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.
Abstract
CONTEXT:
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.
OBJECTIVES:
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.
METHODS:
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.
RESULTS:
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).
CONCLUSION:
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.
https://www.medscape.com/viewarticle/893415
Shinjo T, Morita T, Hirai K, Miyashita M, Sato K, Tsuneto S, Shima Y. Care for imminently dying cancer patients: family members' experiences and recommendations. J Clin Oncol. 2010 Jan 1;28(1):142-8.
ReplyDeleteAbstract
PURPOSE The aim of this study was to clarify the level of emotional distress experienced by bereaved family members and the perceived necessity for improvement in the care for imminently dying patients and to explore possible causes of distress and alleviating measures. METHODS A cross-sectional nationwide survey was performed in 2007 of bereaved families of cancer patients at 95 palliative care units across Japan. Results Questionnaires were sent to 670 families, and 76% responded. Families reported their experiences as very distressing in 45% of cases. Regarding care, 1.2% of respondents believed that a lot of improvement was needed, compared with 58% who believed no improvement was needed. Determinants of high-level distress were a younger patient age, being a spouse, and overhearing conversations between the medical staff outside the room at the time of the patient's death; those reporting high-level necessity of improvement were less likely to have encountered attempts to ensure the patient's comfort, received less family coaching on how to care for the patient, and felt that insufficient time was allowed for the family to grieve after the patient's death. CONCLUSION A considerable number of families experienced severe emotional distress when their family member died. Thus, we propose that a desirable care concept for imminently dying cancer patients should include relief of patient suffering, family advisement on how to care for the patient, allowance of enough time for the family to grieve, and ensuring that family members cannot overhear medical staff conversations at the time of the patient's death.
Hobgood C, Mathew D, Woodyard DJ, Shofer FS, Brice JH. Death in the field: teaching paramedics to deliver effective death notifications using the educational intervention "GRIEV_ING". Prehosp Emerg Care. 2013 Oct-Dec;17(4):501-10.
ReplyDeleteAbstract
INTRODUCTION:
Emergency medical services (EMS) personnel are rarely trained in death notification despite frequently terminating resuscitation in the field. As research continues to validate guidelines for the termination of resuscitation (TOR) and reputable organizations such as NAEMSP lend support to such protocols, death notification in the field will continue to increase. We sought to test the hypothesis that a learning module, GRIEV_ING, which teaches a structured method for death notification, will improve the confidence, competency, and communication skills of EMS personnel in death notification.
METHODS:
The GRIEV_ING didactic session consisted of a 90-minute education session composed of a didactic lecture, small group breakout session, and role-plays. This was both preceded and followed by a 15-minute case role-play using trained standardized survivors. To assess performance we used a pre-post design with 3 quantitative measures: confidence, competency, and, communication. Paramedics from the local EMS agency participated in the education as a part of continuing education. Pre-post differences were measured using a paired t-test and McNemar's test.
RESULTS:
Thirty EMS personnel consented and participated. Confidence and competency demonstrated statistically significant improvements: confidence (percent change in scores = 11.4%, p < 0.0001) and competency (percent change in scores = 13.9%, p = 0.0001). Communication skill scores were relatively unchanged in pre-post test analysis (percent change in scores = 0.4, p = 0.9).
CONCLUSION:
This study demonstrated that educating paramedics to use a structured communication model based on the GRIEV_ING mnemonic improved confidence and competence of EMS personnel delivering death notification.