View source for Delivering bad news

==Background==
*Physicians must disclose bad news to family members - often times unexpected notification of death can be difficult for family. <ref>Meitar D, Karnieli-Miller O. Twelve tips to manage a breaking bad news process: Using S-P-w-ICE-S - A revised version of the SPIKES protocol. Med Teach. 2022 Oct;44(10):1087-1091. PMID 34057007</ref>
*The process can be challenging for providers.
*Using a structured approach can help alleviate the emotional challenging of delivering the bad news.<ref>Maynard DW. Delivering bad news in emergency care medicine. Acute Med Surg. 2017 Jan;4(1):3-11. PMID 29123830</ref> 
*Think of delivering bad news as a procedure (with a pre-procedure time out, a structured approach to the delivery of bad news, and requesting a colleague in the ED to hold your phone or take any runs that come in while you are in your critical five minutes of breaking the news.

==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==
===GRIEVING===
*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
*'''E'''ducated ‐ warning shot "I have some bad news." Don't wait too long before saying "___ has died."
*Verify understanding
*Inquire ‐ questions
*Nuts/Bolts Give contact info
*Give the family space to process; Be silent

===SPIKES===
*SETTING UP the Interview
**Arrange for some privacy, Involve significant others, Sit down.
**Make connection with the patient.
**Manage time constraints and interruptions.
*PERCEPTION
**"What have you been told so far?” 
**Assess receiver's level of health literacy. 
*INFORM
**Briefly explain chronology of events leading up to death (or bad news)
**Avoid euphemisms
*Knowledge
**Allow receiver to ask questions. 
*Empathy 
**Say "I'm sorry."
**Repsond and validate the emotions of grieving: NURSE
***Name the emotion
****"It sounds like this has been overwhelming."
***Understand the emotion (empathize)
****"I cannot imagine how hard this must be for you."
****"I wish I had better news."
***Respect the patient or family
****"You are asking all of the right questions."
****"You are being such a strong advocate for your [family member]."
***Support the patient or family
****"We will be here for you."
***Explore the emotion
****"What other things are you worried about?"
****"Tell me more about what you're thinking."
*Summary and Strategy
**Acknowledge questions may arise 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  (assuming it would not be obviously a lie) what if any utility there would be to saying anything other than: "No, he/passed peacefully." After all, our patients are also the family of the deceased.

==External Links==
*https://www.acep.org/clinical---practice-management/think-griev_ing-when-giving-bad-news-to-loved-ones/

==See Also==
*[[Brain death]]

==References==
<references/>

[[Category:Procedures]]
[[Category:Misc/General]]
[[Category:Palliative Medicine]]