Think GRIEV_ING When Giving Bad News to Loved Ones

an0407grievingACEP News
April 2007

By Fran Lowry
Elsevier Global Medical News

NEW ORLEANS - Remembering the mnemonic "GRIEV_ING" can help busy emergency physicians impart the devastating news of a loved one's death in a sensitive and caring way.

Death notification is a common, difficult, and emotion-laden communication that emergency physicians often find themselves faced with. All too often, training in giving bad news gets short shrift in medical school, Dr. Cherri Hobgood of the University of North Carolina, Chapel Hill, said at the Scientific Assembly of the American College of Emergency Physicians.

"Losing a patient in the [emergency department] is one of the variables that [is] often not in our control as physicians, and this is where we can start feeling bad about our practice. When a death occurs, we've given it our all, and we've failed. And then we have to bolster [ourselves] up to go and tell the family. That's a hard place to be," she said.

Having the skills to compassionately relate a relative's passing can make an enormous difference for the family on the receiving end, said Dr. Hobgood.

'We've had little education to prepare us to deliver bad news. But at the end of life, there are no second chances to get it right. We only have one opportunity to let the family or significant others know that we have done all we could to help their loved one, and the way we deliver the news can help the family heal," Dr. Hobgood said.

Imparting bad news in a compassionate, empathetic way can help families accept their loss and mitigate feelings of guilt. "Often people come in here with a tremendous amount of guilt. Give them some absolution if possible," she said.

Dr. Hobgood confessed that she has been on the receiving end of bad news when her husband suffered a massive stroke. "I'm a doctor, yet I couldn't take it all in. I just could not process the information. I was numb."

She offered the following tips when delivering bad news:

  • Assume an attentive posture when you come into the room. Shake hands. When you sit down, lean forward and put your hands on your knees. This lets the bereaved know that you are opening yourself up to them.
  • Encourage them to talk. Show them they are being heard by repeating one or two of their key words.
  • Know your hospital's policies for reporting deaths. For example, it is the policy at the University of North Carolina to request that the family consider an autopsy on all in-hospital deaths.
  • Avoid saying anything with a religious tone. Try to avoid statements such as, "He's in God's hands."
  • Say you are sorry that this happened. "Saying you are sorry for their loss really makes a difference. It is a normal reaction on your part and a normal thing to say when you see a family suffering the loss of someone they love," she explained. "If you did not feel sorry for their loss, it would be abnormal."

The GRIEV_ING mnemonic can help structure this important communication:

Gather: Ensure that all family or survivors are present. Offer to call others or wait for them.

Resources: Call for support resources that are available, such as friends and ministers. Start this process while still in the resuscitation room.

Identify: Identify yourself. "I am Dr. Hobgood, the one taking care of your mother."

Identify the deceased or injured patient by name. Identify the family's understanding of the day's events. Identify that you are bringing bad news. "Fire the warning shot: 'Things were not going well.' You have to [prepare them for] the fact that the news is bad."

Educate: Briefly educate the family about the events that have occurred in the emergency department.

Educate them about the current state of their loved one. "Fire another warning shot if needed."

Verify: Verify that their family member has died. Be clear! "You cannot use euphemisms. You have to say 'dead' or 'died.' "

(Space _): Give the survivors personal space. Stop talking. Allow them to absorb the information.

"You can touch them if you feel comfortable doing this. You can give them permission to cry by handing them a box of [tissues]," she said.

Hugging is okay, if you feel all right doing so. "Sometimes those hugs are the most consoling part of this whole thing," Dr. Hobgood added.

Inquire: Ask if there are any questions. Answer them all. Take the time--this sends an important message.

Nuts and bolts: Ask about organ donation, funeral services, and personal belongings. Offer the family the opportunity to view the body. "There is often a great deal of comfort in viewing the body." Tell them that the room is a mess, that the patient doesn't look like they might expect to facilitate this viewing; but "giving them the choice is very important," said Dr. Hobgood.

Give: Give them your card and access information. Offer to answer any questions that may arise later.

"Tell them 'I am here for you. You are going to have questions.' This speaks volumes," she said.

"I have been doing this for 5 years, and only five people have called me, all to say, 'Thank you.' Always return their calls.

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