Trauma

Nov. 06, 2021

Mary E. Fallat, M.D., FACS, FAAP, visiting professor who delivered the Annual Peter Mucha Jr. Visiting Professor of Trauma and Acute Care Surgery Lecture at Mayo Clinic in Minnesota, knows relaying a patient's critical status or death to family can be difficult. Dr. Fallat is a pediatric surgeon and medical director of surgical quality at the University of Louisville in Kentucky. As trauma may threaten a patient's life, she says it's crucial for trauma care providers to know how to help family members around the time of a patient's decline and death.

Develop relationships with patients and families

Patient- and family-centered care form the bedrock for communication in an event in which a patient dies due to trauma or illness, says Dr. Fallat. Providing this type of care involves cultivating relationships with patients and family members, who are greatly affected by the patient's condition. Relationship building with patients and their support people also will bolster a health care provider's confidence if a death notification becomes necessary. She concedes, however, that sometimes in trauma medicine health care providers barely know their patients.

Dr. Fallat encourages care providers to imagine standing in the shoes of their patients and loved ones. "We as surgeons need to be more empathetic — to understand how our patients are feeling," she says.

For example, with a mother who has just received bad news about her child at the hospital, she encourages thinking about how the mother might feel. Dr. Fallat explains empathy isn't the same as sympathy, which is feeling sorry for the mother.

She says not only being empathic but also honest and nice — even if you're tired and crabby — is important to convey that you care.

Deliver bad news effectively to loved ones

Dr. Fallat presents strategies to communicate well with families in the event a patient's status declines significantly or the patient dies.

If a patient is doing poorly

If a patient starts to decline, says Dr. Fallat, these steps may be helpful:

• Update the family. If the patient is critical, notify family as soon as this condition is suspected or known. Dr. Fallat says she will speak to family members as soon as she's started the case, updating them every hour thereafter.
• Provide access. Allow family members access to the patient, if possible, including presence during resuscitation under the right circumstances.
• Postpone determination. Delaying death determination may be appropriate if the patient's parent or family is close to the hospital.

If a patient dies

In the event of a patient's death, Dr. Fallat suggests delivering the news quickly, using a D word: died, death or dead. She emphasizes it's important to use the word "died" to help family clearly understand what's happened. She recommends these tips as you communicate with and care for the patient's family around the death:

• Be absolutely certain of the identity of the deceased.
• Get as much information as possible about the family to be notified.
• Don't call unless there is no alternative.
• Determine who will speak with the family.
• Greet family and take them to a private area.
• Sit down, and ask them to sit down.
• Inform simply and directly with compassion.
• Don't discount feelings regardless of cause, such as when speaking to a potential perpetrator in abuse cases.
• Join the survivors in their grief if you know the person or if it seems appropriate, without being overwhelmed by it.
• Answer all questions as honestly as you can and prepare answers to questions such as "Why did this happen to our family?"
• Think about organ or tissue donation.
• Prepare for identification and viewing.
• Offer to make calls or find someone to do this for the family.
• If talking to the media, do so only after discussion with family and getting permission from risk management or public affairs.
• Arrange for someone to call the family the next day.
• Let the survivors know you and the team care.

Dr. Fallat explains that applying these principles will help the family and their memory of hearing about the death; it also will help the health care provider's reflection on the encounter. "If you're the one who gives bad news and you do it well, I think you have less moral distress than if you give someone bad news and you know you didn't do it well," she says.

Dr. Fallat also offers some suggestions on what to say and avoid while talking with a recently deceased patient's family.

Some kind things to say to a family when a loved one dies, according to Dr. Fallat, include:

• "I can't imagine how you feel right now, but I (we) are here and willing to listen and help as much as we can."
• "We know you needed this person and feel a great sense of loss."
• "I know memories are a poor substitute for having this person with you, but I hope they will give you some comfort."

Conversely, Dr. Fallat offers some tips on what not to say to a family when a loved one dies:

• "It must have been his or her time."
• "It was actually a blessing because …"
• "God must have needed her more than you."
• "God never gives us more than we can handle."

Dr. Fallat also shares expectations health care providers may express to families who've lost a family member: unhealthy ones that may be harmful and healthy ones that can help a bereaved family.

Some unhealthy expectations include:

• "You must be strong for your wife and children."
• "You must get ahold of yourself."

Some healthy expectations include:

• "Why not share your feelings with your child?"
• "Perhaps you can lean on each other and help support each other."
• "It's okay to cry, and it may help you feel better."

Dr. Fallat says as she communicates to grieving families, she strives to treat them as if they were her own family. "I always try to take care of my patients the way I'd want my family members to be taken care of," says Dr. Fallat.

For more information

Fallat ME. My patient is dying: Patient-centered and self-care preparation for medical providers. Presentation at: Mayo Clinic, Annual Peter Mucha Jr. Visiting Professor of Trauma and Acute Care Surgery Lecture, Aug. 20, 2021; Rochester, Minn.