the process after death easier (Kubler-Ross, 2008). The fact that we know that those we love are dying soon or are diminishing towards death does not make the actual death easier. Anticipation does not protect us, but it prepares us for the harm. It is often that some people may even experience double grief, meaning that they experience grief before and after the death of a loved one.

Kubler Ross developed a model to describe the process of grieving after death. Patients also experience these stages when they get the diagnosis of their terminal conditions. The stages first developed in the book on death and dying by Kubler Ross. These stages progress from denial, anger, bargaining, depression and then acceptance (Kubler-Ross, 2008). It is not everyone that experiences these stages, and they do not follow the order in every person’s life.

In denial, the stages differ in whether it is the patient of the family members. As for the dying person, they find it hard to accept that they are going to face death (Kubler-Ross, 1969). Anger then sets in for the dying, they are angry with themselves and even their family (Kubler-Ross, 2008). At the bargaining stage, the patient is ready to do anything to gain more time to live. The same occurs for their loved ones they even want to bargain for their life. Depressions, then sets in as the reality of the matter begin to set in, and they find that they cannot do anything about it. Lastly, acceptance where one finally accepts the loss and finally begins to put the broken pieces back to normalcy.

The model developed to help those that were grieving understand what emotions they were experiencing. It was not as a guide of steps of grief that people should follow. It is not everyone who experiences these stages; also, these stages do not occur in a certain order. Grieving is an individual issue and everyone may have different modes of experiencing grief. The stages are only helpful to help one understand the terrain of grieving (Kubler-Ross, 2008).

Rando in her book, how to go on living when someone you love dies acts as a guide to help people recover from loss (Rando, 1995). She believes that grief from sudden death meets someone at a point where they are not prepared and makes it difficult for one to cope. It disrupts one’s life and routine and totally changes one’s life. Grief is a process that helps and leads one through pain and helps one get through the painful ordeal. Rando and Kubler-Ross both agree that one has to continue with their life in dealing with grief. First, one has to deal with their inner self in grieving. This describes the emotional aspect of the person grieving and actions that are therapeutic to cope with the pain of the loss. Second, we have to learn to cope with the outer world (Kubler-Ross, 2008).

Bowlby (1980) and Parkes (1998) also developed a model of grief. Their model classified the stages into four stages. They also believed that the stages were not linear and that they could reverberate. This was in contrary to Kubler-Ross model that was linear. It is common for a person to revolve around the stages without emerging from them. This people, therefore, require frequent care giving. Their model’s stages are; shock and disbelief, searching and yearning, disorganization and despair and rebuilding and healing.

Worden (1982) views mourning as the adaptation to loss. This mourning, he says involves four basics, which finally help a family grieving to achieve equilibrium and accept their loss. He says that this process of mourning takes about one to two years before acceptance. Wolfelt’s model is different, as it does not view grieving as a disease rather as a process or part of life. He introduces the aspect of ‘companioning’ (Wolfelt, 1999), where care givers to those mourning have to act as companions.

Term paper

Grief response of families and patients diagnosed with terminal cancer.


When we lose people that we love, many of us tend to go into mourning or grieving to be able to cope with the loss. Grieving is a process that people need to go through to be able to finally accept the loss. Grieving is different among many people; in fact grieving is seen as an individual process. People often have different modes and ways through which they grieve. Grieving sometimes usually takes more time for some individuals while others do easily recover from the loss.


Subject area

Grieving usually has two aspects; first is grieving from sudden loss. Sudden loss occurs when a loved one suddenly dies. This can be from a fatal accident or from a sudden illness that had not been foreseen or expected. (Rando, 1995). A second aspect of grieving is that of anticipated grieving. This grieving occurs in a situation where one gets diagnosed with a terminal illness. Both patients and their family members experience this type of grief. According to Kubler-Ross anticipated grief begins at an early stage when we are children but becomes more realistic when one is diagnosed with a terminal disease (Kubler-Ross, 2008).

The process of grieving experienced by both the patient and their family members is of interest in this study. This is so especially for patients who are diagnosed with cancer. The process of grief and the stages experienced by the patient and their family members are to be discussed in this paper. The study will also focus on theories that have been put forward to explain this process of grieving.

