“Dan’s father Frank found it too painful to be out of bed for long. Dan wondered what he could do to make this Christmas special for his dad; he didn’t want to ignore the day but also didn’t want to stress his dad. The daily challenges of caring for his dad also made the ordinary expectations of Christmas stressful for Dan, and he didn’t feel he could fulfill them, no matter how much he wished he could. Dan spoke with his father about the idea of having a simple Christmas by moving his father’s bed into the lounge room, next to the decorations and Christmas table. Dan’s father loved the idea. Frank, Dan, and their family had a lovely day, with visitors of Frank’s choice, traditional family Christmas treats, and Frank's favourite festive music. It was a very special Christmas for them all.”
 
Most Australians are looking forward to Christmas, to catching up with family, sharing a meal and family memories, and then relaxing over summer.  However, around 200,000 Australian families will be affected by death and dying this Christmas. During the last 12 months, I have been part of a small team from Flinders University who have been engaging with people who are dealing with the reality of death and dying in their work or as someone in need of palliative care. We have been listening to them talk about what is needed to make us all more aware and able to talk about and support those who are facing death or coping with bereavement.
 
This holiday season, others in our community may be confronting the possibility that this is their last Christmas together or the reality of a first Christmas without someone. Yet many of us are unable to talk about what is happening and may avoid the topic of dying, which can leave families feeling isolated and unsupported. Instead of hiding from the issue we need to bring death out of the shadows. As members of a community, we need to acknowledge the impact of death, dying and grieving because this time of year can be hard for so many families.
 
There is no right or wrong way for individuals and families to cope in managing grief and loss. But planning for anticipated difficult days can help people get through it. Here are some suggestions that have been made^1-7 to help people facing bereavement at Christmas:
 

• Acknowledge that grief can begin before a person dies, and it’s okay if you find it hard to get into the festive spirit. You don’t have to carry on and pretend like nothing has changed. Be kind to yourself and true to your own feelings about what you need at this time.
• Take time to think about ways to help get through these times as positively as possible. For some people this might mean focusing on the Christmas experience for children, simplifying the usual Christmas plans to accommodate your loved-one's illness, or building a new tradition.
• Be open and take the lead. By talking about how you feel about Christmas this year, it can relieve tension and invite others to share how they feel. This also can create opportunities for support.  
• Take your cue from the person who is dying. Provide the chance for them to open up about their feelings. Just being there for them, and willing to listen is the most important thing that you can do.
• Think about family traditions. Consider the family festive rituals that are special to your loved-one who is dying, and ways they can be done in future to honour them. In this way the person continues to have a role, a story, or a connection that remains with you for the future. Ask your loved-one if there is a tradition that they would like to have carried forward for future generations that will leave a legacy to remember them by. If your loved one is especially uncomfortable with talking about dying, you could ask them about their favourite Christmas traditions and memories. You may be able to turn these into a memorial activity for future Christmases.
• Also consider those people you care about who are facing their first Christmas alone since the death of a loved-one. You could ask them if there is something special they would like to do to honour them at this time and if there is a way to support them to do this.

Accessing trustworthy information about dying and palliative care can help us to feel more prepared. This can take some of the fear away and give us a greater sense of control as we face the end of life. The CareSearch website provides free information on palliative care for Patients, Carers, and Families, including How to Care, Living with illness, and coping at the end. The CareSearch page Remembering and the CareSearch factsheet Coping with holidays and special days (239kb pdf) may be useful to share with Patients, Carers, and Families at this time of year. More information can be found on the CareSearch website.
 
Do you know someone who is facing their last Christmas with a loved-one? Reach out to them and let them know you are thinking of them.

Need Support? Ring LifeLine on 13 11 14. Available 24 hours a day.
 
References:

1. Australian Centre of Grief and Bereavement (2014). Grief, Anniversaries and Significant Events (145kb pdf) factsheet.
2. CareSearch (2014). Coping with holidays and special days (239kb pdf) factsheet.
3. CareSearch (2018). Remembering.
4. Harvard Womens Health Watch. (2002). Grief takes no holiday. For people who have lost loved ones, the holidays may elicit dread and apprehension. Here are some ideas that may help, now and year-round. Harvard Womens Health Watch, 10(4), 1-3.
5. Jacob, S. R. (1991). Preholiday grief. Facing it alone. Journal of Psychosocial Nursing Mental Health Services, 29(11), 20-24.
6. Miller, A (2015). Coping with cancer over the festive season. Cancer Council NSW Blog.
7. Ufema, J. (1994). Christmas without Wynn. Nursing, 24(11), 58-59.

Dr Lauren Miller-Lewis, Research Associate, CareSearch, Flinders University