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Giving Bad News: The Family Perspective

Jurkovich, Gregory J. MD; Pierce, Becky RN; Pananen, Laura RN; Rivara, Frederick P. MD, MPH

Journal of Trauma-Injury Infection & Critical Care: May 2000 - Volume 48 - Issue 5 - pp 865-873
Annual Meeting Articles

Background: Death from trauma frequently comes without forewarning. Relating the news of death to the family is often the responsibility of trauma surgeons. The purpose of this study was to investigate the key characteristics and methods of delivering bad news from the perspective of surviving family members.

Methods: We designed and administered a survey tool to surviving family members of trauma patients dying in the emergency department or intensive care unit. The tool consisted of 14 elements that surviving family members graded in importance when receiving bad news (1, least; 6, most). Respondents also judged the attention given to these elements (good, fair, or poor) by the person giving the bad news of death.

Results: Fifty-four family members of 48 patients who died completed the survey (44 intensive care unit deaths, 4 emergency room deaths). Deceased patients ranged in age from 12 to 91 years (mean, 53 years). Death occurred within 2 days of injury in 69% of the patients and within 1 week in 83%. The most important features of delivering bad news were judged to be attitude of the news-giver (ranked most important by 72%), clarity of the message (70%), privacy (65%), and knowledge/ability to answer questions (57%). The attire of the news-giver ranked as least important (3%). Sympathy, time for questions, and location of the conversation were ranked of intermediate importance. Touching was unwanted by 30% of the respondents, but encouraged or acceptable in 24%.

Conclusion: The attitude of the news-giver, combined with clarity of the message and the time, privacy, and knowledge to answer questions are the most important aspects of giving bad news. This information should be incorporated into resident training.

Trauma is always an unexpected event, and death from trauma frequently comes without any forewarning for the loved ones of the victim. Receiving this news is an emotionally upsetting and poignant moment in an individual’s life. Sharing this sad news of death is often the duty of trauma surgeons and nurses. Ideally, this situation should be an opportunity to provide comforting memories for family members and professional satisfaction for the provider. The event can also be an unsettling scene, which creates bitter memories for all parties.

Nearly all previous investigations into the giving of bad news have focused on either oncology patients 1–6 or pediatric patients and their families. 7–11 Remarkably few studies on the giving of bad news are from the perspective of the surviving family members, and fewer still have appeared in the trauma literature. 11,12 This finding is remarkable in that injury is the most common cause of death for people under age 44 in the United States, and the giving of bad news has been highlighted as the most important communication skill a good surgeon must have. 13

With this study, we sought to investigate our performance in the giving of bad news of death to surviving family members, and in doing so, determine the most important or significant features of this conversation and its delivery.

From the Department of Surgery (G.J.J.), and Pediatrics (F.P.R.), the Harborview Injury Prevention and Research Center (G.J.J., F.P.R.), and Harborview Trauma ICU (B.P., L.P.) University of Washington School of Medicine, Harborview Medical Center, Seattle, Washington.

Address for reprints: Gregory J. Jurkovich, MD, University of Washington School of Medicine, Harborview Medical Center, 325 Ninth Avenue, Box 359796, Seattle, WA 98104.

Submitted for publication September 24, 1999.

Accepted for publication December 30, 1999.

Presented at the 59th Annual Meeting of the American Association for the Surgery of Trauma September 16–18, 1999, Boston, Massachusetts.

© 2000 Lippincott Williams & Wilkins, Inc.