Key terms

Loss is a condition where one is deprived or disadvantaged from having something or someone. Loss can be real, this often occurs from tragic events that results into deprivation. It can also be anticipated, where deprivation is foreseen and one is able to prepare adequately. Loss can also be on a primary basis; in this case, the loss is of greater significance. On the other hand, loss can also be secondary.

Grief is the process of experiencing loss. Grief usually occurs after loss. Grief is of an individual level and is seen as a normal process that occurs especially after a loss. Grief involves emotions, thoughts and certain behavior that depicts that one is in grief. Mourning is one of the acts of grieving. It involves an outward display of the grief that one is experiencing. Mourning can be done publicly or privately depending on the individual. Bereavement is the state of living with a loss and finally accepting.

Population affected by the issue

Cancer is one of the most feared diseases in the world. This may be due to what the patients and their family members know of the outcome of being diagnosed with cancer. In America, cancer is the second most common cause of death. In four deaths that occur, one of these deaths is due to cancer. As of 2010, an approximate of 569,490 people died from cancer (American cancer society, 2010). The death rate is at an alarming rate that around 1500 people die each day from cancer in America. It is also evident that as of 2010 more men died of cancer than women did.

Cancer affects anyone, but one is more likely to be diagnosed with cancer as they age. In America, an approximate of 78% of cancers diagnosed was of fifty-five and above. There have also been a number of survivals from cancer. This people now live free of cancer or with lesser symptoms or effects. The funds that are also going into the treatment of cancer patients according to the national institute of health are approximately $263.8 billion (American cancer society, 2010). These costs are both direct and indirect due to the loss of productivity.

Most patients after being diagnosed with cancer are likely to enter into grief. This grief is not only experienced by the cancer patients but also their family members. Grief in this cancer patient is different and may largely depend on a person’s background and their customs. This aspect therefore, makes it necessary for a holistic approach in helping and understanding these patients undergoing this grief.

Potential risk factors, signs and symptoms

It is often that some of these patients may result into changing their behavior and may end up hurting those close to them. For instance, these patients are often rude to the nurses assigned to them. They may also refrain from talking and retrieve into silence. Another characteristic common among such patients is the aspect of denial. These patients totally refuse to accept of their conditions. This may result in some of them even consulting from different doctors. Denial of the presence of cancer though can end up harming the patient especially if they do not seek medical attention, it may lead to death. It is also often that patients may also be angry and may direct the anger to others. These characteristics are also applicable to the family members.

Additionally, patients recently diagnosed with cancer also experience, fear and anxiety. This is mainly due to the fact that they feel that they are going to die and that they are not well prepared. The fear also comes from knowing that one’s life is changing and they might not be able to overcome the cancer. The patients may also feel lonely and resolve into isolation from the others. It is also possible that such patients maybe fatal and commit suicide. This period also results into the blaming predicament. This is for the family members and for patients. The patient may feel that it was his fault that he was able to contract the disease or he or she may end up blaming those close to him for not taking care of him or her. The family members may also feel responsible for cancer and may blame themselves.

The characteristics and signs discussed above are all components of the grieving process. This is the process that is experienced before death and after death. In the part of the patients, they are only able to experience grief before they fully come into terms and acceptance of their conditions. Their family members though experience anticipated grief of the fear of losing their loved ones and the grief that comes after the actual death of their family members.

Concepts, ideas and theories

The first model is that of Elizabeth Kubler-Ross, who is a psychiatrist. She is commonly known for her books that focus of grief and death. Her model is known as the five steps paradigm of grief. These processes are also known as the stages of grieving or stages of dying. These steps or stages are denial, anger, bargaining, depression and finally acceptance. These stages are seen as means of coping with the tragedies that have befallen the patients or their family members. These stages of grieving can sometimes overlap or co-exist at the same time. For instance, one can both experience anger and denial at the same time.

A second model is that John Bowlby and Colin Murray Parkes. The two collaborated to come up with a process that involved four stages. Bowlby borrowed from his work in the attachment theory, while Parkes had done studies on human information processing. They reviewed Kubler-Ross theory and came up with four stages instead of the five in her model. Their model was also different in that it was not linear, as Kubler-Ross had presented her model. According to their model, the process could recycle. This recycling would occur if a person recollected an event or their memory of the event could force them back into the grieving process.

