Palliative care (PC) clinicians regularly encounter a spectrum of coping strategies, from responses such as humor, legacy-building, and meaning-making to more ambivalent behaviors such as avoidance, splitting, or control-seeking. Supporting adaptive coping is central to the role of all interprofessional PC clinicians to improve quality of life and patient outcomes. Drawing upon principles from psychotherapy, behavioral medicine, and PC research, this article provides guidance to understand, assess, and engage with patients’ coping with intentionality. Harnessing a shared language and approach allows teams to align, self-reflect, collaborate, and respond with greater nuance and empathic attunement during profound moments in our patients’ lives.
LazarusRS, FolkmanS. Stress, Appraisal, and Coping. New York, NY: Springer Publishing Company; 1984.
2.
SkinnerEA, EdgeK, AltmanJ, et al.Searching for the structure of coping: A review and critique of category systems for classifying ways of coping. Psychol Bull, 2003; 129(2):216–269; doi: 10.1037/0033-2909.129.2.216
3.
FolkmanS, GreerS. Promoting psychological well-being in the face of serious illness: When theory, research and practice inform each other. Psychooncology, 2000; 9(1):11–19; doi: 10.1002/(sici)1099-1611(200001/02)9:1<11::aid-pon424>3.0.co;2-z
4.
GreerJA, JacobsJM, PensakN, et al.Understanding and addressing the role of coping in palliative care for patients with advanced cancer. J Clin Oncol, 2020; 38(9):1040–1050.
5.
GreerJA, JacobsJM, El-JawahriA, et al.Role of patient coping strategies in understanding the effects of early palliative care on quality of life and mood. J Clin Oncol, 2018; 36(1):53–60; doi: 10.1200/JCO.2017.73.7221
6.
JacobsenJ, BrennerKO, GreerJA, et al.When a patient is reluctant to talk about it: A dual framework to focus on living well and tolerate the possibility of dying. J Palliat Med, 2018; 21(3):322–327.
7.
ShalevD, Robbins-WeltyG, EkwebelemM, et al.Mental health integration and delivery in the hospice and palliative medicine setting: A national survey of clinicians. J Pain Symptom Manage, 2024; 67(1):77–87; doi: 10.1016/j.jpainsymman.2023.09.025
8.
BreitbartW, PoppitoS, RosenfeldB, et al.Pilot randomized controlled trial of individual meaning-centered psychotherapy for patients with advanced cancer. J Clin Oncol, 2012; 30(12):1304–1309; doi: 10.1200/JCO.2011.36.2517
9.
ChochinovHM, McClementS, HackT, et al.Eliciting personhood within clinical practice: Effects on patients, families, and health care providers. J Pain Symptom Manage, 2015; 49(6):974–980.e2; doi: 10.1016/j.jpainsymman.2014.11.291
10.
MeierDE, BackAL, MorrisonRS. The inner life of physicians and care of the seriously ill. JAMA, 2001; 286(23):3007–3014; doi: 10.1001/jama.286.23.3007
11.
HalpernJ. Empathy and patient-physician conflicts. J Gen Intern Med, 2007; 22(5):696–700; doi: 10.1007/s11606-006-0102-3
12.
MahK, ShapiroGK, HalesS, et al.The impact of attachment security on death preparation in advanced cancer: The role of couple communication. Psychooncology, 2020; 29(5):833–840; doi: 10.1002/pon.5354
13.
Van HalG. The true cost of the economic crisis on psychological well-being: A review. Psychol Res Behav Manag, 2015; 8:17–25; doi: 10.2147/PRBM.S44732
14.
JacobsenJ, JacksonV. What’s in the Syringe? Principles of Integrated Palliative Care. Oxford University Press; 2022.
15.
BurkerEJ, MadanA, EvonD, et al.Educational level, coping, and psychological and physical aspects of quality of life in heart transplant candidates. Clin Transplant, 2009; 23(2):233–240; doi: 10.1111/j.1399-0012.2009.00966.x
16.
ChammasD, BrennerKO, GambleA, et al.Top ten tips palliative care clinicians should know about the psychological aspects of palliative care encounters. J Palliat Med, 2024; 27(2):251–254; doi: 10.1089/jpm.2023.0390
17.
BrennerKO, RosenbergLB, CramerMA, et al.Exploring the psychological aspects of palliative care: Lessons learned from an interdisciplinary seminar of experts. J Palliat Med, 2021; 24(9):1274–1279; doi: 10.1089/jpm.2021.0224
18.
LiaoYC, LiaoWY, SunJL, et al.Psychological distress and coping strategies among women with incurable lung cancer: A qualitative study. Support Care Cancer, 2018; 26(3):989–996; doi: 10.1007/s00520-017-3919-x
19.
LinkLB, RobbinsL, MancusoCA, et al.How do cancer patients choose their coping strategies? A qualitative study. Patient Educ Couns., 2005; 58(1):96–103; doi: 10.1016/j.pec.2004.06.002
20.
ChammasD. Should I laugh at that? Coping in the setting of serious illness. N Engl J Med, 2024; 391(4):295–297; doi: 10.1056/NEJMp2402142
21.
KatzRS, JohnsonTA. When Professionals Weep: Emotional and Countertransference Responses in End-of-Life Care. Routledge Press; 2006.
22.
RosenbergLB, BrennerKO, JacksonVA, et al.The meaning of together: Exploring transference and countertransference in palliative care settings. J Palliat Med, 2021; 24(11):1598–1602; doi: 10.1089/jpm.2021.0240
23.
ChammasD, MomentA, RosenbergL, et al.Formulation in palliative care: Elevating our potential for therapeutic communication. Am J Hosp Palliat Care, 2024:10499091241300614; doi: 10.1177/10499091241300614
24.
ChammasD. One size fits … some. N Engl J Med, 2025; 392(9):839–841; doi: 10.1056/NEJMp2412418
25.
MilbergA, FriedrichsenM. Attachment figures when death is approaching: A study applying attachment theory to adult patients’ and family members’ experiences during palliative home care. Support Care Cancer, 2017; 25(7):2267–2274; doi: 10.1007/s00520-017-3634-7
26.
ChammasD, FishelA, CramerM, et al.Facing illness together: Understanding the role of the couple in palliative care. Am J Hosp Palliat Care, 2024:10499091241302413; doi: 10.1177/10499091241302413
27.
ChammasD. Dancing with dyads: Supporting relationships through serious illness. J Palliat Med, 2024; 27(12):1679–1680; doi: 10.1089/jpm.2024.0380
28.
ChammasD. Wishing for a no-show. Ann Intern Med, 2025; 178(1):134–135; doi: 10.7326/ANNALS-24-02744
29.
JohnstonB, PringleJ, GaffneyM, et al.The dignified approach to care: A pilot study using the patient dignity question as an intervention to enhance dignity and person-centred care for people with palliative care needs in the acute hospital setting. BMC Palliat Care, 2015; 14(1):9; doi: 10.1186/s12904-015-0013-3
