Breaking Bad News: Death in ED
Death in the ED is often unexpected, and breaking bad news to loved ones after the death of a patient is stressful and emotionally challenging for even the most experienced ED physician.
Whilst it is a difficult scenario for us, it is much more so for the family/ next of kin. Showing empathy and compassion whilst being careful to communicate effectively will avoid misunderstandings at this stressful time.
Before you begin, think about the following points.
Team – A doctor and nurse who treated the patient, consider social worker and spiritual care.
Space – Ensure the space is suitable- large enough for the family, quiet, private and confidential
Privacy – As above, ensure you will not be disturbed. Let someone know where you will be and that you are not to be disturbed. Turn off your phone / pager.
Use appropriate body language – be compassionate and sincere
Introduce yourself and other team members
Ask families their names and relationship to the patient
Give a warning shot. Often our body language is enough that relatives recognise bad news is on its way, but key phrases such as “I’m afraid I have bad news” are useful.
Use clear language with no jargon for example “I am very sorry, but your husband suffered a heart attack and has died”
Provide assurance and as much or as little medical information as you think necessary.
Allow time for reflection and for silence.
Answer any questions the family may have. Be honest, the answer may be “I don’t know”.
A useful mnemonic, VALUE has been described:
Value and appreciate what family members say.
Acknowledge the family’s emotions.
Ask questions which would help the caregiver understand who the patient is.
Elicit questions from the family members.
Ensure the family has follow up for any questions they may have (go back and see them in 15 minutes)
Offer access to spiritual or religious services
Ensure the family will know about what happens next (eg where the body will go, coroners case).
Document the discussion in your notes
Further References and Resources