Elisabeth Kubler-Ross Model describes five stages in which the dying patient moves through denial, anger, bargaining, depression, and acceptance.
The first stage of the process of grieving and preparing for death is denial. This may initially manifest as shock or speechlessness. It is common to believe a mistake in the prognosis has been made due to inaccurate test results, having not attempted the correct treatment, or deficits in knowledge of their provider.
Anger is the second stage of the Kubler-Ross model. They become frustrated and angry. They typically direct their aggression towards friends, family, and providers. Example statements include “how can you let this happen to me” and “this is your fault.” Though anger and blame can be emotionally difficult for caregivers and loved ones, it is important to remember it is a normal part of the grieving process. Caregivers can provide understanding and support to help the patient progress through this stage.
Bargaining is thoughts of postponing sadness, confusion, or hurt. Instead, tell yourself such as “what if I have done this” and “if only I have done this, it wouldn’t have happended”.
After the thoughts in bargaining, thoughts of the present flood in, which the patient realizes that the situation is real. Empty feelings come forward, and one’s grief moves in on a deeper level than before. This type of depression is not a sign of mental illness, although reaching out for help may be the right step. It is an appropriate response to great loss. An individual may withdraw from their daily life activities, and they may feel a fog of intense sadness.
In the last stage of death, acceptance, patients may focus on finding joy in what time they have left. They will commonly reflect on joyful memories or tell stories from the past. In this stage, the patient may begin to prepare for death by planning their funeral or making sure loved ones will be taken care of financially and emotionally after their death.
Patients will experience the stages of the Kubler-Ross model differently. Each individual will have a unique experience. The healthcare team should have an understanding of the stages of grief, which allows providers to give support and guidance during the dying process and provides a coordinated effort to provide the patient and family with much-needed emotional support.
