An Assessment of Prehospital Provider Education and Sequelae Around the Experience of Breaking Bad News

Objectives Emergency Medical Services clinicians are often tasked with the delivery of bad news including making death notifications and informing loved ones about the termination of resuscitations. Existing trainings for breaking bad news are based around palliative care conversations in dramatically different clinic or hospital settings. We hypothesize that pre-hospital clinicians are not receiving formal training in the skill of breaking bad news and the delivery of bad news can have harmful mental health repercussions. The goals of this study were to: determine if prehospital clinicians are receiving training on delivering bad news, how frequently they are doing so and to explore negative consequences potentially arising from these experiences. Methods We conducted an electronic, cross-sectional survey of U.S. EMS clinicians. Items assess EMS clinicians’ experiences around training related to breaking bad news, frequency of delivering bad news, and experiences of mental health consequences from doing so. Results 1113 participants responded, representing all 50 US states. 84% (933/1111) of participants reported having delivered bad news at least several times in the last year with 42% (422/1001) reporting receiving no education around this topic. 96% (953/991) of participants reported that additional training would be helpful. 54% (528/964) of participants reported experiencing some adverse mental health symptoms (intrusive thoughts, lost sleep, emotional difficulty) in the last year related to delivering bad news and 7% (71/964) experienced these effects frequently. Conclusion EMS clinicians are frequently responsible for delivering bad news, and more than half report adverse mental health symptoms associated with this task. Despite the frequent occurrence and associated emotional trauma, EMS clinicians report insufficient or no training at all in how to deliver bad news. The development and implementation of educational curriculum and mental health support around the delivery of bad news is necessary.