Improving medical students

Clinical Guide to Delivering Death Notification

Posted by medliorator on August 18, 2008

Excerpts from The Last Hours of Living: Practical Advice for Clinicians by Linda Emanuel, MD, PhD et al.

1. Get the setting right
Find a quiet or private area with a telephone. Identify yourself and ask the identity of the person to whom you are talking and their relationship to the patient. Ask to speak to the person closest to the patient (ideally, the healthcare proxy or the contact person indicated in the chart). Avoid responding to direct questions until you have verified the identity of the person to whom you are speaking. Ask whether the contact person is alone. Do not give death notification to minor children.

2. Ask what the person understands
Ask what the person understands about the patient’s condition with a phrase like, “What have you been told about M’s condition?”

3. Provide a “warning shot”
One approach may be to begin with a sentence such as “I’m afraid I have some bad news.”

4. Tell the news
Use clear, direct language without jargon. For example, you could say, “I’m sorry to have to give you this news, but M just died.” Avoid words like “expired,” “passed away,” and “passed on.” They are easily misinterpreted.

5. Respond to emotions with empathy
Most importantly, listen quietly to the person and allow enough time for the information to sink in. Elicit questions with a phrase like, “What questions do you have?” Ascertain what support the person has. Ask if you can contact anyone for them. Consider other support through the person’s church, Red Cross, local police, or other service agencies if it is needed.

6. Conclude with a plan
f the family chooses to come to see the body, arrange to meet them personally. Provide contact information for the physician, nurse, or other professional who can meet with them and/or make arrangements.

Introduction to the Last Hours of Living [Medscape]

Correlate: How to Give Bad News (Randy Pausch)

Correlate: Discussing End-of-Life Care

Correlate: Delivering Bad News & Crying


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