Giving bad news: The family perspective

Background: Death from trauma frequently comes without forewarning. Relatin g the news of death to the family is often the responsibility of trauma sur geons. The purpose of this study was to investigate the key characteristics and methods of delivering bad news from the perspective of surviving famil y members. Methods: We designed and administered a survey tool to surviving family mem bers of trauma patients dying in the emergency department or intensive care unit, The tool consisted of 14 elements that surviving family members grad ed in importance when receiving bad news (1, least; 6, most). Respondents a lso judged the attention given to these elements (good, fair, or poor) by t he person giving the bad news of death. Results: Fifty-four family members of 48 patients who died completed the su rvey (44 intensive care unit deaths, 4 emergency room deaths). Deceased pat ients ranged in ape from 12 to 91 years (mean, 53 gears). Death occurred wi thin 2 days of injury in 69% of the patients and within 1 week in 83%. The most important features of delivering bad news were judged to be attitude o f the news-giver (ranked most important by 72%), clarity of the message (70 %), privacy (65%), and knowledge/ ability to answer questions (57%). The at tire of the news-giver ranked as least important (3%). Sympathy, time for q uestions, and location of the conversation were ranked of intermediate impo rtance, Touching was unwanted by 30% of the respondents, but encouraged or acceptable in 24%. Conclusion: The attitude of the news-giver, combined with clarity of the me ssage and the time, privacy, and knowledge to answer questions are the most important aspects of giving bad news. This information should be incorpora ted into resident training.