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To the Editor: Dr von Gunten and colleagues¹ give important advice for physician communication during end-of-life care. My only criticism of this article is in the section on loss and grief. Most bereavement programs support families for 1 year. These authors perpetuate this notion that normal grief lasts 6 to 12 months. I believe normal grief can go on well past that first year. In fact, I believe the second year is often more difficult because the emotions can be as strong as the first year but the bereaved person feels less comfortable in talking about his or her pain and loss. In that second year fewer friends and relatives talk about the loss or allow the bereaved person to do so. In addition, during that second year bereaved persons perceive the societal message that grief should be finished after 6 to 12 months and respond by keeping their pain . . . [Full Text of this Article]

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ABSTRACT