As a hospitalist, you may be faced with a myriad of challenges when it comes to bereavement care. Whether it’s informing family members about the death of a patient, or as the provider, learning to cope with considerable loss on a regular basis – it can be extremely stressful for a clinician to be in a position of delivering such traumatic news, especially in the instance of an unexpected death. Grief reactions come in many forms from bereaved family members and can add an unsurmountable amount of pressure to a physician. Reactions of sorrow from family members may include initial shock, denial, distress, anger, or guilt; all of which can be directed at the provider. This may make clinicians uncomfortable and ultimately feel inadequate in these types of scenarios.
According to the National Institutes of Health, U.S. National Library of Medicine,
“the onus of speaking with bereaved family members about a sudden death of a patient lies on the health care team and should be carried out with utmost priority.” (1)
Because of this, hospitals should have an action plan in place for bereavement protocols that hospitalists can be confident in following.
Establish a Relationship
Once a patient has been established under a hospitalists’ care, that clinician should seek to make contact with a family member, close friend, or relative of the patient on-site. The physician should continue communication throughout the duration of the patient’s stay with one to two family members or close friends to keep communication consistent. If the patient is alone, a phone call to an emergency contact should be made. This conversation should be personable, compassionate, and sincere.
Explain Next Steps
Especially if a patient is in ICU and/or the outlook isn’t promising, family members need to be made aware of the possibility of death. The clinician should explain prognosis and chances of survival to adequately prepare loved ones for what may happen next. Resources such as social work and bereavement services, as well as pastoral care should be offered. Counseling on advanced directives should also be given. It’s often best to handle discussions around the patient’s prognosis outside of the hospital room, in a quiet space like a waiting room or private hallway.
Even if there is no news to share, simply checking in on the patient and their family can make them feel more comfortable in uneasy times. Something as simple as stopping in to say hello and letting the patient and family know the team is working hard to help them can go a long way.
It is imperative to keep loved ones in the loop as much as possible about the patient’s condition. This keeps family and/or friends feeling connected to the process as well as their physician. When communication is poor from the start, it makes it that much more challenging to break difficult news. Always be sure to explain any new advancements or changes in the patient’s condition as soon as possible.
Ease the Burden
If a patient has died, the clinician should pull designated family members aside (seated is best) and calmly explain what has happened. The provider should speak in layman’s terms, making it as easy to understand as possible. The provider should offer expression of their sympathy and encourage family members by discussing all efforts made by the health care team to try to save the patient. If the provider feels comfortable, they may also wish to share their faith with the family members, expressing that the patient is no longer in pain, and in a better place (in heaven, with Jesus, etc.).
Clinicians should anticipate an array of questions from loved ones. If a question comes up that the hospitalist does not know the answer to or does not feel comfortable communicating, it’s OK to let the patient know in the most tenderhearted way. If a family member does become irrational or angry, it is best to not engage or respond to the behavior. Instead, refer the person to a counselor, or someone trained specifically in grief management.
A key component of bereavement services includes making condolence calls. Within 7-14 days following the death of a patient, the hospitalist should consider making a phone call to family members to offer their condolences once again and check in to see if there is anything the hospital staff may be able to assist with. Hospitalists should work with social workers and hospital psychologist services to receive education and guidance on proper counsel and support.
In the end, it’s important to remember that a health care team’s commitment to high-quality care is what makes the biggest impact, especially in situations of dealing with grief. By remaining communicative, caring, and consoling, hospitalists and patients’ family members can continue to develop and maintain meaningful relationships that make the grieving process a little less painful for each party.
Contact Advanced Care Hospitalists to Learn More
ACH is a Lakeland-based hospitalist group providing comprehensive patient care in community hospitals across Central Florida. If you are interested in learning more about our programs, services, providers or becoming a partner facility, please call us at 863-816-5884 or fill out a contact form online.
- Naik, Sadananda B. “Death in the hospital: Breaking the bad news to the bereaved family.” Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine vol. 17,3 (2013): 178-81. doi:10.4103/0972-5229.117067