Death Pronouncements: Using the Teachable Moment in End-of-Life Care Residency Training

Abstract

The death pronouncement workshop serves to prepare residents emotionally to deal with dying patients and provides them the skills to effectively and compassionately communicate with those patients' families while addressing all six ACGME core competencies.

Which Physicians' Behaviors on Death Pronouncement Affect Family-Perceived Physician Compassion? A Randomized, Scripted, Video-Vignette Study

“…In our study, the majority of participants were bereaved family members. Previous studies recommended optimal methods of death pronouncement essentially based on anecdotal evidence, 2,9 interviews, 6 surveys, 11,18 and educational interventions to clinicians, 7,8,16 but empirical studies to explore the effects of death pronouncements on family perceptions were lacking. In particular, performing examination respectfully and reassuring the families that the patient did not experience pain led to the perception of higher levels of physician compassion.…”

“…However, death pronouncements are often relegated to junior or on-call physicians who have little training on this matter or no long-term relationship with the patients and families. 2,7 Several educational interventions and recommendations have been developed to promote compassionate death pronouncements based on anecdotal evidence and surveys among bereaved families. 1,2,6e11 Previous studies have explored the feasibility and efficacy of such educational interventions for physicians' self-assessed confidence and competency.…”

“…1,2,6e11 Previous studies have explored the feasibility and efficacy of such educational interventions for physicians' self-assessed confidence and competency. 1,7,8 Yet, little is known about the compassionate behaviors that positively affect families' perceptions on death pronouncements. This lack of evidence hinders the development of effective educational interventions in medicine.…”

Communication with Families in the Last Days of a Patient’s Life and Optimal Delivery of a Death Pronouncement

“…Marc et al reported that one and a half lectures regarding the death pronouncement improved the skills of resident physicians who attended an ACLS course [59]. Lucille Marchand et al reported on outcomes derived from a workshop based on six essential competencies (patient care, medical knowledge, practice-based learning and improvement, systems-based practice, professionalism, and interpersonal skills communication) proposed by the Accreditation Council for Graduate Medical Education's Outcome Project [60]. This workshop provided the opportunities to learn poetry, prose, and narratives on delivering death pronouncements by senior residents; reviews and discussion of protocols for death pronouncement, autopsy, and organ donation; and a roleplay of a death pronouncement with the opportunity for reflection [60].…”

Arts-based palliative care training, education and staff development: A scoping review

“…tions, the audience would work together as an active audience to shape the trajectory of the interventions at various stages of the drama 75,76 and/or contribute to post-event debriefing and discussion. 59,77 How the intervention was perceived/ experienced (by those taking part)…”