Understanding delivery of bad news in the emergency department: A scoping review

Background Breaking bad news is a core component of emergency care, but the emergency department (ED) environment of urgency, crowding, and limited privacy presents challenges for sensitive communication. Many communication frameworks originate from other specialities, but the ED has limited evidence and guidance tailored to its context. Objective This scoping review aimed to map the extent, nature, and characteristics of the literature on delivery of bad news in EDs, including terminology, frameworks, stakeholder perspectives, barriers and facilitators, educational resources, reported metrics, and evidence gaps. Methods The review followed Joanna Briggs Institute (JBI) methodology and was prospectively registered on the Open Science Framework (OSF https://osf.io/f6q59/overview ). Four databases (MEDLINE, EMBASE, EMCARE, CINAHL) and grey literature sources were searched in July 2025. Eligible sources included empirical studies, training evaluations, reviews, guidelines, consensus statements, editorials, commentaries, opinion pieces, educational articles, conference abstracts, and relevant grey literature reporting on adult patients, relatives, or clinicians in ED contexts. Data were charted and synthesised narratively. Results From 7985 records, 156 publications were included. Studies originated from 26 countries, though the United States of America (USA) (n = 85) and United Kingdom (UK) (n = 18) dominated the literature. There was a rise in publications from 2010, particularly post–COVID-19. Twenty-five communication frameworks were identified; most were adapted from oncology (with SPIKES most frequently cited). Three frameworks developed specifically for ED practice (GRIEV_ING, 8S, EMTalk) were identified. Stakeholder perspectives were unevenly represented, with a predominance of healthcare professional perspectives. Reported metrics centred on clinician confidence; patient- and family-centred studies were uncommon. Barriers to effective communication consistently included time scarcity, lack of privacy, and insufficient training. Conclusions Research on delivering bad news in EDs is dominated by educational and simulation-based studies, and is largely clinician-centred, with limited evidence of patient and family perspectives, with no studies examining long-term outcomes. Reliance on frameworks from other specialties risks overlooking the contextual specifics of emergency care. Future research should prioritise ED-centred frameworks, patient outcomes, and systemic enablers to support compassionate, effective communication in this demanding environment.