Finding the right words
I think that physicians have trouble talking about grief and fear because we can’t necessarily do anything about it. And since we’re fixers, if somebody says, ‘I’m afraid of dying,’ and we can’t fix that, then we feel uncomfortable.
When a patient dies, we may struggle to find the right words. Unfortunately, there is no singular 'right thing' to say or do when working with bereaved families because grief is so individual. Rather than providing a script, here we provide some tenets to keep in mind and sample phrases that will guide you in communicating sensitively with bereaved families. Sensitive communication is more likely to help families move through a healthy grief process.
Holding a grief-sensitive stance
Remain curious
Although grief is a universal experience, it is also highly individual. All minds are also all unique and work differently. The only way to understand someone's grief is to ask.
- How are you feeling?
- What’s on your mind?
- Can you tell me more about that?
- I want to ask what I can do that you would find helpful.
- How are you making sense of what happened?
- How is your child making sense of this?
Acknowledge that you cannot know for certain what is on another person’s mind
We are not mind-readers, so we can’t know for certain how someone is grieving and what is in their mind. Nonetheless, it is important to make good guesses based on what we know about grief generally, as well as what we know about the patient, their relationship with their family, their family's culture, the circumstances of the death or loss, etc.
- I imagine…
- I don't know for certain…
- Is it possible that maybe…
- I wonder if you might feel/think/wish/want…
- Avoid phrases like: “you must be feeling…”, “I know how hard this is…”, or "I know you're sad."
Be transparent about what is on your mind
Sharing our own mental states and feelings of grief helps to demonstrate our humanity and genuineness.
- I have been thinking of you.
- You’ve been on my mind.
- Your family has been on my mind.
- I’ve been thinking about…
- I’m so glad you’ve shared that.
- I am so sorry you're carrying this pain
- I find myself wishing...
Collaborate with families
Engaging in collaborative discussion about grief and mental states helps families feel heard.
- I want to make sure I'm using language that feels okay to you.
- Let’s think together about how you’d like to remember [patient's name].
- I want to spend some time thinking with you about what the next steps should be.
- Give choice whenever possible: "would you like to sit or stand?"
Keep relationships and bonds in mind
As healthcare professionals working with dying patients and grieving families, we must be mindful of the complexities of family relationships and how they impact grief, mental states, and behaviors.
- I imagine this is not how you anticipated your family would look right now.
- How might we help you have a lasting bond with [person's name]?
- How would you like me to refer to [person's name]?
- I imagine there were lots of things that made [person's name] unique and special. What are some of the things you will remember?
Communicating with children
When talking to a child of any age, the following principles apply, regardless of the circumstances.
- Use simple words appropriate for the child’s age and understanding. It is important to use the real words such as ‘dead’ and ‘died’. Euphemisms including ‘lost’ or ‘gone to sleep’ may seem kinder, but can cause confusion for a child.
- Only give as much information as a child wants. This is usually indicated by them asking a question – if they have asked the question it usually means that they are ready to hear, or need to hear, the answer.
- Try to answer only the question asked and avoid giving extra detail. There is a fine line between being honest and overloading a child with information they do not want. Information can always be added later if needed.
- If faced with a question you find difficult or are not sure how to answer, it can be helpful to ask the child what they think. This will give you an indication of how much the child already knows and understands.
It's really not at all about the goal of any sort of specific conversation as much as it is to just be there for that individual and that family in whatever way it is. I don't think it is about outcome. I think it's just being there however you can be.