Apply Elisabeth Kübler-Ross’s Five Stages of Grief

Another consideration is that patients will work through a grieving process and say goodbye to their prior state of health and the life they had known. There may be daily emotional or physical reminders of how cancer has affected them, and these may be jarring. Elisabeth Kübler-Ross’s Five Stages of Grief model2 is an established guideline that can be integrated into your practice as your patients work toward acceptance of their diagnosis, keeping in mind that patients often move back and forth among the 5 stages: Denial, Anger, Bargaining, Depression, and hopefully, Acceptance.2

As noted by Christina Gregory, PhD, in an article that examined the Kübler-Ross model, grief can be caused by situations and may present itself physically, socially, or spiritually.3 Although patients may run the gamut in terms of emotions (some are inclined to be “emotional”; others “pragmatic”), addressing how each patient approaches their diagnosis and how this change may affect their body image and their emotional well-being can be a difficult, yet poignant and helpful, conversation toward their recovery.

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Openly discuss the changes that treatment or surgery may create

In your work with patients, consider a goodbye ritual as a cathartic way to address physical and emotional loss. For example, a woman undergoing a mastectomy may want to consider saying goodbye to her breast(s) prior to surgery. I have worked with women who decided to take photos prior to their surgery, and none of them said this was not helpful. In fact, it became a meaningful and authentic way to address this loss that occurs in surgery, and allow the release of feelings that are best acknowledged rather than repressed.

Ask patients to consider this thought,With time, might there be a new way to ‘see’ your scars”?

Making peace with scars can lead to acceptance. Patients often express that their scars leave them feeling maligned, ugly, imperfect, or “less-than.” Scars remain as cruel reminders of their cancer. So, we may suggest to patients that they might see their scars in a different way, as symbols of new health, longer life, and as signs of courage and fearlessness or testaments to hope. A woman I worked with was constantly jarred by the mastectomy scars across her chest. She called them “ugly roadmaps.” However, by the end of our work, she saw her scars as “the roads that have made me victorious against cancer.” Others have expressed that, over time, they’ve come to see their scars as badges of honor, proof of their courage, and symbols of rebirth and life.

The ordinary can be so helpful

Most patients have smart phones. I often suggest that patients make a video of their favorite spot, their pet, their favorite places to walk, or other favorites, so in those moments of anxiety they can watch the video and soothe their worry. They could create a wake-up ritual or choose an affirming mantra, or such things that may help them to live with intention and find hope. Each suggested action can be effective in ensuring a positive perspective while still acknowledging the obstacles.

Working with patients is a gift, and finding new ways to meet them emotionally can provide an enormous benefit to their care. These simple strategies can enable patients to receive not only the physical care they need but also holistic care to address all the challenges presented by cancer that they will face throughout their treatment and beyond.

Claire Grainger is a clinical supervisor at CancerCare.


  1. Kripalani S, Weiss BD. Teaching about health literacy and clear communication. J Gen Intern Med. 2006;21(8):888-890. doi:10.1111/j.1525-1497.2006.00543.x
  2. Kübler-Ross, E. On Death and Dying. Macmillan Publishing Company; 1969.
  3. Gregory C. An examination of the Kubler-Ross model.Published February 14, 2018. Accessed June 22, 2021.