Family reaction to bad news can influence organ donation

Newswise — Dr. Bradley Harrold remembers the first time he had to deliver bad news to a family.

“It was traumatic for everyone involved and it never gets easier -- ever,” said Harrold, a fellow in pulmonary and critical care medicine.

Medical schools traditionally haven’t devoted much time to teaching students how to communicate bad news to patients or their families, particularly news about brain death.

While less than 5 percent of all patients die by brain death criteria, it is this same population of patients that comprises the largest group of potential organ donors. With more than 90,000 patients waiting for a solid organ transplant, a clear explanation about brain death is an important first step before families can begin considering the option of organ donation.

“If interactions between doctors and families about brain death are uncomfortable or incomplete, any future discussions about organ donation can be impeded,” says June Hinkle, who works with the families of critically ill or injured patients at The Ohio State University Medical Center.

To help doctors develop confidence when speaking with families about brain death, Hinkle has helped create a training program to improve how physicians and transplant professionals address the topic with families.

“If doctors don’t provide enough information during their initial conversations with families about brain death, or if they move quickly through the dialogue in an effort to get out of the room as fast as possible, the family can’t process the information and mentally prepare to make other critical decisions in the hours or days to come,” said Hinkle.

Brain death is the irreversible loss of all brain function. “It’s a difficult concept for the family to understand,” says Hinkle. “Their loved one is still warm and pink, but the brain function is permanently gone.”

The training at Ohio State takes place in a high-tech educational laboratory at the medical center, complete with dozens of mock exam rooms equipped with cameras and panes of one-way viewing glass. Paid actors play the roles of family members who are about to learn for the first time that a loved one has suffered brain death.

Hinkle said the interactions are very realistic, right down to the tears and the emotions that one would expect to encounter when bad news is delivered. At the end of each 10-15 minute scenario -- after the doctor has left the room -- the “family” completes an evaluation form. Everything from the doctor’s composure and knowledge about brain death to any distracting mannerisms are noted. The data also is used by preceptors to coach the physicians.

“We teach doctors to look for certain behavioral cues that may signal a person’s lack of understanding about brain death and to use words that are clear and concise,” said Hinkle. “Only after the family hears the prognosis in a clear and meaningful way can they begin making important end of life decisions, which could include organ donation.”

The family may later be approached by a transplant coordinator about organ donation, but if family members are confused by the earlier conversation about brain death, the discussion about organ donation may be perceived as awkward or ill-timed. “It’s not a positive transition for the family,” added Hinkle.

The training program was developed by Ohio State and Lifeline of Ohio with support from a grant by the Ohio Department of Health Second Chance Trust Fund. Lifeline is a federally-designated organ procurement organization serving central and southeastern Ohio. This is the first year for the program at Ohio State, but already Hinkle said organizers are seeing a positive reaction from the medical residents. If successful, the program may be made available to other physicians and hospitals.