Introduction    In Part I (Fast Fact # 76), the basic steps and precautions of telephone notication of death were outlined.  This Fast Fact discusses the dilemma of whether to provide telephone information versus asking family members to first come to hospital before telling them that death has occurred.  

Delay vs. Disclose Immediately     Few would disagree that it is always preferable to present death notification in person.  However, when families live at a great distance, or are physically unable to travel, telephone discussion will be necessary.  In other situations, clinicians must weigh the benefits of truthfulness against the risk of potential harm resulting from abrupt disclosure of the bad news.  Factors to consider in making this decision include:

• Whether death was expected or not, including the nature and chronicity of the illness.
• How well the death notifier knows the patient and the patient’s family.
• The relationship of the contact person to the patient.
• The anticipated emotional reaction of the contact person based on prior information.
• Whether the contact person will be alone when receiving the information
• The contact person’s level of understanding.
• Distance, availability of transport, and time of day.

For example, when death is expected due to progressive cancer and the notifier knows both the patient and the contact person, telephone notification is very acceptable.  In fact, you should have prepared for this moment ahead of time by asking the contact how he or she wishes to be contacted at the time of death.  In contrast, if the death is sudden, especially of a minor, notification in person is always preferred, although time and distance issues may make this impractical.

The notifier must be prepared to quickly integrate all these factors to decide whether to reveal that the patient is dead, or whether to describe the patient as gravely ill and request that the contact person come to the hospital immediately. If you decide to delay disclosure of the death, be prepared to make immediate admission of such nondisclosure as soon as you meet the family (e.g. I’m sorry for not telling you the whole thing right away over the phone;  then give your reason for doing so).

Responding to Emotions      Whether in person or by telephone, you should expect an emotional reaction to the death notification (see Fast Fact #29).  Responding to emotions via telephone is especially difficult.  Some tips include:

• Ensure that the contact has someone else with them.  Offer to contact family members, friends, clergy or others.
• Offer to meet with the contact in person.
• Contact your hospital social worker for advice on contacting other local resources such as the Red Cross, local police, or other service agencies.

References:

1.Iserson KV. The gravest words: sudden-death notification and emergency care.  Ann Emerg Med. 2000; 36:75-77.

2.Iserson KV. The gravest words: notifying survivors about sudden, unexpected deaths. Resident and Staff Physician. 2001; 47:66-72.

Version History:  This Fast Fact was originally edited by David E Weissman MD. 2nd Edition published October 2006; 3rd Edition June 2015. Current version re-copy-edited April 2009; then again June 2015.