Introduction: Events during a loved one's terminal period may unnecessarily add to the psychological trauma and cause long-term psychological morbidity in bereavement. Studies on stillbirth, widows and bereaved parents have identified such avoidable stressors: the mother's lack of exposure to a stillborn child, the widow's lack of awareness/preparation for her husband's impending death and lack of parents' communication with dying child.
Method: Using phenomenological research methodology, we interviewed 10 widowers. The themes extracted from the interviews and earlier findings were used to construct our proposed research model.
Results: We propose that widowers must gain emotional awareness of the impending death during the terminal period in order to reduce the probability that the moment of death entails an additional psychological trauma. A precondition of emotional awareness is acknowledgement of the fact that the patient is dying. Emotional awareness can be stimulated by: communication with spouse and others, mental imagery, intimacy and behavioral indicators. Inhibiting factors may be related to access to and time with patient.
Discussion: We will operationalise the proposed stimulating and inhibiting factors quantitatively in a non-selected, nation-wide, population-based cohort of widowers. The Swedish population based registers allow us to identify our study base, which will include around 1000 widowers with an expected response rate of 75-80 percent. The results (released 2004) may give knowledge on how to avoid additional psychological traumata among widowers and improve their possibilities of psychological adjustment.