Viewpoint: How physicians can compassionately pronounce patient's death

Although a physician's pronouncement of a patient's death often carries tremendous impact for a patient's family during end-of-life care, these moments are often impersonal, Betty Ferrell, PhD, RN, argues in a Medscape opinion piece.

"The realities of hospitals often mean that the death pronouncement happens at times when only an on-call physician is present, a person who is often unknown to the family and who has never met the patient," Dr. Ferrell wrote.

Dr. Ferrell cited a recent study, which compared reactions to two video clips showing death pronouncements. The video clips displayed a terminally ill man in his 70s with a chronic, incurable illness who was expected to die. His wife, son and daughter were shown at his bedside.

One version of the video clip showed a standard, business-like death pronouncement, while the other showed a death pronouncement with five behaviors meant to convey compassion. These behaviors included waiting until the family members calmed down, explaining the physician received a sign-out of information about the patient's condition, performing a respectful examination of the patient, ascertaining the patient's time of death with a wristwatch as opposed to a smartphone and reassuring families the patient did not experience pain.

The outcomes of the study included a physician compassion score, trust in the physician and viewer emotions — such as sadness, fear, anger or disgust. The study found the video with a more compassionate death pronouncement was linked to positive outcomes in all of these areas.

Dr. Ferrell suggests replicating this study in other countries to see whether these compassion behaviors can be generalized and whether the perceptions of the families witnessing the death pronouncements are also comparable.

"[The study] also demonstrates that clinician behaviors have lasting impact and that the time of death should promote healing and comfort, [which are] often not the norm," Dr. Ferrell wrote. "The compassionate behaviors are simple in some respects yet profound in others."

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