Bearing Witness to Loss: Formal Caregivers’ Grief in End-of-Life Care

Formal caregivers in end-of-life care routinely accompany patients into death, yet their own grief is often interpreted through individualized constructs—burnout, compassion fatigue, secondary traumatic stress—that obscure how loss is generated relationally and shaped institutionally. Drawing on Doka’s concept of disenfranchized grief and Kastenbaum’s concept of vicarious grief, this study examines how caregivers bear witness to loss: how they carry their own bond with the deceased while empathically engaging with the grief of families and colleagues. Sixteen Italian healthcare and social-care professionals participated in semi-structured interviews, analyzed using reflexive thematic analysis supported by ATLAS.ti. Three interconnected experiential domains were identified: the overlap between personal and professional experience; the organizational shaping of grief expression; and processes of elaboration and integration following the loss. Building on these findings, we advance a process-oriented model in which professional grief develops through sustained relational engagement, is framed by organizational norms that either enfranchise or silence it, and is subsequently integrated into professional identity through meaning-making practices. The findings shift attention from individual coping to institutional conditions that render caregiver loss shareable—including reflective supervision, brief team rituals around the moment of death, and family involvement in end-of-life decisions—as low-cost mechanisms that enfranchise grief and sustain compassionate care over time.s