Center for the Study of Traumatic Stress
CSTS | Department of Psychiatry | Uniformed Services University | 4301 Jones Bridge Road, Bethesda, MD 20814-4799 | www.CSTSonline.org

Notifying Family Members After Unexpected
Deaths: Guidelines for Healthcare Providers
Although death is not a rare eventthe deceased suffered before death.
Although death is not a rare event within
within healthcare settings, healthcare
Healthcare providers cannot lessen theproviders receive little to no training
loss of a loved one, but they can provide
healthcare settings, healthcare providers
on how to notify family members thatfamily members with clear, concise, andreceive little to no training on how to notify
their loved one has died. The task can beaccurate information about the death,stressful for the the family, as well as theand access to helpful resources, in a
family members that their loved
provider, and the quality of the delivery
way that is professionally responsible,
one has died.
of information can impact the healthempathic, and culturally sensitive. The
and well-being of the bereaved family.
scope of responsibilities for health care
While the circumstances of death canproviders regarding death notificationvary widely, notifying family members after an unexpected deathis likely to vary depending upon the situation, the institution(e.g., accidents, suicides, homicides, medical mishaps, disasters,
in which they work, and the availability of ancillary resources
and terrorism) can be particularly challenging. Such deaths willthat share in the death notification process. Below are important
likely be shocking to the family and even more stressful if theguidelines that review the range of responsibilities that healthdeceased was a child, the death was violent or disfiguring, orcare providers should recognize.

PREPARE
Gather information and prepare yourself■ Review the circumstances of death (what is known and notknown)■ Identify the next of kin and their contact information■ Identify age, gender, names, and special needs of familymembers■ Be aware of relationships within the family (either healthy orproblematic) that might affect communication■ Anticipate questions, prepare, and rehearse answers
x What was the cause of death?
x Did my loved one suffer?
x Are you sure? Is there some mistake?
x When can I see my loved one?
■ Dress professionally, e.g., remove or cover any soiled clothing,such as surgical gown
■ Shift from clinical objectivity to empathic sensitivity
Engage other support■ Chaplains can offer spiritual support■ Social Workers can identify therapeutic resources and assist
with planning (i.e., funeral services)■ Interpreters can overcome language barriers■ Support organizations (e.g., Compassion Friends, the Dougy
Center, and Tragedy Assistance Program for Survivors) areavailable for family members who have suffered similar losses
Collaborate with other stakeholders■ Hospital leadership will likely be involved in cases of medical
error, suicide, and emergency room deaths■ Hospital Public Relations personnel should be engaged if

media is involved in reporting about the death■ Law enforcement or fire department may be present if death

was part of a crime, fire, accident, or mass fatality event

Manage the notification setting■ Respect the privacy of the family■ Death notifications are best conducted in person. Ask family
members to come to the hospital: It is important that youcome to the hospital regarding your brother. Is there a friend or
family member who can drive you?
■ Meet in a private room, not in a hallway or waiting room.
■ Ensure everyone is seated, including the notifier■ Certain factors such as distance to the hospital, time of day,weather, or age/functional status of the next of kin may
necessitate a notification be done over the phone. If so:
x Advise they may want to find a quiet place, withoutchildren or distractions to take this callx Ask if there is a support person available
x Ensure they are seatedx Warn that they are about to receive bad news
DELIVER THE NEWSNotify the family■ Identify and introduce yourself, especially if you did not havea prior relationship with the family■ Identify the next of kin and their relationship to the patient■ Quickly set the tone: I am sorry, but I have bad news.
■ Use, non-technical, easy to understand language because
cognition declines under stress, for example:

xMr. S’s heart stopped beating this morning. We attempted
to restart it but were not successful. I am so sorry, he has
died.
x Your brother was brought to the emergency room after aserious accident. Despite attempts to save him, he died.
■ Next of kin may not remember everything you say. Aim
for no more than 3 brief points and be prepared to repeat
information. As appropriate, put information in writing forthe family.
■ Be clear about what is known, as well as what is not known
Additional important conversations■ If appropriate, offer the opportunity to view the deceased
x Clean and prepare the body prior to viewing (e.g.,remove blood, emesis, and medical equipment)
x Prepare the family for what they will see, especially if
the body is disfigured. Remove medical appliances (e.g.,intubation tubes)■ Discuss deceased’s wishes for organ donation whenappropriate■ Discuss autopsy (if family requests or if required by lawenforcement)■ Assist the family in working with hospital personnel thatassist with decedent affairs■ Advise the family how and when to discuss the death withvulnerable family members (e.g., children and special needs
family members)
Be prepared for the family’s reactions■ Next of kin’s initial responses may include numbness, shock,or disbelief, which then may result in:x Denial
x Anger or Bitterness
x Blamex Sadnessx Guilt■ Avoid interpreting or being critical of family members’emotional reactions, or becoming defensive based upon what
they might say■ It may be appropriate to touch or hug the next of kin, but bealert to their comfort or discomfort, and respectful of culture,age, and gender■ Allow the next of kin time to absorb this information in thesafe setting of the private room
Respect culture, race, and ethnicity■ Consider families that may come from a backgrounddifferent than your own■ Deliver information in a way that all families can understand■ Be prepared for questions that indicate unique cultural
perspectives, for example:
x Does the way he died mean he is not going to heaven?
■ Respect displays of emotion that may be culturally unique■ Educate health care providers in cultural awareness as part ofdeath notification training
Follow up■ Answer questions. If you do not know the answer, provide atimeframe in which you will get back to them. Don’t be afraid
to say, “I don’t know.”■ Provide contact and other important information in writing

because details given under stress are likely to be forgotten■ Identify an alternate professional point of contact for thefamily if you go off shift before they leave the hospital■ Evaluate the notification, correct mistakes, and share what

you learned about the process with others

Consider special circumstances■ Death notification may be challenging during mass fatality
events due to limited resources, and special planning istypically required■ Since suicide may be determined after autopsy orinvestigation, it is best to describe the event based on causeof death (e.g., gunshot wound) rather than intention (e.g.,suicide vs. accident)■ Developing competence in death notification requires that
we teach it within the healthcare profession. Allow rotating
medical students to observe death notifications, but never
expect untrained individuals to conduct notifications
independently
AVOID PITFALLS — DON’T…

■ Discount the magnitude of the loss if the patient is old,

terminally ill, or if the death was medically expected■ Assume ANY death is “expected” by family members■ Use euphemisms for death (e.g., ‘passed away’ or ‘no longerwith us’) that can cause confusion■ Postpone the notification■ Speculate about information if you are uncertain■ Place blame on the deceased or other people or organizations

or become defensive■ Refer to the deceased as “the body” or “it” (use their nameinstead)■ Offer false reassurances■ Rush the family to leave their loved one- most will view thebody for about 15 minutes.

■ Bring patient’s personal belongings with you to the initial

notification■ Discuss death-related administrative matters at the initial

notification

ADDITIONAL RESOURCESGRIEV_ING
https://www.mededportal.org/publication/8210/
The educational intervention GRIEV_ING is targeted atEmergency Medicine physicians but can be adapted for otheraudiences to improve death notification delivery.
We Regret to Inform You…
https://deathnotification.psu.edu/
Death notification training program developed by the FBIand Pennsylvania State University for Law Enforcement“In Person, In Time”
https://irp-cdn.multiscreensite.com/ac5c0731/files/uploaded/
in_person.pdf
Recommended procedures for death notification