• J Pain Symptom Manage · Feb 2018

    Randomized Controlled Trial

    Which physicians' behaviors on death pronouncement affect family-perceived physician compassion? A randomized, scripted, video-vignette study.

    • Masanori Mori, Maiko Fujimori, Jun Hamano, Akemi S Naito, and Tatsuya Morita.
    • Palliative Care Team, Seirei Mikatahara General Hospital, Hamamatsu, Shizuoka, Japan. Electronic address: masanori.mori@sis.seirei.or.jp.
    • J Pain Symptom Manage. 2018 Feb 1; 55 (2): 189-197.e4.

    ContextAlthough the death of a loved one is a devastating family event, little is known about which behaviors positively affect families' perceptions on death pronouncements.ObjectivesThe objective of this study was to evaluate the effect of a compassionate death pronouncement on participant-perceived physician compassion, trust in physicians, and emotions.MethodsIn this randomized, video-vignette study, 92 people (≥50 years) in Tokyo metropolitan area viewed two videos of death pronouncements by an on-call physician with or without compassion-enhanced behaviors, including five components: waiting until the families calm themselves down, explaining that the physician has received a sign-out about information of the patient's condition, performing examination respectfully, ascertaining the time of death with a wristwatch (vs. smartphone), and reassuring the families that the patient did not experience pain. Main outcomes were physician compassion score, trust in physician, and emotions.ResultsAfter viewing the video with compassion-enhanced behaviors compared with the video without them, participants assigned significantly lower compassion scores (reflecting higher physician compassion) (mean 26.2 vs. 36.4, F = 33.1, P < 0.001); higher trust in physician (5.10 vs. 3.00, F = 39.7, P < 0.001); and lower scores for anger (2.49 vs. 3.78, F = 18.0, P < 0.001), sadness (3.42 vs. 3.85, F = 11.8, P = 0.001), fear (1.93 vs. 2.55, F = 15.8, P < 0.001), and disgust (2.45 vs. 3.71, F = 19.4, P < 0.001).ConclusionTo convey compassion on death pronouncement, we recommend that physicians initiate prompt examination, explain that the physician has received a sign-out, perform examination respectfully, ascertain the time of death with a wristwatch, and reassure the families that the patient did not experience pain.Copyright © 2017 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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