Mourning: medical attitudes and a person’s expectations in the general practice/family medicine ambience
DOI:
https://doi.org/10.32385/rpmgf.v41i4.14012Keywords:
Mourning, Prolonged grief disorder, Family doctor, Therapeutics, Empathy, Person-centred medicineAbstract
Introduction: Grief, a personalized response to the loss of a significant other, often leads to seeking medical consultation.
Objective: To evaluate and compare the attitudes to be used by family medicine doctors (m-FM) and the expectations of bereaved individuals.
Methods: An exploratory, cross-sectional observational study was conducted on a sample of m-GP, chosen conveniently, and on individuals who have been in mourning for less than a year, applying a specifically designed clinical case and response to similar medical attitudes and expectations in closed multiple-choice and open-ended options. The application process took place after consultation and was also conducted remotely, following an invitation from the m-MGF, by the inclusion criteria. Readability analysis of the text and descriptive and inferential statistics of the data were performed.
Results: In a sample of 21 m-MGF, 13 (46.4%) women and n=12 (57.1%) specialists, and from 20 people, n=15 (75.0%) were women. Significant differences were found in the responses of m-MGF and people (p<0.001), with empathetic counseling being the most chosen option by m-MGF, 69.6%, and people, 27.5%. For 91.7% of the specialists, only empathetic counseling was selected, with specialty interns responding with more options (p=0.014). People significantly chose more associations of therapeutic attitudes, 31.7% (n=13), than GPs, 2.4% (n=1, p<0.001).
Discussion: The differences found in this unprecedented study, simultaneously academic and practice-oriented, regarding medical attitudes and the expectations of people in the face of a bereavement case, suggest the need for a more comprehensive approach by doctors in managing people in mourning, such as the use of empathy, person-centered medicine, and social prescription.
Conclusion: In this sample, despite the same attitudes and expectations, differences were observed between m-MGF and people. Doctors predominantly opted for empathetic counseling (69.6%), while people chose other simultaneous approaches.
Downloads
References
1. Dias T, Sousa N. A morte, o sofrimento e a doença: um luto diferente [Death, suffering and disease: a different kind of grief]. Rev Port Med Geral Fam. 2014;30(2):110-6. Portuguese
2. Breen LJ, Kawashima D, Joy K, Cadell S, Roth D, Chow A, et al. Grief literacy: a call to action for compassionate communities. Death Stud. 2022;46(2):425-33.
3. Cruse Bereavement Support. Understanding the five stages of grief [homepage]. CBS; s.d. [cited 2023 Dec 29]. Available from: https://www.cruse.org.uk/understanding-grief/effects-of-grief/five-stages-of-grief/
4. Johnson JG, First MB, Block S, Vanderwerker LC, Zivin K, Zhang B, et al. Stigmatization and receptivity to mental health services among recently bereaved adults. Death Stud. 2009;33(8):691-711.
5. Corr CA. Elisabeth Kübler-Ross and the ‘Five Stages’ Model in a sampling of recent American textbooks. Omega (Westport). 2020;82(2):294-322.
6. Szuhany KL, Malgaroli M, Miron CD, Simon NM. Prolonged grief disorder: course, diagnosis, assessment, and treatment. Focus (Am Psychiatr Publ). 2021;19(2):161-72.
7. American Psychiatric Association. Prolonged grief disorder [homepage]. APA; 2022. [cited 2023 Sep 22]. Available from: https://www.psychiatry.org/patients-families/prolonged-grief-disorder
8. World Health Organization. 6B42 – Prolonged grief disorder [homepage]. In: ICD-11 for mortality and morbidity statistics. WHO; 2025 Jan. 11th ed. Available from: https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/1183832314
9. Delalibera M, Coelho A, Barbosa A. Validação do instrumento de avaliação do luto prolongado para a população portuguesa [Validation of prolonged grief disorder instrument for Portuguese population]. Acta Med Port. 2011;24(6):935-42. Portuguese
10. Carmassi C, Shear MK, Socci C, Corsi M, Dell'osso L, First MB. Complicated grief and manic comorbidity in the aftermath of the loss of a son. J Psychiatr Pract. 2013;19(5):419-28.
11. Prigerson HG, Bridge J, Maciejewski PK, Beery LC, Rosenheck RA, Jacobs SC, et al. Influence of traumatic grief on suicidal ideation among young adults. Am J Psychiatry. 1999;156(12):1994-5.
12. Prigerson HG. Complicated grief: when the path of adjustment leads to a dead-end. Bereave Care. 2004;23(3):38-40.
13. Prigerson HG, Bierhals AJ, Kasl SV, Reynolds CF 3rd, Shear MK, Day N, et al. Traumatic grief as a risk factor for mental and physical morbidity. Am J Psychiatry. 1997;154(5):616-23.
14. Macedo A, Cavadas LF, Sousa M, Pires P, Santos JA, Machado A. (2011). Empathy in family medicine. Rev Port Clin Geral. 2011;27(6):527-32.
