How doctors should give bad news to family members of patients

You are at home quietly and suddenly they call the phone. It is from the service of intensive hospital medicine (ICU) and ask for him family of a patient what has enteror there. They have one bad news to give you, but for ethics they won't do it if it's not in person.

It is possible that your brother, your partner or someone very close has suffered a fatal accident and the health personnel I should communicate that potentially traumatic event (any information that drastically alters your expectations about your future) as soon as possible. But as incredible as it sounds, in general, there are no expert psychologists in crisis intervention in this type of units in our country. Anecdotally, some type of sick is covered by some associations, but it is something residual. It is the medicine service of the 12 de Octubre University Hospital, the pioneer in promoting and valuing the work of these professionals in such a complex service.

Evidently, death is inevitable, but when these events occur they should be enabled communication protocols and treatment where transparency, humanity and empathy with family members of patients prevail. Oddly enough, in Spain there is no official one, although last April, at the International Congress of Humanization of Healthcare held at the Hospital La Fe in Valencia, a pioneering proposal was presented.

So, Jesús Linares Martín, an expert psychologist in emergency contexts, covered by the intensive medicine service of October 12, the HUCI project and the European University of Madrid, presented the communication protocol in Intensive Care units. Though has not been implanted yet, this will facilitate in this service the arduous task of communicating this type of news in the contexts where illness and pain are continuously breathed.

Consequences

When a healthcare professional does not know how to express this information correctly, it is very possible that the recipients suffer more, be confused, misinterpret the data, get angry, hostile reactions and confrontations occur or suffer from anxiety-depressive symptoms. Do youWhy is it so necessary? this protocol? It will increase the probability of diagnostic acceptance, will be protected from adverse psychological results, satisfaction on both sides and certainty in treatments will increase, resilience will be promoted and will improve the perceived self-efficacy of the professional and the rehabilitation of the patient and the family.

The message must be clear, concise, without technicalities and adapted to the language on foot. In addition to establishing a trust bond

Which are the most common mistakes? Not giving importance to the place and moment where it occurs, presuppose that the other person knows, give false hopes or grant more seriousness, assume that it is understood or overinform, use many technicalities or make great detours, use words with high emotional content or exclude the patient himself when talking with the family. In addition, feelings may be avoided, there are awkward silences and not adequate or the news is communicated without the support of other health professionals.

Protocol. (Hospital October 12)

What should be the suitable forms? Broadly speaking, the main thing is to be prepared: necessary documents, be aware of the status, evolution and prognosis, know who will transmit the information, look for a partner to accompany you (the nursing staff is the perfect ally, because they spend many hours with patients), look for some private site and cozy, at the foot of the bed or in the hallway, where there are no noises and distractions.

The first is the presentation: the toilet must identify and announce your position and ask the family member's name, always establishing eye contact. The professional must be close, refer to family members and the patient by their first names, ask what they know or need to know, what worries them, not take anything for granted Y flee from paternalism.

The support is essential

The message must be clear, concise, without technicalities and adapted to common language. Establishing a bond of trust, being empathetic, keeping an active listener, not positioning oneself by default in a bad outcome are keys to everything going well. The doctors they should make small breaks to give opportunity to ask, clarify and summarize, avoid interruptions and concentrate, respect religious and cultural beliefs, clarify doubts and show a nonverbal communication that shows interest.

Although not yet implemented, this protocol will facilitate the arduous task of communicating this type of bad news in this service.

To communicate this potentially traumatic event, the idea of ​​the team decisionmake a story that summarizes the situation, do not get around rodeos or euphemisms and summarize and explain what will happen From now on, showing everyone's commitment.

It is no accident that this kind of initiatives appears in the intensive medicine service of the 12 de Octubre University Hospital, as it is recognized, in addition to its high technological level and professional elite, for its insistence on the humanization of its assistance and special concern for the families that live there, probably one of the most difficult moments of his life.

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