According to their model, one may take time revolving around the stages before they can finally emerge from the grieving process. It therefore becomes necessary for those around such a person, such people as doctors, nurses of their friends to properly care for these people. This care given to them may facilitate their recovery and the emergence from the grieving process. This model is adamantly against viewing grieving as a process, it rather wants to view it as a period in time that people undergo.

The stages in this model include; the first stage is the shock and disbelief. This model disregards the denial stage of Kubler-Ross model. In this stage, the body tries in every way to cope with the news of the tragedy. The body, soul and the mind may react in a way as if they were blocking the entry of the reality only to let little information in as time progresses. Characteristics such as numbness or withdrawal from people are experienced in this stage. The second stage is the searching and yearning phrase. In this stage, the person begins to undo the harsh reality. They usually find themselves asking questions. It is at this stage that one may result to anger and even agitation.

The third stage is the disorganization and despair phrase. It is at this stage that the truth or the reality begins to fully settle. At this stage a person is in so much despair that they even view their life as being over. At this stage depression sets in, there is also so much disorganization of one’s life. The way forward is not clear and is full of uncertainty. This signs should be treated, as part of grieving and care should be provided to guide these people through this stage.

Lastly, there is the rebuilding stage and healing stage. It is here that the person begins to recover and to reconstruct their life. The tragedy is accepted at this stage and one begins to plan on how to go on with their life. As for the terminally ill, they begin to take the time left and make the best out of that time. The loss ceases to be viewed as personal but as a larger perspective.

The third model is by William Worden a psychotherapist and researcher. He is also a professor at the Harvard University. He has written a text on grief counseling and grief therapy. Worden focuses on mourning, he views mourning as an adaptation to coping with loss. In his model, he says that mourning involves four basic tasks that must be undertaken. It is after undertaking of these tasks that a patient or their family members are able to return to equilibrium and achieve bereavement.

The tasks are not linear or progressive and therefore do not need to follow each other. The tasks though can be concurrent or cyclical. Worden says that the tasks are essential for a person to go through so that they can finally emerge healed. These tasks are first one has to accept the reality of the loss, second one has to experience the pain of the grief, third, one should adjust to an environment in which the deceased is missing and lastly, is the withdrawal of emotional energy and investing it into another relationship.

According to Worden, the fourth task is the most difficult of the tasks. This is mainly because a person takes more time investing their emotions in the present or in the tragedy rather than finding a newer relationship. In this model, emotional recovering has to be allowed so as to bury the old emotions of the loss and create a newer relationship. This process of mourning may take time, in some cases it may go up to two years.

The tasks are essential and must not be interrupted. The interruption of one on these tasks may result into the grief process intensifying and it may become hectic and even pathological for the griever. Worden also gives symptoms that should be noted and detected as they may be signs of masked grieving yet pathological illness may be developing.

Elizabeth Kubler-Ross five stages of grieving

The model has five stages that are denial, anger, bargaining, depression and lastly acceptance. These stages were developed in the book of death and dying (1969). The steps were initially developed for those patients that were suffering after being diagnosed with terminal illness. These patients were undergoing processes that they could not understand as they waited for their death. This model was developed to help people understanhe process of grief. In addition, the model was supposed to help medical officials such as nurses to understand the grieving process of the patients (Sisler, 2010).

The first stage, which is the denial stage, helps us to cope well with the loss, it is also essential for one to be able to survive the loss. At this stage, the griever views the world as a meaningless place. They are deeply overwhelmed with feelings and emotions. The best part about denial is that it let patients and family members to only let in whatever they can handle. It is at this stage that healing begins and as one begins to easily accept the reality, the denial stage begins to fade.

The anger stage then starts to prevail. in this stage the persons feels angry with themselves and with those close to him. He blames himself for having not taken proper care of himself. For instance if a patient contracts cancer caused by smoking they start to become angry for not having quit smoking. On the part of the family members, they become angry because the person about to die did not take care of himself or herself or they did not do enough to prevent the terminal illness. Anger can also be directed toward the doctor or nurses for not seeing the illness on time. Anger then begins to subside as feelings such as sadness, hurt loneliness start to appear. Anger is seen as essential in the healing process. The anger experienced in this stage lacks limits and may be expressed towards anybody or anything.

