|
| |
|
|
EPERC Fast Fact and Concept #76
Telephone Notification of Death |
Authors: Rosalia R. Osias, MD, Daniel H.
Pomerantz, MD, Jeffrey M. Brensilver, MD,FACP
Telephone notification to family members about a death is one of the most
challenging and stressful communication skills, especially for
cross-covering housestaff who may have had no direct interactions with the
patient or family. Unpredictable variables are involved; telephone
notification does not allow the same level of interaction possible with
direct personal contact. When telephone notification is unavoidable, here
are suggested guidelines (see next Fast Fact for discussion of immediate
telephone vs. delayed in-person notification).
Preparing for the Call
Review death pronouncement protocol (See Fast Facts # 4, #64)
Positively identify the patient (hospital ID tag) and confirm death.
Obtain relevant information; e.g. patient's name, age, gender, SS# and
other ID numbers.
Obtain the full name, address, phone number(s) of the person/s you are
calling. Try to establish from the chart and nursing staff the
relationship of the contact to the deceased patient.
Establish the circumstances of death; expected or sudden. Write down the
key information you need and thoroughly review what you will say.
Find a quiet or private area with a phone.
TIMING
The call should be made as soon as possible following the death. Whenever
possible, inform the family of a grave turn of events prior to death. When
substantial delay is likely, the responsibility for informing the family
should be taken by the covering doctor (or the resident).
The Actual Notification
Identify yourself; ask the identity of the person you are talking to and
their relationship to the patient. Ask to speak to the person closest to
the patient (ideally, the health care proxy or the contact person
indicated in the chart). Avoid responding to any direct question until you
have verified the identity of the person to whom you are speaking. Ask if
the contact person is alone. Do not give death notification to minor
children.
If you don't have a prior relationship with the person you are speaking
to, ask what they know about the patient's condition: What have the
doctors told you about ____'s condition?
Provide a warning shot: I'm afraid I have some bad news
Use clear and direct language, no medical jargon; I'm sorry, ____ has just
died.
Note
Words like "dead" or "died" should be used; "expired", "passed away" or
"didn't make it" can be misinterpreted.
Never deliver the news of death to an answering machine or voice mail.
Instead, leave specific contact information. If you are unable to make
contact within 1-2 hours, contact a hospital representative (e.g. Social
Worker) to assist you in locating family or others.
Speak clearly and slowly, allow time for questions; be empathetic. A
perceptive family can easily tell whether the notifier cares or is merely
"going through the motions".
If the family chooses to come to see the body, arrange to meet them
personally.
Provide contact information for the physician or hospital official who can
meet with them and answer questions about the patient's death and other
administrative issues.
Ask if you can contact anyone for them. Assess their emotional reaction
(see next Fast Fact).
If you feel uncomfortable about telephone notification, ask for help.
One issue not previously discussed is the dilemma of providing telephone
information versus asking family members to first come to hospital and
then tell them that death has occurred. Few would disagree that it is
always preferable to present death notification in person. However, when
families live at a great distance, or are physically unable to travel,
telephone discussion will be necessary. In other situations, clinicians
must weigh the benefits of truthfulness against the risk of potential harm
resulting from abrupt disclosure of the bad news. Factors to consider in
making this decision include:
 | whether death was expected or not; the nature and chronicity of the
illness; |
| how well the death notifier knows the patient and the patient's
family; |
| the relationship of the contact person to the patient; |
| the anticipated emotional reaction of the contact person based on
prior information; |
| whether the contact person will be alone when receiving the
information; |
| the contact person's level of understanding; |
| distance, availability of transport, and time of day. |
For example, when death is expected due to progressive cancer and the
notifier knows both the patient and the contact person, telephone
notification is very acceptable. In fact, you should have prepared for
this moment ahead of time by asking the contact how they wish to be
contacted at the time of death. In contrast, if the death is sudden,
especially of a minor, notification in person is always preferred,
although time and distance issues may make it impractical.
The notifier must be prepared to quickly integrate all these factors to
decide whether to reveal that the patient is dead, or whether to describe
the patient as gravely ill and request that the contact person come to the
hospital immediately. If you decide to delay disclosure of the death, be
prepared to make immediate admission of such nondisclosure as soon as you
meet the family (e.g. "I'm sorry for not telling you the whole thing right
away over the phone" then give your reason for doing so).
Responding to Emotions Whether in person or by telephone, you
should expect an emotional reaction to the death notification (see Fast
Fact #29-Responding to Patient Emotions). Responding to emotions via
telephone is especially difficult. Some tips include:
| Ensure that the contact has someone else with them; offer to contact
family members, friends, clergy or others. |
| Offer to meet with the contact in person. |
| Contact your hospital social worker for advice on contacting other
local resources such as the Red Cross, local police, or other service
agencies. |
References:
| Iserson, KV. The Gravest Words: Sudden-Death Notification and
Emergency Care. Ann of Emerg Med 2000: 36:75-77. |
| Iserson, KV. The Gravest Words: Notifying Survivors about Sudden,
Unexpected Deaths. Resident and Staff Physician. 2001: 47:66-72 . |
|
|
