‘I am afraid the news is not good’ – Breaking bad news in the time of COVID: Experiences from a field hospital

TL;DR

This paper explores the challenges healthcare workers faced in breaking bad news to families during the pandemic in a South African field hospital.

Contribution

The study highlights communication challenges and lessons learned in a newly formed team dealing with high mortality in a field hospital setting.

Findings

Communication challenges were worsened by illness unpredictability and lack of family visitation.

Digital access and cultural barriers hindered effective communication with families.

Training, teamwork, and palliative care guidelines were identified as critical needs.

Abstract

The COVID-19 Pandemic had profound effects on healthcare systems around the world. In South Africa, field hospitals, such as the Mitchell’s Plain Field Hospital, managed many COVID patients and deaths, largely without family presence. Communicating with families, preparing them for death and breaking bad news was a challenge for all staff.

This study explores the experiences of healthcare professionals working in a COVID-19 field hospital, specifically around having to break the news of death remotely.

A150-bed Mitchells Plain Field Hospital (MPFH) in Cape Town.

A qualitative exploratory design was utilised using a semi-structured interview guide.

Four themes were identified: teamwork, breaking the news of death, communication and lessons learnt. The thread linking the themes was the importance of teamwork, the unpredictability of disease progression in breaking bad news and barriers to effective communication. Key lessons learnt included effective management and leadership. Many families had no access to digital technology and linguo-cultural barriers existed.

We found that in the Mitchell’s Plain Field Hospital, communication challenges were exacerbated by the unpredictability of the illness and the impact of restrictions on families visiting in preparing them for bad news. We identified a need for training using different modalities, the importance of a multidisciplinary team approach and for palliative care guidelines to inform practice.

Breaking the news of death to the family is never easy for healthcare workers. This article unpacks some of the experiences in dealing with an extraordinary number of deaths by a newly formed team in the COVID era.

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