title: Alignment of the Kübler-Ross grief cycle phases with the process of adaptation to type 1 diabetes mellitus.
abstract: OBJECTIVE
  To understand the process of adaptation to type 1 diabetes mellitus (DM1) and analyze its alignment with the grief cycle phases described by Kübler-Ross.
  
  
  METHODS
  We performed an ethnographic study through in-depth interviews with 20 patients, 10 relatives and 12 health professionals (6 physicians and 6 nurses). For the analysis, the Miles and Huberman qualitative data analysis model was used.
  
  
  RESULTS
  Patients diagnosed with DM1 and their families face a loss of lifestyle and of the objects, real or imaginary, of their previous life. Patients and relatives experience emotional reactions that in some cases can be similar to the grief cycle phases described by Kübler-Ross for terminal diseases (denial, anger, bargaining, depression and acceptance). However, there are some differences depending on personal and psycho-social factors. Health professionals tend to relate low adherence to denial of the disease, but some patients feel threatened by the demands of treatment and control and their effects on their quality of life, and consciously choose not to follow recommendations. It is more realistic to talk about disease adaptation than acceptance, since the loss processes are ongoing and patients must reconstruct their identity according to their situation. The grief cycle also affects the family and may differ from that of the patient in its duration, intensity and assessment of problems.
  
  
  CONCLUSIONS
  Adaptation is a complex process in which many variables intervene. There are observable differences among the mechanisms used by each specific individual. Healthcare professionals, and specifically nurses, should consider the multiple psycho-social dimensions of chronic disease.
authors.affiliation: Unidad de Enfermería de Salud Pública. Universitat de Barcelona. Barcelona. España.
authors.forename: Pilar
authors.initials: P
authors.lastname: Isla Pera
authors.forename: Joaquín
authors.initials: J
authors.lastname: Moncho Vasallo
authors.forename: Oscar
authors.initials: O
authors.lastname: Guasch Andreu
authors.forename: Alberto
authors.initials: A
authors.lastname: Torras Rabasa