The stress associated with advancing and incurable illness inevitably causes distress for patients, families and caregivers. A palliative approach to care aims to improve the quality of life for individuals with a life-limiting illness and their families by reducing their suffering through early identification, assessment and treatment of pain, physical, cultural, psychological, social, and spiritual needs. 

Additional sources of distress for family members, beyond dealing with the physical and emotional demands of care giving, are the multiple losses and relationship changes that unfold as the person’s illness progresses. Commonly family members begin to anticipate life without the patient, and some will experience intense feelings of grief associated with this loss before the patients dies.

For the patient, the grief over the many losses that have occurred over the illness trajectory such as loss of physical strength and well-being, loss of role, loss of control, loss of life expectancy and safety can be intense. The experience of the patient’s death and any associated trauma may impact on the bereavement phase. 

Coping with a life-limiting illness brings about particular challenges for couples and difficult conversations about plans for the future, changes in prior roles and responsibilities, and varying levels of adjustment as they respond to the increasing demands of the disease and ultimately to the death of one partner and the bereavement of the other. Patients and their partner may avoid discussing fears and concerns to protect the other person. However, by avoiding discussing illness related concerns, spouses can harbor guilt, remorse and regret, leading to poorer bereavement outcomes.

This presentation will discuss loss, grief and bereavement across the illness trajectory. It will present data on how patients cope with their impending death, how they bring meaning to the experience and the strategies health professionals who journey with the patients and their families can bring to support and build resilience.

Learning Objectives

• Define loss, grief and bereavement across the illness trajectory
• Define anticipatory, ambiguous and disenfranchised grief in the palliative care population
• Identify risk factors for poor outcomes for caregivers
• Identify methods of support including strategies for end-of-life communication
  

Dr Liz Lobb – PhD (Psychological Medicine), M. App. Sci., (Behavioural Science) B. Adult Ed. (Community), Post Grad Dip Bereavement Counselling

Professor Elizabeth Lobb has established national and international research collaborations and pursued independent multi-disciplinary clinical collaborations in oncology, haematology, cancer genetics and palliative care for 20 years.

Liz holds an academic appointment as Professor of Palliative Care at Calvary Health Care Sydney and the Cunningham Centre for Palliative Care and an Adjunct appointment as Professor of Palliative Care (Allied Health) in the School of Medicine, the University of Notre Dame Sydney. She has worked clinically as a bereavement counsellor for many years

Her research has enhanced evidence based communication and psycho-social care across the cancer continuum from diagnosis, through treatment, remission and survivorship or relapse, palliative care and bereavement support for families and caregivers.  She has been a CI or AI on peer-reviewed research grants exceeding $16 million since 1998.

Her research interests in psycho-oncology and palliative care include the development of clinical practice guidelines, communication of prognosis in metastatic cancer, doctor/patient communication, patient information and decision-making preferences, the needs of patients with high grade gliomas and their carers, bereaved carers of women with ovarian cancer, couple communication on end of life issues, dignity therapy and complicated grief. 

Liz has a commitment to adult education having taught in the community and welfare sector with the Association of Children’s Welfare Agencies (ACWA), Centre for Community Welfare Training for 10 years. She has been involved in the training of loss, grief and bereavement and support of practitioners working in areas as diverse as domestic violence, aged care, sexual assault, disabilities, foster care, prisons and refugee advocacy. She has facilitated post-graduate training in bereavement counselling for general practitioners, nurses, clinical psychologists, social workers and welfare workers.