Communicating sudden death in the field: a systematic review and qualitative evidence synthesis of prehospital professionals’ experiences

1. Title Communicating Sudden Death in the Field: A Systematic Review and Qualitative Evidence Synthesis of Prehospital Professionals’ Experiences 2. Review question What are the experiences of prehospital emergency care professionals in communicating sudden death or delivering death notifications in the field? 3. Searches Databases to be searched: MEDLINE (via PubMed), CINAHL, Scopus, Web of Science, PsycINFO, LILACS, SciELO, and EBSCOhost. Search strategy will include key terms and MeSH headings related to emergency medical services, prehospital care, death notification, breaking bad news, and communication. Grey literature searches will include TDX (Tesis Doctorals en Xarxa) and RCAAP (Repositório Científico de Acesso Aberto de Portugal). Language restrictions: English, Portuguese, and Spanish. Searches will be limited to studies published up to December 2023. 4. Types of study to be included Qualitative and mixed-methods studies that include extractable qualitative data exploring EMS professionals’ experiences of communicating sudden death or delivering death notifications in prehospital settings. Quantitative-only studies will be excluded. 5. Condition or domain being studied The focus is on communication and psychosocial experiences of prehospital professionals during the delivery of death notifications in the field following sudden death or termination of resuscitation. 6. Participants/population Inclusion: Prehospital emergency care professionals (e.g., paramedics, nurses, emergency physicians, emergency medical technicians). Exclusion: Family members, patients, or non-clinical staff. 7. Intervention(s), exposure(s) Not applicable — this is a qualitative evidence synthesis. The exposure of interest is the act of communicating sudden death or delivering death notifications in prehospital contexts. 8. Comparator(s)/control Not applicable. 9. Context Out-of-hospital or prehospital emergency settings, including ambulance services, EMS, and field emergency response environments. 10. Main outcome(s) Thematic synthesis of experiences, challenges, strategies, and support needs related to death communication in prehospital care. Data type: Qualitative themes and synthesized findings. 11. Additional outcome(s) Emotional and ethical impact on professionals. Perceived training gaps. Influence on professional identity and wellbeing. 12. Data extraction (selection and coding) Two independent reviewers will screen titles, abstracts, and full texts. Disagreements will be resolved through discussion or by a third reviewer. Data will be extracted using the Joanna Briggs Institute (JBI) Qualitative Data Extraction Tool, including study context, participant characteristics, methods, and key findings. 13. Risk of bias (quality) assessment Methodological quality of included studies will be assessed independently by two reviewers using the JBI Critical Appraisal Checklist for Qualitative Research. Disagreements will be resolved through discussion. 14. Strategy for data synthesis A meta-aggregation approach (JBI) will be used to synthesise findings. Steps: Extracted findings will be coded and categorised into groups of similar meaning. Categories will be further aggregated into synthesised findings. Confidence in the findings will be evaluated using ConQual (JBI). 15. Subgroup analysis Not applicable (qualitative synthesis). 16. Type and method of review Systematic review and qualitative evidence synthesis following JBI meta-aggregation methodology and PRISMA 2020 reporting guidelines. 17. Funding sources/sponsors No external funding. 18. Conflicts of interest None declared.