The bargaining stage is characterized with sacrifice. It is at this stage that family members are willing to do anything for their loved ones. The patients are also willing to do anything that will delay his death. Bargaining helps one to escape the pain of the grief. It also helps one to easily transit from one stage to another. Bargaining helps individuals to see hope and to begin and restore normalcy in their chaotic life.

Depression is a stage that sets in after bargaining. In this stage, the present and reality is now more real. In this stage a person experiences empty feeling and grief becomes more heightened. At this stage, things feel as if they will never be better or as they were before. Kubler – Ross says that depression is necessary to get over the loss, but it should be seen as a visitor and welcomed. This will in turn help in the quick comeback from depression.

Lastly is the acceptance of the stage. This stage the grief has subsided and we have totally come into terms with the reality. In this stage, patients and family members of cancer patients learn to accept the situation, because they understand they can do nothing to change the loss. Healing is achieved in this stage; also, feelings like anger and despair begin to subside. It is at this stage that the cancer patients and their family members have to let go and readjust their lives. The patient has to prepare for their death and after a loss, the family members begin to create a new environment without their loved ones at this stage.

Diagnosing grief in patients by nursing

Nurses in their profession are expected to take care of their patients and be able to notice changes in their patients. This though becomes difficult as diagnosing grief from psychological and psychiatrist conditions. This is because the nurses may assume that patients are simply slipping due to the news about cancer yet the patients may be going into a deep depression. An approximate of 80% of cancer patients develop psychiatrist problems without this problems getting noticed (Williams, 2000).

The difficulty in diagnosing deep depression from grief is heightened from the lack of physical signs, diagnostic tests and biological markers that may enable medical caregivers to clearly distinguish the difference between the two. Tools used in other patients to detect depression are rather discouraged in patients with terminal illness. This is because these patients are seen as grieving from the tragedy they are experiencing.

Nursing intervention

Nurses that are dealing with cancer patients and their families should be careful in how they treat these people. First, the nurse should have knowledge of palliative care. Palliative care is care given to maintain good quality of life. This care is essential for those patients that are dying as it helps them cope well with the situation. Palliative care is of physical, emotional and social aspect. It aims at maintaining equilibrium in a patient’s life.

Palliative care is designed to provide both active and compassionate care to terminally ill patients and their families. This care in some situations is combined with the treatment of the disease. Additionally, palliative care is supposed to remain sensitive to personal, religious and customs preferences of the patients. Palliative care requires skills and knowledge in all the medical officials. This is crucial to help the patient fully recover.

The nursing profession considers grief and loss as a family issue and therefore sees it necessary to involve the family in addressing grief. Nurses are also said to experience grief if one of their patient is diagnosed with a terminal illness. Nurses are therefore advised to first deal with their grief so that they can be able to help their patients and their families. The nurses are also expected to act as a guide to their patients and families in making decisions about treatment and symptoms management. The nurse can also maintain contact with the deceased family by following up on their progress and how they are coping with the loss.


A primary prevention of grief can be family based therapy. Grief cannot be avoided, as it is a natural process that helps people to cope with loss. The only solution to grief is to make the process more endurable and shorter. Family focused therapy focuses on making the process easier. This therapy begins with palliative care and continues into bereavement. This therapy is seen to control and prevent pathological grief. Family focused therapy though does not work in all families especially the hostile families but it helps one to cope better with grief from loss.


Bowlby, J. (1980). Loss, Sadness and Depression. New York, NY: Basic Books.

Kubler-Ross, E. (1969). On Death and Dying. New York, NY: Macmillan publishers.

Kubler-Ross, E. (2008). On Grief and Grieving. New York, NY: Simon and Schuster Co..

Parkes, C. M. (1998). Bereavement: Studies of Grief in Adult Life. 3rd ed. Madison: International Universities Press.

Rando, A. T. (1995). Grieving: how to go on living when someone you love dies. New York, NY: Bantam Books.

Sisler, R. A. (2010). Dealing with Grief. New York: CreateSpace.

Worden, J. W. (1982). Grief Counseling and Grief Therapy: A Handbook for the Mental Health Practitioner. New York, NY: Springer Publishing Co.

Wolfelt, A. D. (1999). Companioning Philosophy. London: Sage.

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PsychologyWriting. "Grief Response of Patients Diagnosed With Cancer." January 25, 2023.