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Updated: Jul 1, 2025
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Setup and Execution of the Rapid Cycle Deliberate Practice Death Notification Curriculum
Published on: August 5, 2020
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How Primary Care Clinicians Process Patient Death: Logistics, Emotions, and Opportunities for Structural Support
Jessica Alcalay Erickson1, Bridget C O'Brien2,3, Sarah Nouri4
1Department of Medicine, University of California San Francisco, San Francisco, CA, USA. Jessica.erickson@ucsf.edu.
Journal of General Internal Medicine
|March 8, 2024
Summary
Primary care clinicians (PCCs) face challenges in managing patient deaths, experiencing emotional distress and logistical uncertainty. Improved support, including clear guidance and peer debriefings, is essential for PCCs to cope with patient loss.
Area of Science:
- Primary Care Medicine
- Physician Well-being
- Grief and Loss Studies
Background:
- Patient death is an inherent aspect of medical practice, yet research on primary care clinicians' (PCCs) experiences is limited.
- Existing studies predominantly focus on inpatient settings, neglecting the unique challenges faced by PCCs in outpatient environments.
- Understanding how PCCs navigate patient loss is crucial for developing targeted support systems.
Purpose of the Study:
- To investigate the logistical and emotional experiences of primary care clinicians (PCCs) following a patient's death.
- To identify and explore suggestions for supportive resources that can aid PCCs in processing patient loss.
- To bridge the gap in research concerning PCCs' coping mechanisms in the outpatient setting.
Main Methods:
- A qualitative study design utilizing semi-structured interviews.
- Interviews were conducted with 12 primary care clinicians (physicians and nurse practitioners) from three academic primary care clinics.
- Template analysis was employed to iteratively identify themes in the interview transcripts regarding patient death navigation.
Main Results:
- PCCs reported inconsistent and delayed outpatient death notifications, coupled with uncertainty about post-notification procedures.
- Clinicians experienced significant emotional distress, including sadness and guilt, particularly with deaths of young, vulnerable, or those with preventable conditions.
- Identified needs included procedural guidance, peer debriefing sessions, and formal acknowledgments of deceased patients.
Conclusions:
- Primary care clinicians' experiences with patient death highlight significant logistical and emotional processing challenges.
- The unique aspects of primary care, such as long-term patient relationships and professional isolation, necessitate tailored support.
- Enhancing guidance and support for PCCs is vital to reduce burnout and effectively manage grief associated with patient loss.
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