Family Support at End of Life

End-of-life care affects more than the person who is dying. Family members may be providing physical care, making decisions, managing medications, communicating with the health-care team, and trying to maintain ordinary responsibilities while anticipating a profound loss. Their distress is not an incidental reaction; it can affect their health, their ability to continue caregiving, and the safety of care at home. Anticipatory grief is mourning that begins before death when a person recognizes that a significant loss is approaching. It is a normal response to life-limiting illness and may include sadness, anger, fear, guilt, numbness, relief, or difficulty concentrating. These reactions can coexist. A caregiver may feel devoted to the patient and still long for the caregiving period to end. Validating that ambivalence reduces shame and creates an opening for honest assessment. Caregiver burden is broader than sadness. Sleep deprivation, missed medical appointments, poor nutrition, social isolation, lost income, physical strain, spiritual distress, and conflict about treatment decisions may accumulate until a caregiver can no longer function safely. The experienced nurse listens for the mismatch between “I’m fine” and observable...