The role of expressing feelings before bereavement : a cross-national study of relatives of cancer patients in Aberdeen and Jamaica
Bereavement in the literature has been discussed mainly in terms of the bereaved. This is in spite of research indicating that the widowed considered their experiences prior to bereavement as being more stressful than being recently bereaved (Vachon, 1988). Furthermore, although the benefits to relatives of terminally ill patients from expressing their emotions before or after bereavement have been emphasised, the possible harmful effects of such grief responses have seldom been examined. Similarly, the positive and negative effects of controlling grief feelings have been relatively unexplored. In this study both the controlling and expressing of grief feelings were studied in relatives who were coping with a loved one who had terminal cancer. Forty relatives were interviewed from the local hospices in Kingston, Jamaica and an additional 40 from the continuing care-unit in Aberdeen, Scotland. The relatives were interviewed by the investigator who used a semi-structured interview format to obtain self-reports on their health, coping strategies, grief reactions, availability of social support and so on. Fifty per cent of the sample were also reassessed 4-6 weeks following the patient's death. Both non-parametric and parametric statistics were used to analyse the data. The results indicated that mode of expression was related to coping with an imminent loss but the outcome of grief expression differed depending on the cultural and social norms of the individual. In addition, an ethno-focal model on grief which was developed for the present investigation, and which emphasised the socio-cultural beliefs of the subjects in the study, was proven to be effective in predicting the health effects of relatives of patients. The investigator concludes that cultural differences in grief experiences are not fictitious. A number of suggestions are made for practitioners, especially those within a hospice setting, for health professionals in general who work in a multi-racial or multi-ethnic society, and for future research on the parallels of different kinds of loss experiences.