Delivering bad news
- Physicians must disclose bad news to family members - often times unexpected notification of death can be difficult for family.
- The process can be challenging for providers.
- Using a structured approach can help alleviate the emotional challenging of delivering the bad news.
- Think of delivering bad news as a procedure (with a pre-procedure time out, a structured approach to the delivery of bad news, and requesting a colleague in the ED to hold your phone or take any runs that come in while you are in your critical five minutes of breaking the news.
- Notification of death
- Informing of poor prognosis e.g. "It's not my job to take away all hope, but I am very worried about _ and he/she is very sick"
- Time Out Before the Procedure (Mandatory)
- Confirm identity of patient and family specifically that family is TRULY the family of the patient. Can be difficult when the patient arrives as a "Joe Doe" without family. Before having meeting, identification processes (social work can assist) with confirming age, demographic, location that patient came from (can be found on the EMS run sheet).
- Confirm that you known the name of the patient so that way you can refer to him/her by his/her name. Ask social work if they know the names of the family and/or their relation to the patient.
- Gather ‐ Get SW in room,
- Resources ‐ +/‐ security, tell attending will have to be gone, get pager/trauma coverage
- Identify person we are talking about, myself and all people in room, identify level of understanding of what has happened already
- Educated ‐ warning shot "I have some bad news." Don't wait too long before saying "___ has died."
- Verify understanding
- Inquire ‐ questions
- Nuts/Bolts Give contact info
- Give the family space to process; Be silent
- SETTING UP the Interview
- Arrange for some privacy, Involve significant others, Sit down.
- Make connection with the patient.
- Manage time constraints and interruptions.
- "What have you been told so far?”
- Assess receiver's level of health literacy.
- Briefly explain chronology of events leading up to death (or bad news)
- Avoid euphemisms
- Allow receiver to ask questions.
- Say "I'm sorry."
- Repsond and validate the emotions of grieving: NURSE
- Name the emotion
- "It sounds like this has been overwhelming."
- Understand the emotion (empathize)
- "I cannot imagine how hard this must be for you."
- "I wish I had better news."
- Respect the patient or family
- "You are asking all of the right questions."
- "You are being such a strong advocate for your [family member]."
- Support the patient or family
- "We will be here for you."
- Explore the emotion
- "What other things are you worried about?"
- "Tell me more about what you're thinking."
- Name the emotion
- Summary and Strategy
- Acknowledge questions may arise after processing, establish your availability to be reached by social work in they have questions that come up when they see their loved one.
- Leave receiver with social work. "I'm going to step out and let (the social worker) help you with the next steps"
- If family asks if they suffered, consider (assuming it would not be obviously a lie) what if any utility there would be to saying anything other than: "No, he/passed peacefully." After all, our patients are also the family of the deceased.