Background The COVID-19 pandemic has resulted in restricted hospital visiting by relatives. Staff have been forced to deliver unwelcome news over the telephone. There are few training resources around how to do this. We created a bespoke training package consisting of a 15-minute eLearning session and a 1-hour facilitated role-play session using an actor. As these conversations can be often challenging, we wanted to use the feedback from the actor to help create a frame work for having these challenging conversations in the acute setting.

Method Two simulated telephone calls to a professional actor posing as the relative were undertaken on a speakerphone. Following each call, the actor gave feedback to the caller focusing on the likely experience of a relative during these conversations. Using some of the principles from the traditional models and the learning from discussion with the observers, participants and actors, we created a framework that may be useful for structuring a breaking bad news conversation over the telephone in the emergency department.

Results 240 staff received this session over 12 months, from May 2020- May 2021. Participants were nurses and doctors of all grades. Common themes from the actor’s feedback included the avoidance of medical jargon, speaking slowly and using unambiguous terminology, avoiding over-optimism, tips for breaking news of the death clearly and rapidly, and frequently checking comprehension. Elements specific to telephone conversations included ensuring the safety of the recipient to take the call i.e., not driving a car, and ensuring they had adequate local support. A framework structured around the eight S’s; Setup and Safety, Situation, Space and Silence, Suggest, Sum up and Stop was developed. We added the eighth ‘S’ for STOP, to remind the caller to stop, to ensure they are also considering their own well-being.

Conclusion This framework created, could be used to help deliver bad news quickly in the emergency department and other acute settings. Further work needs to explore the use of this framework.