Prompt

A 52-year-old man dies after prolonged resuscitation for out-of-hospital cardiac arrest. His adult daughter is in the relatives' room and does not know the outcome. Outline how you structure the death-notification conversation using SPIKES, the wording you use, the practical next steps (including coronial and donation pathways), and how you debrief the team. (12 marks)

Model answer

Reveal model answerShow

SPIKES^[1]:

Setting: private room, sit, phones silent, tissues, introduce role, confirm relationships.
Perception: "What do you already know about why your father came in?"
Invitation: implicit once family present; allow support person.
Knowledge: warning shot then plain language — "I am sorry to tell you that your father has died" (not "passed").^[2]
Emotion: NURSE statements; silence; do not fill space.
Strategy: viewing body, bereavement leaflet, named contact, timeframe.

Next steps: coronial referral per local protocol if unexpected/violent/post-procedure; decouple organ-donation conversation (treaters declare death; donor coordinator later).^[3] Offer family-witnessed presence principles if resuscitation ongoing in future cases.^[4]

Team: hot debrief immediately; cold debrief later; second-victim support.^[5]

References5Show

[1]Baile WF, Buckman R, et al. SPIKES-A six-step protocol for delivering bad news. The Oncologist, 2000.PMID 10964998
[2]Lei C, et al. Difficult Conversation Case: Death Notification. JETEM, 2025.PMID 41522637
[3]Tocher J, et al. The role of specialist nurses for organ donation: A solution for maximising organ donation rates? J Clin Nurs, 2019.PMID 30549359
[4]Jabre P, et al. Family presence during cardiopulmonary resuscitation. N Engl J Med, 2013.PMID 23484827
[5]Scott SD, et al. The natural history of recovery for the healthcare provider "second victim" after adverse patient events. Qual Saf Health Care, 2009.PMID 19812092

Model answer

Reveal model answerShow

SPIKES^[1]:

Setting: private room, sit, phones silent, tissues, introduce role, confirm relationships.
Perception: "What do you already know about why your father came in?"
Invitation: implicit once family present; allow support person.
Knowledge: warning shot then plain language — "I am sorry to tell you that your father has died" (not "passed").^[2]
Emotion: NURSE statements; silence; do not fill space.
Strategy: viewing body, bereavement leaflet, named contact, timeframe.

Team: hot debrief immediately; cold debrief later; second-victim support.^[5]

References5Show

[1]Baile WF, Buckman R, et al. SPIKES-A six-step protocol for delivering bad news. The Oncologist, 2000.PMID 10964998
[2]Lei C, et al. Difficult Conversation Case: Death Notification. JETEM, 2025.PMID 41522637
[3]Tocher J, et al. The role of specialist nurses for organ donation: A solution for maximising organ donation rates? J Clin Nurs, 2019.PMID 30549359
[4]Jabre P, et al. Family presence during cardiopulmonary resuscitation. N Engl J Med, 2013.PMID 23484827
[5]Scott SD, et al. The natural history of recovery for the healthcare provider "second victim" after adverse patient events. Qual Saf Health Care, 2009.PMID 19812092

Death notification and SPIKES in the ED

Model answer

Death notification and SPIKES in the ED

Model answer