Telling survivors of a motor vehicle collision (MVC) that someone else has died in that incident is a sensitive undertaking for health professionals. The paper highlights that there is no consensus in the literature as to the best timing to deliver this potentially upsetting news, or even whether it should happen at all in the early stages of the survivors’ management and treatment, especially if they do not ask for this information.
This study set out to examine the views of survivors of severe MVCs to try and find out more about their preferences as to when and where they would like to find out about any fatalities involved in the incident.
Between May and August 2010, patients who had been involved in a MVC between 2005 and 2009 in Ohio were approached to participate in a telephone survey. Participants were identified by using the University of Toledo Medical Center’s (Level 1 Trauma Centre) Institutional Trauma Registry Database.
People were excluded if they were under 18 years old; if there had been no death associated to the MVC; if they did not speak English; if they were in prison at the time of the survey, or if they were deemed not to have the mental capacity required to participate. In total, 51 people were invited to participate but only 26 people were available for contact due to inaccurate addresses and disconnected phones, for example. Of these, 21 people consented to participate.
The telephone interview comprised of 30 questions and focused on the patients’ communications with doctors and nurses, although the results also make reference to pre-hospital personnel and other emergency services. The questions asked about a variety of issues including the quality and quantity of information delivered by hospital staff, their levels of compassion, and the location and timing of death notification.
The study generated both quantitative and qualitative data although it is not completely clear how the qualitative data were analysed. Of the participants, 10 were female and 11 were male and their relationship to the deceased is identified as spouse (n=5); child (n=1); friend (n=5); significant other (n=2); no relationship (n=8).
Three people were told about the death at the scene; nine in the emergency department; and nine after they had been admitted as an inpatient. A variety of people informed the survivors about the deaths: family member (n=9); friend (n=2); pre-hospital staff (n=2); police (n=2); fireman (n=1); indirect communication such as overhearing a conversation (n=3) or unsure/cannot remember (n=2).
A majority of people (n=15) had to ask about the outcome of other people involved in the incident and 11 people believed they were given insufficient information about the status of other people in the MVC (four people were unsure about this); however most participants (n=17) considered that the hospital staff had given them adequate information about their own condition.
Participants expressed different opinions as to when would be the best time to tell people about fatalities: immediately (n=5); in the emergency department (n=5); in the inpatient setting (n=6); depends on circumstances (n=5). There was no significant association between the relationship to the deceased and recommended time of notification (P=0.59).
The authors recognise some limitations of the study including the small sample taken from one institution&— also the fact that the results are reliant on recall, in some cases of an event that had occurred several years earlier. Interestingly, there is no discussion of the challenges of using a structured telephone interview to examine a topic area that is personal and potentially highly sensitive for the participant.
Though an interesting preliminary study, it would have been useful to have had more detailed information about the qualitative data in order to provide a richer insight into this phenomenon. Clearly, this area would benefit from further research to increase our knowledge and understanding of the management of appropriate timing and settings for death notification in these circumstances.