Breaking the worst possible news in the best possible manner

into the process of giving information about the death, says Pierce. "For instance, when people stop asking questions, it means they have heard all they can handle and it would be a burden to hear more. If you volunteer too much detail, you risk creating a bad memory. However, it's important to allow them to obtain more information later."

People got the most comfort from being left with the sense that everything possible had been done to save the patients' lives. If information is unclear or not readily available or if doctors are uncaring, people also have to deal with anger, which interferes with the grieving process," Pierce explains.

Relating news of death is the responsibility of the doctor who is the most aware of the events surrounding the death, who can speak frankly and knowledgeably, and has an empathetic demeanor, says Jurkovich. The seniority of the doctors was less important than their manner, and the family members' most positive comments described those who expressed sympathy and sensitivity.

"The doctor who spoke with us asked us what kind of man dad was," said one respondent. "It gave us a chance to talk about him. That was a very positive memory." "The ER doctor initially called my mother," said another. "He talked with her and figured out she was frail and alone. He called her neighbor and me and made sure someone was with her before telling her of my brother's almost certain death."

A private room in which to break the news and letting the family remain there is important, as is allowing them time with the body if they wish. Several respondents expressed gratitude at being able to see the patients as soon as they left the ER, whether or not they were presentable, if the prognosis looked bad. "In the past, we would try to first stabilize the patient but found it might be too late," says Pierce. "At first there was concern that the family would be disruptive, or that we needed to protect them from the patient's appearance,

Contact: Ellen Liang
University of Washington

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