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DEATH NOTIFICATION

Death notification is perhaps the most difficult, emotionally laden physician communication. In most situations, the notification of death occurs during the first meeting of the emergency physician with the deceased patient’s family. The notification often comes after extensive resuscitation efforts, creating an upheaval of emotion for the physician and ED staff and leaving the team emotionally and physically exhausted.1,2

For survivors, death notification is a life-altering event. The language used during the communication, the venue, and the characteristics of the individual delivering the news create indelible memories for the family.3

EFFECTS ON SURVIVORS

Because death that occurs in the ED is frequently sudden, unexpected, and often violent, survivors can develop complicated bereavement and/or posttraumatic stress disorder.4-7 Death notifications that provide limited or incorrect information about the death or occur in chaotic settings with limited support may exacerbate the grief reaction.6 When properly performed, death notifications may mitigate substantial negative effects on surviving family members.8 A well-delivered death notification can reduce the incidence of posttraumatic stress disorder in the families of patients who died suddenly, particularly notifications involving the loss of a spouse or the death of a child.9

WHAT REACTIONS TO EXPECT

Responses to loss vary greatly. Families often describe themselves as numb immediately after learning of the loss. They have difficulty processing information and making decisions. Following the initial shock, the family may experience denial, anger, and/or guilt.10 Denial is most typically expressed as incredulity and is thought to be a defensive mechanism. Your role is to understand this condition and allow time and, if needed, to provide additional information to confirm death. Seeing the body of the deceased may help the family to accept the truth. Anger is not unusual. Be prepared to react in a supportive manner rather than responding with anger or becoming defensive. These are typically expressions of grief and misplaced guilt.

The survivors’ culture is an important predictor of the types of emotional responses that may be exhibited. These may range from no expression of emotion to wailing and hysterical collapse. Allow these expressions and remain calm and respectful. If you want to touch the grieving individual, the shoulder is the most suitable location.

EFFECTS ON PHYSICIANS

Physicians find death notification physically and emotionally difficult, with evidence of increased heart rate, heart rate variability, and cortisol levels immediately after the event.11-14 Common emotional reactions in emergency physicians faced with the task of death notification are sadness (60%) and disappointment (38%), resulting in insomnia in 37%.14 The cause of death, the patient’s age, the presence of family, and the similarity to self are the most common reasons cited by emergency physicians for powerful impact of a recent death notification experience.14,15 Other factors that may also ...

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