Takeaway
When families seem confused or ask repetitive questions during end-of-life discussions, they may be experiencing anticipatory grief—processing loss before it happens. It can be helpful to acknowledge the emotional weight they are carrying.
Lifelong learning in clinical excellence | April 9, 2026 | 3 min read
By Nettie Reynolds, MDiv, interfaith chaplain
The daughter stood at the foot of the bed, asking questions that had already been answered.
“How much longer do you think?”
“Is she in pain?”
“Should we be doing more?”
The plan was clear and the monitors were steady. Still, the questions continued.
Anticipatory grief
As patients decline in the hospital, families often begin grieving before death occurs. This experience is known as anticipatory grief. Anticipatory grief is future-oriented and characterized by separation distress and worry about a future without the person being physically present.
Manifestations
Families sometimes start to respond to the ensuing death before it happens. This isn’t always visible in obvious ways. It may show up as repetitive questions, or as confusion even when the care plan is clear. These are just a couple of ways grief may manifest as families anticipate their loved ones’ death.
Different responses to grief
People may respond to this moment in very different ways. One person may still be focused on treatment and recovery, while another is beginning to consider comfort. These are not simply differences in opinion; they reflect where each person is in relation to the expected loss.
Creating space for processing
It can be helpful at this moment for healthcare professionals to slow down and give families a bit of time to process. It can also help to hold both clinical and emotional realities at the same time. You could say, “We can keep walking through the plan together, and I want to make sure we’re also checking in on how this is feeling for you.” This allows the family to stay engaged in decision-making while also recognizing the weight of what those decisions represent.
The importance of pacing
Pacing matters as well. Anticipatory grief often brings a sense of urgency that’s not driven by the clinical situation alone. Families may feel pressure to act because they sense change. Slowing the conversation, allowing a pause, or giving space after a difficult statement can help reduce that pressure.
Understanding what families are really asking
It’s also important to recognize that some questions are not requests for new information. When a family member asks, “Are we sure?” they may be asking whether they’re making the right decision. A response that includes both clarity and acknowledgment can be more effective than repeating clinical details alone.
The impact of recognition
When clinicians can recognize anticipatory grief, even without naming it directly, the tone of the room changes. There’s less urgency and more clarity about navigating decisions at the end of life. Anticipatory grief doesn’t need to be resolved. It can’t be shortened or made more efficient. It can be acknowledged in ways that help families stay oriented to both the present moment and what lies ahead.
Three ways healthcare professionals can help:
1. When questions are repetitive, acknowledge emotions.
Repetition often signals processing, not confusion. Families are trying to understand what the information means for their future. Pair clarity with recognition. “We’ve talked through the plan, and I want to check in on what feels most uncertain right now.”
2. When families disagree, widen the frame.
Differences often reflect where each person isin the loss. One may still be focused on prolonging life, while another is beginning to consider comfort. Naming that both perspectives are grounded in care can reduce tension and create space for alignment.
3. When urgency rises, slow down the pace.
Emotional urgency can drive the conversation more than clinical need. A pause, a slower response, or allowing silence can reduce pressure and help families absorb what they are facing. Slowing down supports clearer decision-making.
This piece expresses the views solely of the author. It does not necessarily represent the views of any organization, including Johns Hopkins Medicine.