Breaking bad news and managing family during an out-of-hospital cardiac arrest

Mainds, Matthew D; Jones, Colin

doi:10.12968/jpar.2018.10.7.292

Cited by 13 publications

(15 citation statements)

References 28 publications

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“…In a small study of semistructured interviews with paramedics it was highlighted that clinicians primarily learnt how to break bad news through observing others, leading to a wide variety of skills and styles of breaking bad news and a general feeling of discomfort with the practice. 3 This feeling of discomfort is not unique to the paramedic profession; similar findings have been observed in studies of doctors and medical students. 4 When doctors and medical students get specific training, this helps build their confidence in the act of breaking bad news and assists both the clinician and family member to have better outcomes from the experience.…”

Section: Challenges and Considerations In Out-of-hospital Bad News Desupporting

confidence: 67%

“… 5 6 Some clinicians feel the protection they have from the emotional reality of their work slips in these moments. As one paramedic interviewed in the Mainds and West 3 study said, it ‘ pulls you from back out of the clinical and into the human ’. These are the times when we are no longer just the professional doing our job but are a part of an intensely human and emotionally resonant scenario.…”

Section: Challenges and Considerations In Out-of-hospital Bad News Dementioning

confidence: 99%

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Paramedic delivery of bad news: a novel dilemma during the COVID-19 crisis

Campbell

2020

J Med Ethics

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As a result of the COVID-19 global pandemic, paramedics in the UK face unprecedented challenges in the care of acutely unwell patients and their family members. This article will describe and discuss a new ethical dilemma faced by clinicians in the out-of-hospital environment during this time, namely the delivery of bad news to family members who are required to remain at home and self-isolate while the critically unwell patient is transported to hospital. I will discuss some failings of current practice and reflect on some of the ethical and practical challenges confronting paramedics in these circumstances. I conclude by making three recommendations: first, that dedicated pastoral outreach teams ought to be set up during pandemics to assist family members of patients transported to hospital; second, I offer a framework for how bad news can be delivered during a lockdown in a less damaging way; and finally, that a new model of bad news delivery more suited for unplanned, time-pressured care should be developed.

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Section: Challenges and Considerations In Out-of-hospital Bad News Desupporting

confidence: 67%

Section: Challenges and Considerations In Out-of-hospital Bad News Dementioning

confidence: 99%

Paramedic delivery of bad news: a novel dilemma during the COVID-19 crisis

Campbell

2020

J Med Ethics

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“… 55 71 During OHCAs, some PHPs preferred families not to be present in the room during resuscitation and described feeling pressure from families, and expressions of disquiet related to their presence. 69 Others considered that relatives could aid resuscitation by putting on hold their own feelings and emotions, thus helping PHPs focus on the condition of the patient. 76 77 PHPs and families could provide mutual reassurance following unsuccessful resuscitations, that efforts were not inappropriate.…”

Section: Resultsmentioning

confidence: 99%

Death and dying in prehospital care: what are the experiences and issues for prehospital practitioners, families and bystanders? A scoping review

et al. 2020

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ObjectiveTo identify the factors that shape and characterise experiences of prehospital practitioners (PHPs), families and bystanders in the context of death and dying outside of the hospital environment where PHPs respond.DesignA scoping review using Arksey and O’Malley’s five-stage framework. Papers were analysed using thematic analysis.Data sourcesMEDLINE; Embase; CINAHL; Scopus; Social Sciences Citation Index (Web of Science), ProQuest Dissertations & Theses A&I (Proquest), Health Technology Assessment database; PsycINFO; Grey Literature Report and PapersFirst were searched from January 2000 to May 2019.Eligibility criteria for selecting studiesQualitative and mixed methods studies reporting the experiences of PHPs, families and bystanders of death and dying in prehospital settings as a result of natural causes, trauma, suicide and homicide, >18 years of age, in Europe, USA, Canada, Australia and New Zealand.ResultsSearches identified 15 352 papers of which 51 met the inclusion criteria. The review found substantial evidence of PHP experiences, except call handlers, and papers reporting family and bystander experiences were limited. PHP work was varied and complex, while confident in clinical work, they felt less equipped to deal with the emotion work, especially with an increasing role in palliative and end-of-life care. Families and bystanders reported generally positive experiences but their support needs were rarely explored.ConclusionsTo the best of our knowledge this is the first review that explores the experiences of PHPs, families and bystanders. An important outcome is identifying current gaps in knowledge where further empirical research is needed. The paucity of evidence suggested by this review on call handlers, families and bystanders presents opportunities to investigate their experiences in greater depth. Further research to address the current knowledge gaps will be important to inform future policy and practice.

