Core Concepts for Grief-Sensitive Care
What is Grief?
Grief is a Response to Change
Grief is a natural response to change.
Grief can be present any time a person is adjusting to a new reality. While often associated with bereavement (death-related loss), grief can also be present in many non-death-related losses, including illness, injury, and life transitions. It reflects a natural, developmental way people adapt to change across the lifespan.
Experiences That Can Involve Grief
Disruptions to a person’s sense of identity, safety, connection, or routine can involve grief. Below are examples of some of the many experiences people may grieve.
Changes to Ability, Identity, or Body Image
- Birth control pills or hormone replacement therapy (HRT): weight gain, breast enlargement or tenderness, and changes in fat distribution
- Changes to the body/body image related to medical treatment
- Surgical interventions: mastectomy, orchiectomy, amputation
- Corticosteroids: weight gain, "moon face," acne, and fat redistribution (e.g., buffalo hump), muscle wasting or thinning of the skin
- Androgen deprivation therapy: breast tissue enlargement in males, reduced body hair, weight changes
- Chemotherapy or radiation: hair loss, weight fluctuation
- Estrogen therapy: breast development, body fat redistribution
- Testosterone therapy: facial/body hair growth, voice deepening, acne, hair loss
- Antipsychotics: may lead to breast tissue enlargement in males and lactation
- Cognitive decline or loss of mental clarity (e.g., dementia, brain injury)
- Diagnosis of a learning disability, mental health condition, or chronic illness
- Gender-affirming care/Denial of gender-affirming care
- Infertility
- Loss of autonomy or independence (a person who can no longer drive, live alone, or manage daily tasks due to illness)
- Loss of mobility (e.g., after a spinal cord injury or amputation)
- Loss of physical ability due to injury, illness, or surgery
- Loss of professional role or licensure (A clinician who loses their license may grieve not only the job, but a core part of their identity and purpose; illness may preclude working)
- Menopause
- Role changes that affect identity (e.g., no longer a sibling after a sibling’s death)
Death
- Death of someone personally known (e.g., family member, friend, mentor, neighbor)
- Death of a beloved animal
- Death of a large group of people or community
- Death of a public figure (e.g., author, musician, community leader)
- Pregnancy loss
Disappointments and Missed Opportunities
- Not getting a job, promotion, award, or grant
- Career setbacks or academic rejections
Displacement/Separation
- Deportation
- Foster care placement
- Experiencing homelessness
- Forced displacement due to conflict or persecution
- Immigration
- Incarceration
- Military deployment
Environmental and Social Losses
- Natural disasters
- Loss of home or community
- Loss of normalcy or routine (e.g., during the COVID-19 pandemic)
- Loss of safety due to abuse, violence, systemic harm, or war
- Loss of treasured or sentimental items
Loss of Safety, Trust, or Belonging
- Experiencing moral injury as a provider
- Experiencing harm, harassment, or discrimination and no longer feeling safe in a familiar environment
- Loss of trust in caregivers or healthcare providers (after a medical error or misdiagnosis)
- Loss of trust in the system (provider who advocates for a treatment that’s denied by insurance may feel powerless, grieving their sense of justice or professional integrity)
Relationship Changes
- Breakups or divorce
- Conflict or disconnection with peers
- Colleagues changing jobs, being laid off, retiring
- Ending of a long-term clinician-patient bond ( discharge, transfer)
- Estrangement from family or friends
- Loss or shift in custody/caregiving roles
- Social exclusion or marginalization
Learning to Recognize Non-Death Loss
This video, shared with permission from Dr. Arazoo (@balanceinpsych on TikTok and Instagram), highlights an example of non-death loss through her experience as a medical student not matching into a residency program during Match Day.
The reel is captioned as “disappointment,” but grief is often present in experiences like these, even if unnamed.
Recognizing Grief in Positive Experiences
Grief can be present even when a change is welcomed or expected.
Milestone moments can involve letting go of a previous role, identity, or chapter of life and can bring mixed emotions.
For example:
- Adoption or birth
- Changing jobs
- Graduation
- Marriage
- Moving to a new home
- Retirement
All Grief is Valid
When the grief that accompanies joyful, chosen, or natural life changes is not named, emotional responses can be easily misinterpreted. Feeling sadness, fear, or anxiety during a “positive” event does not signal ingratitude. It reflects a normal response to transitions that may involve significant changes to routine, roles, or expectations.
The same is true when decisions are voluntary. Ending a relationship, starting or stopping treatment, moving to a new home, or choosing a new path can still involve grief. Having agency does not eliminate emotional impact. Grief and choice can exist side by side. Naming this reality can support compassion and reduce confusion or shame.
Grief can also occur during natural and expected life transitions such as aging, puberty, menopause, or when adult children leave home. Because these experiences are common and, often, unavoidable, the losses associated with them can sometimes be minimized. Acknowledging and validating these feelings can help normalize the grief experience and support people as they adjust to change.
Grief After a Medically Successful Outcome
In healthcare, an outcome can be clinically successful while still carrying meaningful loss. Even when a procedure goes well, changes in function, identity, or family dynamics can involve grief that unfolds after the medical crisis has passed.
In this video, Paola Ayora, MD, MPH, Assistant Professor of Child Psychiatry at the Child Study Center at Yale School of Medicine, shares a personal reflection on how grief can emerge even after a medically successful outcome.
Dr. Ayora’s experience highlights that loss in healthcare is not limited to clinical outcomes, but can unfold over time as people adapt to what life after treatment looks like. Grief related to these changes can require ongoing support and acknowledgment.
Grief in Moments of Recalibration
Grief can be present when reality unfolds differently than expected, even when a patient is medically stable or outcomes are uncertain rather than catastrophic.
In healthcare settings, these moments often surface when individuals or supporters begin to recalibrate hopes for the future, and providers may find themselves holding both clinical responsibilities and the emotional weight of that adjustment.
In this video, Elizabeth Peacock-Chambers, MD, Associate Professor of Healthcare Delivery and Population Sciences at UMass Chan Medical School–Baystate, reflects on an encounter that challenged her assumptions about grief in healthcare.
The baby was actually doing quite well and was healthy, but it's just 'Oof, I thought life was going to go this one way and it's going to be completely different.'
Through a parent's questions about the future, she highlights how grief can arise when expectations shift, even in the absence of a life-threatening outcome, and how healthcare professionals may find themselves navigating uncertainty alongside the families they support.
Recognizing Grief to Strengthen Care
Grief is present in many healthcare interactions, often outside of bereavement or crisis moments. Strengthening the ability to recognize, normalize, and validate grief can support more attuned communication, reduce misinterpretation of emotional responses, and build confidence in interactions where grief is present but not always named. Over time, this awareness can help healthcare professionals respond with greater clarity, compassion, and steadiness.