Breaking bad news to families is a vital part of training for most healthcare workers, but when the Covid-19 pandemic broke out a few years ago, breaking the news of death to families became even more difficult due to the isolation the pandemic created that made it impossible for patients to have visits or close contact with their loved ones.
According to a new study by the University of Cape Town (UCT), the clinical unpredictability and sudden death of Covid-19 patients not only left healthcare workers with anguish and fear of their own demise but restrictions in movement and the need for social distancing resulted in poor relationships between medics and patients’ families.
The poor human relations often resulted in medics taking a lot of criticism from grief-stricken families, who often blamed them for the death of their loved ones.
While the pandemic made online interactions a norm for many, healthcare workers who worked 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 as they had not seen their relatives for a long time after admission. The unpredictability of Covid-19 meant healthcare workers were sometimes caught off-guard by sudden deaths and therefore did not always prepare families for the sad news.
That patients were in a field hospital, where they were not severely ill and 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 often conflicted over what to tell the family because they were unsure about the disease progression and prognosis. Concern about creating false hope for the family 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 come back ... all of a sudden, this patient now is [gone].
“That made it difficult for us and for the family because you’ve already told the family, 'No, she’s doing well.' You’re about to send her home, we just waited for this [or that] and then suddenly they deteriorate and they die,” said one of the study participants.
Healthcare providers planning for future pandemics can learn not only from the dynamic multidisciplinary team but also mainstreaming regular, high-quality communication with families
— Dr Charmaine Cunningham
Breaking bad news remotely was particularly difficult for healthcare workers, who felt unprepared.
“We never had formal training on how to break bad news over the phone,” a medic said.
Families reacted in different ways when told over the phone about the death of their loved one. 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 think that was for me the hardest ... to not always be sure what their response is going to be. We like to know what to expect,” said another participant.
Non-verbal cues and responses were missing in the interaction between medics and families.
“It’s difficult because you don’t have the rapport you normally have when you’ve got the family in front of you. You can’t see their reactions ... you don’t know how they are perceiving what you’re saying. The phone lines weren’t always that great, either.”
Healthcare workers felt unprepared for dealing with dying patients but especially in dealing with their families and breaking the news over the phone.
“I don’t think people have been trained enough to know how to deal with those situations,” said another medic in the study interview.
Healthcare workers found many patients were dealing not only with their own illness and fears but were also worried about their family at home. Sometimes patients were dealing with the death of other family members and had to cope with their own grieving while being isolated from their support network.
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 to be able to communicate regularly with their loved ones. Many were dependent on staff to help them connect and keep their families informed about their condition.
The success of videoconferencing also depended largely on family members’ 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 noted one of the lessons from the study is 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.
“Though breaking bad news is now an integral part of most healthcare professional training, it is necessary to teach how to do it using different methods, including remotely. Healthcare providers planning for future pandemics can learn not only from the dynamic multidisciplinary team but also mainstreaming regular, high-quality communication with families.”
Would you like to comment on this article?
Sign up (it's quick and free) or sign in now.
Please read our Comment Policy before commenting.