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Caregivers become involved in the bereavement process as soon as they imply themselves in patient accompaniment. This bereavement process is a defence mechanism, but it requires energy and can therefore destabilise any caregiver.

Risk factors

Many risk factors should be known:

• intimacy and length of care (therefore an increased risk for nurses or registered nurses),
• young patients (major identification risk)
• self-reproach (because no patient-carer relationship is perfect)
• fatigue (work overload which does not allow the necessary breaks to enable discussion between caregivers),
• repeated bereavements (therefore a major difficulty in wards associating acute and palliative care),
• problems between colleagues,
• personal difficulties (personal bereavement, family difficulties).

For the physician

There is a major risk for physicians who completely invest themselves in their work, have no rich or satisfying personal life or have no external activities (like sport or music). The following observations are often made:

• overinvestment in new techniques, new chemotherapy,
• the need to learn how to care when cure is not feasible,
• swinging from insensitivity to euthanasia.

Burn-out

Burn-out is the term used to express caregiver (including physician) depression. Refer to the psychology chapter.