COMMENTARY

The Hardest News: Death Disclosure in the Emergency Department

Tammie Quest, MD

Disclosures

August 18, 2008


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I am sorry but your son has died...

One in 500 people who visit a US emergency departmentwill be pronounced dead on arrival or die during their emergency department stay.[1] The finality of death is often devastating to survivors, even if a lengthy illness or advanced age made it expected. If the information is improperly conveyed, the trauma may be multiplied.

Death disclosure is a special type of breaking bad news that cannot be deferred.

Death in the emergency setting still means defeat to many clinicians, and we rate death disclosure as the most stressful among communications.[2] This is especially likely if the clinician feels that the death could have been prevented or that the medical care could have been improved; or if the patient was a child; or if there is no explanation for the death. However, clinicians must temporarily suspend their own needs in order to help survivors comprehend what has happened and allow them to begin the grieving process.

Key components of a well-conducted death disclosure include:

  1. Care of the survivors upon arrival;

  2. Unambiguous notification of death;

  3. Allowing for the grief response; and

  4. Offering viewing.

Skills in death disclosure can and should be taught.[3,4,5] A practical and detailed guide can be [obtained] from the Education in Palliative and End-of-life Care (EPEC) -- Emergency Medicine Curriculum. The procedure by which one delivers it should be done with the same care as surgery. This critical communication should be well thought out, practiced and critiqued for errors, and praised for success. When done well, you avoid the harm of making a difficult situation worse and maybe make it just a little better. When done poorly, its memory can never be erased.

That's my opinion. I'm Dr. Tammie Quest, Director of EPEC -- Emergency Medicine Project, and Associate Professor, Emory University School of Medicine.

For more information, visit www.epec.net/EPEC/Webpages/epecem.cfm


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