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Anticipatory Grief

The Grief Journey that starts before the loss

The Grief Journey that starts before the loss: Anticipatory Grief 

Dr. Erica Dickie, DVM, CHPV, BScH 

When we open our hearts to a companion animal we must also prepare our hearts for the day when we say goodbye. Death is an inevitable part of life. We all know this, we just don’t want to think about it as we look into those precious eyes of our dear pets. To many, pets not only provide companionship, they are the one we share our love with, who provide security and confidence, support and comfort, and give us a purpose in caring for another1. Companion animals give us total acceptance, providing a beautiful partnership in life. This human-animal bond that forms and strengthens with time makes it hard to imagine a time where they will no longer be in our lives. The feelings and changes we experience when that time comes closer to reality represent a form of grief called anticipatory grief. 

What is Anticipatory Grief? 

Anticipatory grief is a natural reaction that occurs before the loss of a pet. While it is a very common and normal grief process, it is also an unconscious form of coping that helps us prepare emotionally for the coming loss. Any and all of the grief reactions that occur after the loss of a pet can also be expressed during this “in-between” time. 

While anticipatory grief commonly occurs when faced with the news of a serious illness, terminal diagnosis, or the realisation that your pet is in significant decline, it may also be experienced as early as the first signs of aging. Kristi Lehman, MSW, LISW, shares that changes related to advancing age may represent a series of many losses as time goes on2. For example, as a dog ages and her arthritis worsens, she may one day no longer be able to go for her daily walk, climb stairs, or chase a ball. As pets age, the changes in activities of daily living represent endings. They remind us that our pet’s end of life is drawing nearer. We grieve each of these various losses along the way, ultimately leading to the day when we realise that we will soon be saying goodbye. It is heart-breaking. Anticipatory grief will be felt more deeply in those highly bonded with their pets. Additionally, anticipatory grief may be experienced more profoundly with caregivers whose pets share links, connections, or memories to other people or animals that have died. The thought of losing their present pet may feel like losing that person or pet all over again compounding the anticipatory grief reactions. 

What does anticipatory grief look like? 

This is a really significant period for pet caregivers as their brains attempt to process the news of a poor prognosis, full of anxious thoughts of the unknown to come, along with dread of what life will look and feel like without their pet. Anticipatory grief is commonly experienced in waves, like an emotional rollercoaster. This time can be very overwhelming. While anxiety is the predominant feeling, other common feelings during this time may include: 

  • sorrow 
  • depression 
  • anger 
  • dread 
  • worry 
  • fear 
  • guilt 
  • confusion 
  • indecision 
  • feeling isolated and forgetful 

In addition to the range of grief reactions to the impending loss, there is also the inherent stress of caring for and meeting the needs of an ill pet while facing the daily caregiving dilemma of evaluating quality of life and end of life decision making. This hypervigilant state is mentally and physically exhausting; it is understandable that some may experience physical changes in appetite, weight and sleep patterns. In tandem with the emotional and physical symptoms experienced during anticipatory grief, many also experience high pet caregiver burden and possibly burnout. Caregiver burden is the term used to describe the response of distress to difficulties encountered while providing care for an individual with an illness. It is present in approximately one-half of pet caregivers in the context of a serious illness3. In a 2019 study by Spitznagel and Carlson, greater caregiving burden correlated with poorer pet caregiver psychosocial functioning, including greater stress, symptoms of anxiety and depression, and lower quality of life.3 With feelings of anxiety and depression commonly experienced during anticipatory grief and greater caregiving burden, one can see how important emotional, physical, spiritual and/or moral support is during this time. 

As their pet’s health changes daily, some days better than others, pet caregivers also experience these good and bad days or moments alongside their pets and that is often reflected in their ongoing emotional state and grieving process. With good days comes hope. Hope can bring with it confusion as families hope that their pet may be rallying when in fact, they know there is no getting better. Making informed decisions in knowing when the “right time” to euthanize may be becomes that much more difficult. However, hope can be fostered in other ways. It is during this time that a family may look towards an interdisciplinary animal hospice and palliative care team for guidance and support during the emotional rollercoaster of anticipatory grief. 

While this time of impending loss of companionship may feel like a total loss of control of all things in life, especially emotions, some can experience times of acceptance, peace, growth and reflection. An interdisciplinary animal hospice and palliative care team can become invaluable in facilitating positive changes and growth. 

How can Animal Hospice and Palliative Care Providers help support those experiencing anticipatory grief? 

Animal Hospice and Palliative Care (AHPC) is comfort care during the bridge between life and death, most commonly after a serious illness has been diagnosed. The four major cornerstones to AHPC are pain management, education, communication, and preparation for death. Animal Hospice and Palliative Care providers, such as Certified Veterinarians and Technicians have advanced training in caring for the psychosocial needs of their clients. When pet caregivers begin the process of shifting their mindset to palliation or end of life vet care, the unit of care for the vet team is no longer the animal alone, but also includes the person or people caring for the pet who are equally involved, and also need support and care. 

Communication is very bond-centered, with the client’s needs being equally important as the animal’s needs. Many Certified Hospice and Palliative Care Veterinarians (CHPV) have additional training in collaborative communication. They partner with clients in open, non-judgmental, difficult conversations, guiding and supporting families down the path of least regrets. AHPC providers are able to recognize signs of anticipatory grief in clients and help create awareness for those experiencing these natural responses to the loss ahead. Caring for an aged or ailing pet is emotionally & physically exhausting; AHPC providers acknowledge this and honour the final walk alongside their clients, providing honest, informative conversations about grief and sincere emotional comfort4. Clients are provided a safe space to express their fears, beliefs, stresses, thoughts and overall feelings in a supportive relationship with their AHPC provider, who may help by naming, acknowledging, normalising and validating their feelings. This alone can be very powerful to those feeling anticipatory grief. 

