Research by Douglas et al. (2012), in plain language
What’s this study about?
This study looks at what it’s like to deliver bad news about death as a paramedic.
Why did they do this study?
Paramedics often deliver bad news. Many patients die before they make it to hospital, and new rules about when to stop CPR makes it more likely that paramedics will be the ones to deliver bad news about death.
Research shows many health professionals don’t feel prepared to deliver bad news. There’s hardly any research looking at how paramedics deliver bad news about death. The researchers in this study wanted to hear from paramedics about their experiences of delivering bad news about death, and how they cope.
How did they do this study?
The researchers ran focus group interviews with 20 primary care and eight advanced care paramedics in Ontario, Canada. 22 were male and six were female. On average, the primary care paramedics had 8.5 years’ work experience and the advanced care paramedics had 21.5 years’ work experience. They were asked to describe a time when they delivered bad news about death, how the experience affected them, how they dealt with their emotions, the type of support they received and would like to receive.
What did they find in this study?
The paramedics said they knew talking with the family is an important part of their job, especially when a patient dies on the scene. Most said they got barely any training on how to talk to patients and families, including about death, even though it’s one of the hardest things to do.
The paramedics weren’t sure what their role is in terms of delivering bad news about death. Some questioned whether it’s their place to tell someone their dying. One paramedic said her personal views on death probably affect the way she talks to someone who’s dying. Many described feeling helpless, uncomfortable, and awkward when delivering bad news:
“they call you for help, and you’re supposed to help them… I have to break the news to the family that we’re leaving the body there… there’s no easy way of saying that… that’s very hard… very uncomfortable”
Still, the paramedics talked about having rewarding experiences, like times when people show their heartfelt gratitude. One paramedic also talked about the importance of making sure that if the patient dies they die in a dignified way.
The paramedics said delivering bad news in the time before reaching hospital has unique challenges. For example, driving an ambulance is hard enough without distractions and even harder when there’s a crying family in the back who you’re trying to talk to. Another difficult thing is being at a scene where it’s obvious the patient has died, but having to wait for the police with the relatives who don’t yet understand that their loved one is already dead. Sometimes at hospital paramedics are still the ones to deliver bad news, even though it’s no longer their responsibility.
The paramedics talked about how hard it is to quickly shift gears and deal with the emotional side of things after being so focused on the task of trying to save the patient. Showing the right level of empathy when talking with the family, and dealing with their reactions to the bad news, are also very difficult. The emotional side can start from the moment a paramedic takes the call and hears how bad the situation is. The paramedics talked about pushing their emotions to the side as a way to be more focused on the job.
The paramedics use different types of support for coping after delivering bad news. Most is informal. Often, debriefing with colleagues is the first and main way of coping. Distraction is also used as a way to cope:
“sitting on the back of the truck and either tears or just you know got to take a deep breath… do a lap of the hospital… get a coffee… go out with friends after work and have a couple beers and talk about anything but work”
Some paramedics said they avoid talking to their friends and family about their emotions, to keep them “innocent”. If they do, they prefer talking to someone who works in the field too, or has done in the past.
In terms of formal support, the paramedics said their willingness to reach out for help is influenced by the culture in emergency services:
“it’s that boys club, you’re untouchable, you’re too strong, this shouldn’t affect you, when really it does… far more I think than anybody else, because we’re immersed in it”
Because of the stigma, new paramedics are reluctant to ask for help coping. Some explained that they don’t want to look bad in front of their supervisor. Formal systems like peer support teams, staff psychologists, and employee assistance programs might be in place but aren’t always used because they can be stressful and unhelpful. The paramedics described mixed experiences of using formal support. Some remembered times when they felt supported by their managers, while others remembered being told to get back to work.
The paramedics also had mixed thoughts on whether getting support should be something they’re forced to do, or something they can choose to do. One said that how they feel is no one else’s business, and if they were to share they’d share with someone they trust. Others said they would want formal support from properly trained people who are their colleagues or who’ve had similar experiences. The paramedics talked about wanting support to be offered to them straight away after a stressful call. They said downtime after a stressful call helps with decompressing and preparing for the rest of the shift.
What do the findings mean?
Delivering bad news about death is part of a paramedic’s job, but there’s not enough training and support for it. This is needed because talking with the family is one of the most important parts of taking a call. Done properly, it can help reduce their stress and anxiety.
Colleagues are an important source of support for coping with the emotional toll of delivering bad news. Having formal systems in place that are compulsory might also be useful for breaking down the stigma of asking for help. It might be especially helpful for support to come from professionally trained staff with similar experiences.
Where can I learn more?
This blog post is based on the following paper:
Douglas, L., Cheskes, S., Feldman, M., & Ratnapalan, S. (2012). Paramedics' experiences with death notification: a qualitative study. Journal of Paramedic Practice, 4(9), 533-539. doi:10.12968/jpar.2012.4.9.533
You can read the original paper here:
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