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

Abstract

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.

The “CONNECT” Protocol: Delivering Bad News by Phone or Video Call

“…Dying in solitude has become a rule, and so has the experience of facing the death of a close person without the ability to say goodbye in a face-to-face encounter. 26 This new situation has triggered the need to develop solutions and support mechanisms involving novel forms for the delivery of bad news so as to normalize the processes of mourning. 26 , 27 …”

“… 26 This new situation has triggered the need to develop solutions and support mechanisms involving novel forms for the delivery of bad news so as to normalize the processes of mourning. 26 , 27 …”

Bedeutung der Einfluss- und protektiven Faktoren bei der psychischen Belastung von medizinischem Personal in Zeiten der SARS-CoV-2-Pandemie

“…Es erfolgen Verlegungsfahrten von Coronapatienten in ein weiterbetreuendes Krankenhaus oder es bestehen längere Einsatzzeiten durch verlängerte Strecken zur Zielklinik, da das regionale Krankenhaus "coronabedingt" nicht aufnehmen kann. Ein weiteres Problem besteht darin, dass in vielen Fällen der notfallmäßigen Krankenhauseinlieferungen durch den Rettungsdienst die Angehörigen zunächst zu Hause bleiben müssen, während der kritisch kranke Patient ins Krankenhaus transportiert wird [32] [35]. Dabei bieten psychologische Interventionen Möglichkeiten, den sozialen Rückhalt sowie die Selbstwirksamkeit zu fördern.…”

Comunicació de males notícies en context sanitari

“…És habitual l'ús d'eufemismes o fórmules per vestir amb paraules amables notícies desagradables per suavitzar la gravetat de la situació i mitigar el dolor (Campbell, 2021;Caswell et al, 2015;De Moura Villela et al, 2020;DeForest, 2019;Dos Santos et al, 2021;Kelley, Morrison, 2015;Maynard, 2017;Sanders, 2015;VandeKieft, 2001). Aquests missatges o la manera de transmetre'ls poden despertar rebuig o, fins i tot, augmentar l'agressivitat.…”

“…El paternalisme mèdic clàssic, present també avui, es fonamentava en el reconeixement clínic i la resolució de problemes mèdics, un patró relacional asimètric en el qual el metge assumia tota la responsabilitat i prenia les decisions del pacient segons els principis de beneficència i no maleficència (Consuegra et al, 2020). En aquest context, era freqüent ocultar informació clínica potencialment dolorosa a la persona malalta (Oken, 1961), limitar-la o maquillar-la amb eufemismes per tal d'evitar el patiment dels pacients i familiars (Campbell, 2021;Caswell et al, 2015;De Moura Villela et al, 2020;DeForest, 2019;Dos Santos et al, 2021;Kelley & Morrison, 2015;Maynard, 2017;Sanders, 2015;VandeKieft, 2001).…”