Fast Fact and Concept #76: Telephone Notification of Death: Part 1

Title: Fast Fact and Concept #76: Telephone Notification of Death: Part 1

Author(s): 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).

1. Review death pronouncement protocol (see Fast Fact #4: Death Pronouncement, and Fast Fact #64: Informing significant others of a patients death).
   
2. Positively identify the patient (hospital ID tag) and confirm death.
3. Obtain relevant information; e.g. patient's name, age, gender, SS# and other ID numbers.
4. 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.
5. Establish the circumstances of death; expected or sudden. Write down the key information you need and thoroughly review what you will say.
6. Find a quiet or private area with a phone.

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).

1. 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.
2. 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?
3. Provide a warning shot: I'm afraid I have some bad news
4. 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.
   
   
5. 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".
6. If the family chooses to come to see the body, arrange to meet them personally.
7. 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.
8. Ask if you can contact anyone for them. Assess their emotional reaction (see next Fast Fact).
9. If you feel uncomfortable about telephone notification, ask for help.

Also See:
Fast Fact #4: Death Pronouncement
Fast Fact #64: Informing significant others of a patients death
Fast Fact #77: Telephone Notification of Death: Part 2

• 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 .

Copyright and Referencing Information: Users are free to download and distribute Fast Facts for educational purposes only. Citation for referencing. Fast Facts and Concepts #76 Telephone Notification of Death Part 1. RR Osias, D H Pomerantz, and JM Brensilver. October 2002. End-of-Life Physician Education Resource Center @ www.eperc.mcw.edu.

Fast Facts and Concepts was originally developed as an end-of-life teaching tool by Eric Warm, MD, U. Cincinnati, Department of Medicine. See: Warm, E. Improving EOL care--internal medicine curriculum project. J Pall Med 1999; 2: 339-340.

Disclaimer: Fast Facts provide educational information, this information is not medical advice. Health care providers should exercise their own independent clinical judgment. Some Fast Fact information cites the use of a product in dosage, for an indication, or in a manner other than that recommended in the product labeling. Accordingly, the official prescribing information should be consulted before any such product is used.

Creation Date: 10/2002

Format: Handouts

Purpose: Instructional Aid, Self-Study Guide, Teaching

Audience(s)

Training: Fellows, 1st/2nd Year Medical Students, 3rd/4th Year Medical Students, PGY1 (Interns), PGY2-6, Physicians in Practice

Specialty: Anesthesiology, Emergency Medicine, Family Medicine, General Internal Medicine, Geriatrics, Hematology/Oncology, Neurology, OB/GYN, Ophthalmology, Pulmonary/Critical Care, Pediatrics, Psychiatry, Surgery

Non-Physician: Clergy/Chaplains, Nurses, Social Workers

ACGME Competencies: Interpersonal and Communication Skills, Patient Care

Keyword(s): Communications skills, Death pronouncement, Discussing hospice care, Family conference, Giving bad news, Negotiating treatment goals, Personal reflection, Prognosis

The Fast Facts series is distributed for educational use only and does not constitute medical advice. For the most current version of Fast Facts visit the EPERC web site at www.eperc.mcw.edu. This mirror version is provided subject to copyright restrictions for educational use within the Inter-Instutional Collaborating Network on End-of-Life Care (IICN).