Chapter 3: Grief and bereavement

Factors affecting grief

The grief expert says
Dr. Betty Davies explains how healthcare providers can affect family grief. (3:22)
The palliative care expert says
Marianne Arab discusses how the support paramedics provide can assist families in their grief. (3:22)Video transcript

You may be surprised by either the depth or lack of feeling expressed by patients and family members. As we’ve discussed previously, everyone grieves in their own way and in their own time. Click on the following options to reveal other factors that may affect a person's grief reactions. 

Nature of the relationship

Serious illness and death often bring families in closer touch with each other. However, the presence of family members doesn’t necessarily mean the relationships are close, healthy or stable. You’ll probably never know the whole story – if the relationship was positive and mutually respectful, fraught with emotional upheaval and judgement, or something you would never guess. 

Circumstances of the illness or death

The way a person dies can have a strong impact on bereavement. Death that is unexpected, or witnessing a disturbing event associated with the death, usually has some impact on grief.

These difficult circumstances may include:

  • Pain crisis
  • Excessive or sudden bleeding
  • Delirium (including paranoid and aggressive outbursts)
  • Shortness of breath
  • Seizures
  • Emergency hospitalization 
  • Physical agitation
  • Paralysis

Research studies suggest that family members experience high levels of anxiety, depression and sleep disturbance when the deceased had unrelieved pain or anxiety before death. 

State of consciousness

Many patients experience a decreased level of consciousness, and may even become unresponsive, in the time leading up to death. Families are often concerned about how to assess the patient’s comfort. This can be very troubling for them when this period stretches for a significant amount of time.


Interactions with health care providers

The family’s experience with you and your partner and other health care providers can also impact the grief experience. Building rapport through active listening and sensitive communication can go a long way.


Multiple losses

The impact of multiple losses is cumulative: a fresh loss is layered on top of previous losses. If past losses feel unresolved, or there hasn’t been adequate time to process these, grief can become overwhelming. This is also the case where someone is dealing with concurrent losses, such as when two or more family members or close friends are dying at the same time. Psychologist and gerontologist Robert Kastenbaum called this bereavement overload.


Click on each item for more detail

Conversation Prompts

Avoid using the term “loved one” as the relationship may not be grounded in love at all. Also avoid terms like "dear" or "sweetie" or "honey" which can be seen as condescending. Instead, refer to the person by name or relationship.  

How was Fred feeling when he woke up this morning? 

How long has your sister been experiencing this symptom?