Death Notification: Challenges for Health Care Providers and Other Professionals
Stephen J. Cozza, M.D., Rafael F. Zuleta, B.S., Brian W. Flynn, Ed.D.
April 4, 2020
Although the phrase, death is a part of life, is commonly stated, discussions about death and informing those who are impacted by it remain uncomfortable topics for professionals. How do we tell someone that a death has occurred, especially when it is sudden and unexpected? ISTSS Blog readers are likely to have experiences with death in their personal lives, and possibly in their professional lives. Although it is never easy to be the receiver of such news, it can be especially challenging to notify others when a loved one dies in unexpected or unanticipated circumstances (e.g., automobile accidents, suicides, homicides, mass casualty events). To whom, how, and where this news is delivered will be determined by the circumstances of death, and will likely impact recipients. For example, death notifications resulting from the current COVID-19 outbreak are not likely to occur in-person and may be provided by healthcare providers or other professionals who do not have any existing relationship with family members, complicating its delivery. Despite the frequency of sudden and unexpected deaths in emergency departments and other healthcare settings, there is limited research to inform practical implementation for notification of family members. These questions have prompted researchers at the Center for the Study of Traumatic Stress, Uniformed Services University to develop resources to inform health care providers and other professionals when faced with such circumstances.
Every aspect of the notification process is important for those receiving the news, from the words used during the delivery to the characteristics of the notifier and those being notified, as well as the physical setting where the notification takes place (Soreff, 1979; Von Bloch, 1996). Unexpected deaths resulting from suicides, homicides, accidental deaths, national disasters, or unanticipated medical outcomes increase the risk of PTSD and complicated grief for those bereaved and underscore the need for supportive notifications (Singh & Raphael, 1981; Stewart, 1999). Further complicating the notification process are characteristics of the family member who is notified. Relationship-to-the-deceased (e.g., parent, spouse, sibling), health status, culture/race/ethnicity, and developmental age of the family member (adults versus children or teenagers) must inform notification methods and strategies, the amount of information shared, and the use of language. It is of little wonder, but of great concern, that the uncomfortable task of death notification is often delegated to those health care providers or professionals who are the least equipped and experienced, thus contributing to problematic consequences.
Recently, researchers at the Center for the Study of Traumatic Stress created an informational guide titled Notifying Family Members After Unexpected Deaths: Guidelines for Healthcare Providers that is readily available here on the ISTSS website. The guide is designed to inform the health care community of the importance of death notification, and to provide tips and strategies so that health care providers are better prepared to deliver the notification. These materials have been adapted as an interactive mobile website, allowing easier access via a handheld device, which is available online to view and download on iOS devices: https://www.cstsonline.org/notifying-family-members-after-unexpected-deaths.
Regardless of format, the guide recommends procedures at each stage of the notification process (i.e., preparing for, delivering, and following up after the notification). Also included are recommendations of what to avoid, as well as common mistakes that may worsen the experience for all involved. By providing practical recommendations and potential pitfalls, the guide attempts to lessen the stress felt by both the notifier and the bereaved. ISTSS Blog readers are encouraged to use and share these materials among healthcare providers and other professionals in their communities.
Although these materials were developed for the health care community, the content is relevant to other professionals and situations. For example, they may be helpful to educational institutions, the criminal justice system, and emergency managers, to name a few. Unfortunately, few training opportunities are openly available, and most are several years old (e.g., Hobgood, 2005). However, of the resources that are available, blog readers may want to check out “We Regret to Inform You...” (https://www.deathnotification.psu.edu/we-regret-to-inform-you), an online death notification course created by the FBI and Penn State University (Penn State Public Media, 2015).
Our goal in writing this blog and sharing resources is to stimulate thinking and action among scientists and other stakeholders in areas including, but not limited to:
For many health care providers and professionals, the task of notifying someone that a death has occurred will be required whether prepared or not. Anticipation and preparation benefits all involved. Hopefully, this blog has provided guidance, motivation and thought stimulation, offering reassurance to those who find themselves in the position of providing death notification.
- application in diverse settings and circumstances,
- assurance of cultural competence within training, application, and products,
- adaptation and sharing of knowledge/guidance among a variety of potential notifiers (e.g., faith community),
- development of various knowledge dissemination methodologies (e.g., written material, apps, live/internet based training, etc.),
- advancing research into the relative efficacy of various training/dissemination methodologies.
The opinions and assertions expressed herein are those of the author(s) and do not necessarily reflect the official policy or position of the Uniformed Services University or the Department of Defense.
Hobgood, C. (2005). The educational intervention “GRIEV_ING” improves the death notification skills of residents. Academic Emergency Medicine, 12(4), 296-301. doi: 10.1197/j.aem.2004.12.008
Penn State Public Media (2015). We regret to inform you…. Retrieved from https://deathnotification.psu.edu
Singh, B. & Raphael, B. (1981). Post-disaster morbidity of the bereaved: A possible role for preventive psychiatry? The Journal of Nervous and Mental Disease, 169, 203-212. doi: 10.1097/00005053-198104000-00001
Soreff, S. M. (1979). Sudden death in the emergency department: A comprehensive approach for families, emergency medical technicians, and emergency department staff. Critical Care Medicine, 7(7), 321-323.
Stewart, A. E. (1999). Complicated bereavement and posttraumatic stress disorder following fatal car crashes: Recommendations for death notification practice. Death Studies, 23(4), 289-321. doi: 10.1080/074811899200984
Von Bloch, L. (1996). Breaking the bad news when sudden death occurs. Social Work in Health Care, 23(4), 91-97. doi: 10.1300/J010v23n04_07
Reference Informational Guide
Center for the Study of Traumatic Stress (2019). Notifying family members after unexpected deaths: Guidelines for healthcare providers. Retrieved from: https://www.cstsonline.org/resources/resource-master-list/notifying-family-members-after-unexpected-deaths-guidelines-for-healthcare-providers
Center for the Study of Traumatic Stress (2020). Notifying family members after unexpected deaths. Retrieved from: https://www.cstsonline.org/notifying-family-members-after-unexpected-deaths