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==Background==
Physicians must disclose bad news to family members - often times unexpected notification of death can be difficult for family. 
The process can be challenging for providers.
Using a structured approach can help alleviate the emotional challenging of delivering the bad news. 
Think of delivering bad news as a procedure (with a pre-procedure time out and a structured approach).

==Types==
*Notification of death
*Informing of poor prognosis e.g. "It's not my job to take away all hope, but I am very worried about _ and he/she is very sick"

==Procedure==

*Time Out Before the Procedure (Mandatory)
**Confirm identity of patient and family specifically that family is TRULY the family of the patient.  Can be difficult when the patient arrives as a "Joe Doe" without family.  Before having meeting, identification processes (social work can assist) with confirming age, demographic, location that patient came from (can be found on the EMS run sheet). 
**Confirm that you known the name of the patient so that way you can refer to him/her by his/her name.  Ask social work if they know the names of the family and/or their relation to the patient. 

==Approaches==

*GRIEV_ING: (Pnuemonic)

***Gather ‐ Get SW in room,

***Resources ‐ +/‐ security, tell attending will have to be gone, get pager/trauma coverage

***Identify person we are talking about, myself and all people in room, identify level of understanding of what has happened already

***Educated ‐ warning shot "I have some bad news." Don't wait too long before saying "___ has died."

***Verify understanding

***_ Be silent, give the family space to process

***Inquire ‐ questions
***Nuts/Bolts Give contact info


*SPIKES

**S - SETTING UP the Interview
***Arrange for some privacy,
Involve significant others,
Sit down.
Make connection with the patient.
Manage time constraints and interruptions.

**P - PERCEPTION
***"What have you been told so far?” 
***Assess receiver's level of health literacy. 

**I - INFORM
***Briefly explain chronology of events leading up to death (or bad news)
***Avoid euphemisms

**K - Knowledge
***Allow receiver to ask questions. 

**E - Empathy 
***Validate emotions of grieving. 
***Say "I'm sorry."

**Summary and Strategy
***Acknowledge questions may arrise after processing, establish your availability to be reached by social work in they have questions that come up when they see their loved one. 
*** Leave receiver with social work. "I'm going to step out and let (the social worker) help you with the next steps" 


==Tips==
*If family asks if they suffered, consider what if any utility there would be to saying anything other than no. 

==External Links==
https://www.acep.org/clinical---practice-management/think-griev_ing-when-giving-bad-news-to-loved-ones/


==References==
Emergency Medicine Conference at Boston Medical Center 2015. Contributions by multiple facutly (including Dr Jeffrey Schneider and BMC EM residents

Lowry, Fran. Think GRIEV_ING When Giving Bad News to Loved Ones. ACEP News
April 2007
SPIKES—A Six-Step Protocol for Delivering Bad News: Application to the Patient with Cancer, Baile, et al. The Oncologist. Jun 2000. (http://theoncologist.alphamedpress.org/content/5/4/302.full)

Shoenberger, Jan MD et al. Death Notification in the Emergency Department. Western J Emerg Med. 2013;14(2):181-185. 

[[Category:Procedures]]
[[Category:Misc/General]]