Breaking bad news is now an integral part of most healthcare professional training, but it’s important to teach how to do it using different methods, including remotely, say the authors of a study which found that notifying families of deaths during the pandemic was even more difficult because of the isolation and lack of training.
The clinical unpredictability and sudden death of Covid patients not only left the medical profession wracked with anguish, and fear of their own demise, but restrictions in movement and the need for social distancing resulted in poor relationships between healthcare workers and patients’ families, said the University of Cape Town researchers.
Frequently, medics would take flak from grief-stricken families, who often blamed them for the death of their loved ones.
TimesLIVE reports that healthcare workers at the Mitchells Plain Covid-19 field hospital – who took part in the study – said for patients and families, the time of separation was particularly difficult as they were not able to visit sick and dying relatives or communicate with them.
As a result, accepting death became difficult for families. The unpredictability of Covid-19 also meant staff were sometimes caught off-guard by sudden deaths and did not always prepare families for the sad news.
That patients were in a field hospital, where they were not severely ill, and were likely to recover or were no longer on ventilators or receiving critical care, gave many hope that their loved ones were doing well.
Healthcare workers were freqently conflicted over what to tell them because they were unsure about the disease progression and prognosis. Concern about creating false hope for families made them careful with their words.
“Changes in patients’ condition were often rapid and unexpected. The condition of patients prepared for discharge could unpredictably deteriorate and they could die within hours. You could be talking to the patient now, and then when you came back … all of a sudden, this patient now is (gone).
“That made it difficult for us and for the family because you’d already told them the patient was doing well,” said one of the study participants.
“We never had formal training on how to break bad news over the phone,” another medic said.
Families reacted differently when told over the phone about the death of a relative. Often their initial reaction was anger and blaming the hospital staff for doing something wrong or not telling them earlier about the gravity of the situation.
“I don’t think people have been trained enough to know how to deal with those situations,” said another medic.
Healthcare workers found many patients were dealing not only with their own illness and fears but were also worried about their families at home.
While digital communication in the form of audio and video calls between patients and families was later made possible, this was not without challenges. Only a minority of patients had phones or data, and many depended on staff to help them connect and keep their families informed about their condition.
The success of video-conferencing also depended largely on people possessing smartphones with video capacity and data, which was difficult for many.
Writing in the African Journal of Primary Healthcare and Family Medicine, lead author Dr Charmaine Cunningham said one of the lessons from the study was the importance of transparent communication between medics and families.
“Early, transparent communication with families, and understanding that they suffer psychological distress when receiving incomplete information, is key. Under the circumstances of the pandemic, there were not enough resources to schedule daily communications with all families. This was not a task that could be delegated to volunteers or lay-carers,” she said.
“Healthcare providers planning for future pandemics can learn not only from the dynamic multidisciplinary team but also mainstreaming regular, high-quality communication with families.”
Study details
I am afraid the news is not good’ – Breaking bad news in the time of COVID: Experiences from a field hospital
Charmaine Cunningham, Pat Mayers, Janet Giddy, Magdaleen de Swardt, Peter Hodkinson
Published in African Journal of Primary Health Care & Family Medicine on 23 February 2024
Background
The Covid-19 pandemic had profound effects on healthcare systems around the world. In South Africa, field hospitals, such as the Mitchell’s Plain Field Hospital, managed many Covid patients and deaths, largely without family presence. Communicating with families, preparing them for death and breaking bad news was a challenge for all staff.
Aim
This study explores the experiences of healthcare professionals working in a Covid-19 field hospital, specifically around having to break the news of death remotely.
Setting
A 150-bed Mitchells Plain Field Hospital (MPFH) in Cape Town.
Methods
A qualitative exploratory design was utilised using a semi-structured interview guide.
Results
Four themes were identified: teamwork, breaking the news of death, communication and lessons learnt. The thread linking the themes was the importance of teamwork, the unpredictability of disease progression in breaking bad news and barriers to effective communication. Key lessons learnt included effective management and leadership. Many families had no access to digital technology and linguo-cultural barriers existed.
Conclusion
We found that in the Mitchell’s Plain Field Hospital, communication challenges were exacerbated by the unpredictability of the illness and the impact of restrictions on families visiting in preparing them for bad news. We identified a need for training using different modalities, the importance of a multidisciplinary team approach and for palliative care guidelines to inform practice.
Contribution
Breaking the news of death to the family is never easy for healthcare workers. This article unpacks some of the experiences in dealing with an extraordinary number of deaths by a newly formed team in the COVID era.
See more from MedicalBrief archives:
Western Cape COVID-19 field hospital receives its first patients
The real State of Disaster is SA’s new Covid regulations – Scientists’ Collective
Lockdown must go or else non-coronavirus mortality will outstrip COVID-19 deaths