Providing disease education in a manner that is informative without being overwhelming is another skill that AHPC providers are constantly fine-tuning. These conversations are so important for clients experiencing anticipatory grief. As previously discussed, anxiety, or fear of the unknown is generally the predominant feeling during this time. Providing clients with knowledge of the possible trajectory of their pet’s illness, including specific signs of advancing disease, helps reduce some of the anxiety of the unknown and sets expectations that aid in informed decision making. 

When caregivers are actively involved in the end of life care for their pets, setting the goals of care, providing the care, monitoring their pets and giving feedback to the AHPC provider, a beautiful partnership exists. This partnership not only benefits the pet, it also helps clients in redirecting their focus to what they can control during a time when everything feels out of control. This is empowering. When anticipatory grief is directed towards things clients can control, for example, creating an end of life plan, anxious feelings may be channelled towards actions in the present. This may help foster hope, looking at the time they have left as a gift or blessing; time to prepare hearts and minds, and create a bucket list of experiences or activities clients may want to enjoy before the goodbye. 

One’s past may inform one’s future. Previous experiences inform the decisions made as one moves through life. Previous loss may impact the current state of anticipatory grief and therefore decision making. In creating an end of life plan, AHPC providers sensitively open up dialogue surrounding death and pet loss and explore past experiences. These conversations help inform present decision making, which may help lessen the current grief reactions or those following the loss. Giving clients permission to change their mind throughout the journey with the guidance of their vet is empowering and may alleviate some decisional regret. Avoiding anxiety driven decision making will help clients better cope after the loss of their pet, feeling that they prepared for death from a position of power and empowerment rather than fear. 

During this difficult “in-between” time clients experience many emotions at once. It can be very overwhelming. AHPC providers recognize that client self-care is vital and encourage clients in seeking support. Physical support, in the form of active caregiving, such as walking, massaging, assisting with biological breaks, administering medications, bandage changes, etc. can be of great relief to the primary caregiver. Emotional support can be found from the client themself or significant other, immediate family, friends who are in similar situations with their pets or had a recent loss, those who know your bond with your pet, pet related support circles, a pet loss specialist, or professional counsellor, and the hospice team. AHPC providers typically have a list of pet loss support resources, including options for all preferred methods of reaching out, for example, by phone, online, or in-person. The Association for Pet Loss and Bereavement hosts a chat room specific to anticipatory grief, which is a great option for those who may wish to remain anonymous or just listen. Finding a support system is invaluable. 

Animal hospice providers further help their clients by affirming there is no right or wrong way to grieve. Providers give permission to feel all the feelings, including the overwhelm, and give permission to ask for help from others. However, it is important that AHPC providers know their limitations when they are not mental health professionals, and should recognize when a referral is warranted. AHPC providers are encouraged to form an interdisciplinary team which includes a social worker for this purpose. 

In summary, AHPC providers help support clients experiencing anticipatory grief through: 

  1. Recognition & awareness – NAME it. 
  2. Acknowledging, normalizing, & validating feelings. 
  3. Providing education. 
  4. Redirecting focus – on what they can control = empowering. 
  5. Fostering hope – creating a bucket list. 
  6. Preparing for pet death – making a plan, alleviating fears. 
  7. Encouraging clients in seeking support. 
  8. Developing coping strategies. 
  9. Referring to a pet loss specialist or mental health professional. 

Animal Hospice and Palliative Care providers play a significant and pivotal role; offering emotional support and guidance before and after the loss of a pet. Their role may potentially have a deep, long-lasting impact on pet caregivers’ peace of mind and emotional well-being4

“When families have a better end of life experience with their pets, they heal more quickly from debilitating emotional loss. They are better able to cope with their decisions, feel confident in their ability to care for their pets, and more quickly open their homes and hearts to pet ownership again5” 

– Dr. Mary Gardner, DVM 

Cited References 
  1. Pasek, K. (2019). Understanding Caregiver’ Responses to Impending Loss. Proceedings from the Ninth Annual International Association for Animal Hospice and Palliative Care Conference.
  2. Lehman, K. 2019. Anticipatory Grief: The Sadness Before the Loss. MN Pets. Retrieved Sept 28, 2021 from: mnpets.com
  3. Spitznagel, MB, Carlson, MD. (2019). Caregiver Burden and Veterinary Client Well-Being. Vet Clin Small Anim, (49), 431-444.
  4. Lagoni, L, Shanan, A. (2017). Bond-Centered Animal Hospice and Palliative Care. In A. Shanan, J. Pierce, T. Shearer (Eds.) Hospice and Palliative Care for Companion Animals Principles and Practice. (pp. 44). NJ, USA: Wiley Blackwell.
  5. Gardner, M. Planning for the End: Hospice Pearls, Caregiver Fatigue and Pet Loss Preparation. Retrieved October 14, 2018 from: ovma planning for the end PDF
 
Other References 
1. Ellis, C. (2017). Aftercare. In A. Shanan, J. Pierce, T. Shearer (Eds.) Hospice and Palliative Care for Companion Animals Principles and Practice. (pp. 309). NJ, USA: Wiley Blackwell. 2. Jennings, K. Anticipatory Grief: Preparing for end-of-life. [Brochure]. Day By Day Pet Caregiver Support. {no longer in publication}

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