15. Santos P, Sá AB, Santiago L, Hespanhol A. A árvore da WONCA: tradução e adaptação cultural para português [The WONCA tree: Portuguese translation and cultural adaptation]. Rev Port Med Geral Fam. 2021;37(1):28-35. Portuguese
16. Coelho BM, Santiago LM. Medicina centrada na pessoa: validação populacional de um instrumento de medida pela pessoa [Person-centered medicine: validation of a person perception instrument]. Rev Port Med Geral Fam. 2022;38(3):247-56. Portuguese
17. Johns Hopkins; American Healthways. Defining the patient-physician relationship for the 21st century. Dis Manag. 2004;7(3):161-79.
18. Stewart MA. Effective physician-patient communication and health outcomes: a review. CMAJ. 1995;152(9):1423-33.
19. Abel J, Kellehear A, Aoun SM. Bereavement care reimagined. Ann Palliat Med. 2023;12(4):816-25.
20. Reiland H, Banerjee A, Claesges SA, Giuca AM, Hillard CJ, Reynolds CF 3rd, et al. The influence of depression on the relationship between loneliness and grief trajectories in bereaved older adults. Psychiatry Res Commun. 2021;1(1):100006.
21. Prigerson HG, Maciejewski PK, Reynolds CF 3rd, Bierhals AJ, Newsom JT, Fasiczka A, et al. Inventory of Complicated Grief: a scale to measure maladaptive symptoms of loss. Psychiatry Res. 1995;59(1-2):65-79.
22. Vaz T, Sá L. A prescrição social: uma revisão de tema [Social prescribing: a review]. Psicol Saúde Doenç. 2021;22(3):971-8. Portuguese
23. Rebelo L. Família e cuidados de saúde [Family and health care]. Rev Port Clin Geral. 2007;23(3):295-7. Portuguese
24. Broeiro P. Literacia em saúde e utilização de serviços [Health literacy and use of health services]. Rev Port Med Geral Fam. 2017;33(1):6-8. Portuguese
25. Dias T, Sousa N. A morte, o sofrimento e a doença: um luto diferente [Death, suffering and disease: a different kind of grief]. Rev Port Med Geral Fam. 2014;30(2):110-6. Portuguese
26. Santiago LM, Ramalho M, Ferreira PL. O médico e a prática da Medicina Centrada na Pessoa: adaptação cultural e validação de questionário de autoavaliação retrospetiva [The doctor and the Patient-Centered Medicine practice: cultural adaptation and validation of a retrospective self-assessment instrument]. Rev Port Med Geral Fam. 2023;39(6):523-32. Portuguese
27. Monteiro M, Santiago LM, Simões JA. Validação da escala ‘Profundidade da Relação Médico-Doente’ e a sua influência nas consequências em saúde: qual a importância da inteligência emocional na relação com o paciente? [Patient-Doctor Depth of Relationship Scale validation and its influence on the outcomes: what is the importance of emotional intelligence when approaching the patient?] Rev Port Med Geral Fam. 2024;40(2):112-22. Portuguese
28. Santiago LM, Gomes C. Relação médico-doente: principais obstáculos e como superá-los [Doctor-patient relationship: main barriers and how to overcome them]. Rev Port Med Geral Fam. 2024;40(3):268-84. Portuguese
29. Moutinho B, Santiago LM, Simões JA. Profundidade da relação médico-doente: escala para autoavaliação da perspetiva do médico [Patient-doctor depth-of-relationship scale: the doctor’s perspective]. Rev Port Med Geral Fam. 2024;40(4):328-37. Portuguese
30. Santiago LM, Mendes T, Carvalho C. General practice/family medicine Portuguese doctors: ‘technicists’ or ‘systemics’? Aten Primaria. 2022;54(6):102315.
31. Ferreira PM, Silva PA, Jerónimo P, Marques T. Processos de envelhecimento em Portugal: usos do tempo, redes sociais e condições de vida [homepage]. Lisboa: Fundação Francisco Manuel dos Santos; 2013. Available from: https://ffms.pt/pt-pt/estudos/estudos/processos-de-envelhecimento-em-portugal
32. Santana P. Este país não é para velhos? [homepage]. Lisboa: Fundação Francisco Manuel dos Santos; 2019. Available from: https://ffms.pt/pt-pt/atualmentes/este-pais-nao-e-para-velhos
33. Marques S. Vencer o medo de envelhecer: educação e contacto entre as gerações ? [homepage]. Lisboa: Fundação Francisco Manuel dos Santos; 2019. Available from: https://ffms.pt/pt-pt/atualmentes/vencer-o-medo-de-envelhecer-educacao-e-contacto-entre-geracoes
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Portuguese Journal of Family Medicine and General Practice
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
The authors will assign to the RPMGF the sole right to publish and distribute the content of the manuscript specified in this declaration via physical, electronic, broadcasting or any other medium that may come into existence. They also grant the RPMGF the right to use and exploit this manuscript, in particular by assigning, selling or licensing its content. This permission is permanent and takes effect from the moment the manuscript is submitted, has the maximum duration allowed by applicable Portuguese or international law and is of worldwide scope. The authors further declare that this assignment is made free of charge. If the RPMGF informs the authors that it is not going to publish their manuscript, the exclusive assignment of rights ceases forthwith.
The authors authorise the RPMGF (or any entity it may appoint) to act on their behalf when it believes that copyright may have been infringed.
