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.

Prepare

  • 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.

The Conversation

  • 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.

  • Listen.

  • Ask questions which would help the caregiver understand who the patient is.

  • Elicit questions from the family members.

Finishing

  • 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

  • Team debrief

Further References and Resources

© Agency for Clinical Innovation 2021

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