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“…Nine included studies reported inadequate training and/or a desire for more training in this area (27)(28)(29)(30)(32)(33)(34)36,39,41). Results from qualitative research by Bremer, Dahlberg and Sandman (36) Mainds and Jones (32) and Fernández-Aedo et al (33) all found ambulance personnel participants felt particularly concerned about the skills required to deliver death notification and communicate with family and bystanders. Tataris et al's (27) recent survey of over 2000 Chicago Emergency Medical Service providers showed that 36% of respondents had no training in performing death notification, and only 25% had received training through certification courses.…”

Section: Resultsmentioning

confidence: 99%

“…• Termination of resuscitation guideline derivation, prognostic indicators and survival statistics (30,42) • Local medicolegal issues including documented patient wishes (28,31) Improved self-confidence through rehearsal/role-play and discussion of: • Managing death scenes and bystanders (27)(28)(29)(30)(32)(33)(34)36,39,41) • Death notification delivery and communication with bereaved family (27)(28)(29)(30)33,36,38,39) Identified support needs Access to: • Clear policies or guidelines (36,41) • Informal peer support and opportunities to discuss difficult decisions (33,35,36) • Professional support for occupational or personal stressors (30,42)…”

Section: Identified Preparation Needsmentioning

confidence: 99%

How are Ambulance Personnel Prepared and Supported to Withhold or Terminate Resuscitation and Manage Patient Death in the Field? A Scoping Review

Anderson

Slark

Gott

2019

Australasian Journal of Paramedicine

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IntroductionResearch shows that ambulance personnel can find it challenging to withhold or terminate resuscitation and manage patient death in the field. This scoping review provides a synthesis of published research that has addressed three main questions. Each relates to ambulance personnel enacting decisions to withhold or terminate resuscitation and manage patient death: How are they prepare; what supports and coping strategies are utilised; and what preparation and support needs have been identified?MethodsUsing Arksey and O’Malley’s five-stage scoping review framework this review identifies what is known and what further research is needed in this area.ResultsSixteen methodologically heterogenous papers were located. Half of the studies were conducted in the United States, with the remainder in Canada, Singapore, Spain, Sweden and the United Kingdom. Ambulance personnel receive little formal training and feel unprepared to manage situations where resuscitation is unsuccessful or unwarranted, particularly communicating with family, breaking bad news and managing death scenes. These aspects of termination of resuscitation are so challenging that distancing and avoidance are sometimes used as coping strategies, even when medical futility has been established. In addition to formal counselling for personal loss and stressors, ambulance personnel value downtime and informal peer debriefing, following difficult resuscitation decisions and patient deaths.ConclusionAmbulance personnel feel inadequately prepared to withhold or terminate resuscitation and manage patient death in the field. They want more opportunities to learn about death notification, communication with bereaved families and safe, sensitive management of death scenes. More research is needed to determine how best to prepare and support ambulance personnel for the challenges of resuscitation decision-making and patient death.

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Breaking bad news and managing family during an out-of-hospital cardiac arrest

Abstract: The version presented here may differ from the published version or from the version of the record. Please see the repository URL above for details on accessing the published version and note that access may require a subscription.

Cited by 13 publications

References 28 publications

Paramedic delivery of bad news: a novel dilemma during the COVID-19 crisis

Paramedic delivery of bad news: a novel dilemma during the COVID-19 crisis

Death and dying in prehospital care: what are the experiences and issues for prehospital practitioners, families and bystanders? A scoping review

How are Ambulance Personnel Prepared and Supported to Withhold or Terminate Resuscitation and Manage Patient Death in the Field? A Scoping Review

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