Title: Fast Fact and Concept #77: Telephone Notifcation of Death, Part 2
Author(s): Rosalia R. Osias, MD, Daniel H. Pomerantz, MD, Jeffrey M. Brensilver, MD, FACP
In Fast Fact #76, Telephone Notification of Death: Part 1, the basic steps and precautions were outlined.
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:
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:
Fast Fact #76: Telephone Notification of Death: Part 1
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 .
Copyright and Referencing Information: Users are free to download and distribute Fast Facts for educational purposes only. Citation for referencing. Fast Facts and Concepts #77 Telephone Notification of Death Part 2. 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
Purpose: Instructional Aid, Self-Study Guide, Teaching
|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).