Delivering Bad News
==Background==
*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 and a structured approach).
==Types==
*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”
==Procedure==
*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.
==Approaches==
*GRIEV_ING: (Pnuemonic)
***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
what has happened already
***Educated ‐ warning shot “I have some bad news.” Don’t wait too long before saying “___ has died.”
***Verify understanding
***_ Be silent, give the family space to process
***Inquire ‐ questions
***Nuts/Bolts
Give contact info
Give contact info
*SPIKES
**S – SETTING UP the Interview
***Arrange for some privacy,
Involve significant others,
Sit down.
Make connection with the patient.
Manage time constraints and interruptions.
**P – PERCEPTION
***“What have you been told so far?”
***Assess receiver’s level of health literacy.
**I – INFORM
***Briefly explain chronology of events leading up to death (or bad news)
***Avoid euphemisms
**K – Knowledge
***Allow receiver to ask questions.
**E – Empathy
***Validate emotions of grieving.
***Say “I’m sorry.”
**Summary and Strategy
***Acknowledge questions may arrise 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”
==Tips==
*If family asks if they suffered, consider what if any utility there would be to saying anything other than no.
==External Links==
==References==
<references/>
Emergency Medicine Conference at Boston Medical Center 2015. Contributions by multiple facutly (including Dr Jeffrey Schneider and BMC EM residents
Lowry, Fran. Think GRIEV_ING When Giving Bad News to Loved Ones. ACEP News
April 2007
SPIKES—A Six-Step Protocol for Delivering Bad News: Application to the Patient with Cancer, Baile, et al. The Oncologist. Jun 2000. (http://theoncologist.alphamedpress.org/content/5/4/302.full)
Shoenberger, Jan MD et al. Death Notification in the Emergency Department. Western J Emerg Med. 2013;14(2):181-185.
[[Category:Procedures]]
[[Category:Misc/General]]
*This information is intended for educational purposes only and not intended for use in patient care (which requires a trained credentialed attending physician and individualization of the medical care plan to the specific patient).