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Underdiagnosed grief is the most frequently ignored of the types of psychosocial concerns patients have. When the psychosocial concerns of patients are ignored, there is an increase in maladaptive coping, adherence issues, and poor provider-patient communication (Hong et al., 2018; Kentish-Barnes et al., 2015). By looking at the psychosocial strain of their patients through a lens of loss, health social workers can explore and validate their patients' emotions. By doing this, we can help our patients shift from being "stuck" in their emotions to better managing their health care.
The six types of Underdiagnosed Grief (UG) identified explain the living health losses patients experience. In order to understand the best way to address UG, I have provided a three-prong assessment framework for health social workers to identify and intervene in UG.
The three-prong approach steps are:
Step 1: Explore Underdiagnosed Grief through questions or statements
Step 2: Acknowledge Underdiagnosed Grief
Step 3: Process Underdiagnosed Grief
Use questions to draw out general information on the losses.
Sample Questions:
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How would you describe your life if I met you before this diagnosis?
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How about now?
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What has changed?
Use more in-depth questions specific to the six types of Underdiagnosed grief that patients experience.
Sample Questions:
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What, if any, changes have you noticed in your relationship?
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Has your diagnosis affected your work or income?
In the Clinician Resource section, I have added a worksheet to use with patients.
Step 1a:
Exploring Underdiagnosed
Grief
through Questions
Exploring UG through Questions-Video highlights:
Health social workers can:
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Identify a patient's perception of their health losses.
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Identify the types of Underdiagnosed Grief a patient experiences.
Exploring UG through Statements- Video highlights:
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During hospitalization, patients are inundated with questions.
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Patients' frustration may increase with the bombardment of questions.
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Be attuned if multiple questions stress your patient.
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Use empathic statements instead to solicit a response.
The use of questions may be too overwhelming for certain patients.
Instead, use empathic statements such as:
"Things seemed to have changed dramatically for you in recent months."
"It must be difficult to lose some connections to your support."
Empathic statements will lead to two responses:
"Yes and...." or
"No, this is how I am feeling."
Either way, you have open the exploration with them.
Then continue to explore the patient's Underdiagnosed Grief types.
Step 1b:
Exploring
Underdiagnosed Grief
through Statements
Step 2:
Acknowledging Underdiagnosed
Grief
Use reflective listening statements that connect to the patient's types of UG.
Use the word "loss" in your statement.
By using the word "loss."
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Patients recognized their struggles as a loss.
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Can shape their understanding of their experience.
"It sounds like you have lost an integral part of your support system."
Acknowledging UG-Video highlights:
Health social workers can:
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Follow the words of pain that patients often hide.
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Acknowledge the patient's losses in a way for patients to understand their emotions are those of grief.
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Expect some patients not to be overwhelmed by loss.
Processing UG-Video highlights:
Health social workers can:
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Build upon the information they have learned in step 1 & 2.
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Process how the patient has created meaning of their health losses.
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Process the patient's stress and strain of the health losses.
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Incorporate therapeutic interventions that align with the social worker's skill set.
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The goal is to move the patient into accepting and adapting.
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Aid the patient in figuring out how this loss fits in their lives
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Look for ways to decrease the impact of loss.
"It sounds like the friendship you formed at work are very important to you. Let us explore ways you can still maintain a relationship with them."
