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ligation. It’s reasonable to suggest that patients put off decisions that seem
“rushed” until more time has passed and they are able to weigh all of their options.- Physical and psychological symptoms (e.g., insomnia, loss of appetite, depres-
sion, hopelessness). - Guilt for passing along a defective gene to one’s child.
- “Anger is a recognized aspect of the grieving process, arising from feelings of
loss of control, dignity, or well-being, and/or from dormant feelings about past
experiences that result in anger towards family members or caregivers...”
(Schema et al. 2015 ; p. 718). Anger may be directed at the medical professionals
for not arriving at a diagnosis, or for not arriving at a diagnosis sooner, for not
being sympathetic enough, etc. or toward the person they lost―“If she had
treated her breast cancer sooner, she might have lived”—or anger at God/higher
power, which can be particularly problematic for religious patients who believe
it’s not OK to be angry with God. In this latter situation, you might explain that
anger is a normal part of the grieving process and suggest the patients look for
support from their religious community. - Idealization of the person or thing they have lost (e.g., believing their lives would
have been perfect if their baby had lived). - Realism that the loss is permanent. At this phase, and in the subsequent accep-
tance process, patients will be more capable of hearing and understanding infor-
mation, and they will be better able to evaluate the information they receive. - Acceptance of the loss. Until your patients can accept their situation, you must
show patience and support and allow them to be indecisive, confused, angry, etc. - Readjustment—the “new normal.”
- Personal growth.
Strategies for Addressing Grief
Often grieving individuals will cry. During the genetic counseling session, many
patients will be on the verge of tears, although some may attempt to hold back their
tears (out of embarrassment, fear of appearing weak, etc.). You should give them
permission and provide an accepting atmosphere in which to cry. Both verbally and
nonverbally show that you will listen with concern: “It’s OK to go ahead and cry.”
Move your chair a bit closer; move a box of tissue within easy reach. These actions
suggest you are comfortable with patients who lose their composure. Allow yourself
to become tearful if that is what you are feeling. Research has found “When a pro-
vider was tearful with the family, several parents indicated that this seemed appro-
priate” (Gold, 2007 , as cited in Sebold and Koil 2009 , p. 201). Along with a safe
supportive environment in which to discuss their grief, provide relevant resources
(Douglas 2014 ; Helm 2015 ).
It’s also important to reassure patients that what they are feeling is a normal reac-
tion to loss and that grieving takes time (Gettig 2010 ). Experts estimate the grieving
process can take from 6 months to 5 years. To reassure patients and to normalize
their experience, you might say, “You’ve lost so much. I can see how you would feel
9 Patient Factors: Resistance, Coping, Affect, andfiStyles