Mori M, Fujimori M, Hamano J, Naito AS, Morita T. Which Physicians' Behaviors on Death Pronouncement Affect Family-Perceived Physician Compassion? A Randomized, Scripted, Video-Vignette Study. J Pain Symptom Manage. 2018 Feb;55(2):189-197.
Although the death of a loved one is a devastating family event, little is known about which behaviors positively affect families' perceptions on death pronouncements.
The objective of this study was to evaluate the effect of a compassionate death pronouncement on participant-perceived physician compassion, trust in physicians, and emotions.
In this randomized, video-vignette study, 92 people (≥50 years) in Tokyo metropolitan area viewed two videos of death pronouncements by an on-call physician with or without compassion-enhanced behaviors, including five components: waiting until the families calm themselves down, explaining that the physician has received a sign-out about information of the patient's condition, performing examination respectfully, ascertaining the time of death with a wristwatch (vs. smartphone), and reassuring the families that the patient did not experience pain. Main outcomes were physician compassion score, trust in physician, and emotions.
After viewing the video with compassion-enhanced behaviors compared with the video without them, participants assigned significantly lower compassion scores (reflecting higher physician compassion) (mean 26.2 vs. 36.4, F = 33.1, P < 0.001); higher trust in physician (5.10 vs. 3.00, F = 39.7, P < 0.001); and lower scores for anger (2.49 vs. 3.78, F = 18.0, P < 0.001), sadness (3.42 vs. 3.85, F = 11.8, P = 0.001), fear (1.93 vs. 2.55, F = 15.8, P < 0.001), and disgust (2.45 vs. 3.71, F = 19.4, P < 0.001).
To convey compassion on death pronouncement, we recommend that physicians initiate prompt examination, explain that the physician has received a sign-out, perform examination respectfully, ascertain the time of death with a wristwatch, and reassure the families that the patient did not experience pain.
The act of pronouncing death is recognized as a profound moment for families. The memories of how the death pronouncement occurred have been recognized as a factor in bereavement and also as a sacred moment. Yet, the realities of hospitals often mean that the death pronouncement happens at times when only an on-call physician is present, a person who is often unknown to the family and who has never met the patient. Previous literature and clinical experiences have also reported that many physicians are ill-prepared to perform a death pronouncement.
This study adds to the literature by demonstrating that physician behaviors intended to convey compassion have the capacity to more positively affect the surviving family or friends at the time of a loved one's death. The study authors acknowledged the limitations of this study, including awareness that the hypothetical scenarios shown on video may be different from actual patient death pronouncements. They also recognized that other variables and behaviors could be important in different patient situations, such as with patients or family members of different ages or dying from different diseases or conditions. It would also be very interesting to replicate this study, conducted in Tokyo, in other countries to determine whether the compassion behaviors are generalizable and whether the perceptions of those witnessing the pronouncements are also similar.