
Fast Fact and Concept #016: Conducting a Family Conference
2nd Edition
Author(s): Bruce Ambuel, PhD and David E. Weissman, MD
At some point during the course of a terminal illness, a meeting between health care professionals and the patient/family is usually necessary to review the disease course and develop end-of-life goals of care. Learning the process steps of a Family Conference are an important skill for physicians, nurses and others who are in a position to help patients and families reach consensus on end-of-life planning.
Family Conference Process Steps
- Why are you meeting? Clarify conference goals in your own mind. What do you hope to accomplish?
- Where are you meeting? A room with comfort, privacy and circular seating.
- Who are you meeting with? Patient (if capable to participating); legal decision maker/health care power of attorney; family members; social support; key health care professionals.
- Introduction and Relationship Building
- Introduce self & others; Review meeting goals; clarify if specific decisions need to be made
- Establish ground rules: Each person will have a chance to ask questions and express views; No interruptions; Identify legal decision maker, and describe importance of supportive decision making.
- If you are new to the patient/family, spend time seeking to know the “person”—ask about hobbies, family, etc.
- Determine what the patient/family already knows:tell me your understanding of the current medical condition; ask everyone in the room to speak. Also ask about the past 1-6 months—what has changed in terms of functional decline, weight loss, etc.
- Review medical status
- Review current status, prognosis and treatment options.
- Ask each family member in turn if they have any questions about current status, plan & prognosis
- Defer discussion of decision making until the next step
- Respond to emotional reactions (See Fast Facts #29, 59)
- Family Discussion w/ Decisional Patient
- Ask patient What decision(s) are you considering?
- Ask each family member Do you have questions or concerns about the treatment plan? How can you support the patient?
- Family Discussion w/ Non-Decisional Patient
- Ask each family member in turn What do you believe the patient would choose if they could speak for themselves?
- Ask each family member What do you think should be done?
- Ask if the family would like you to leave room to let family discuss alone.
- If there is consensus, go to 10; if no consensus, go to #9.
- When there is no consensus:
- Re-state goal: What would the patient say if they could speak?
- Use time as ally: Schedule a follow-up conference the next day.
- Try further discussion: What values is your decision based upon? How will the decision affect you and other family members?
- Identify other resources: Minister/priest; other physicians; ethics committee.
- Wrap-up:
- Summarize consensus, disagreements, decisions & plan
- Caution against unexpected outcomes
- Identify family spokesperson for ongoing communication
- Document in the chart-- who was present, what decisions were made, follow-up plan
- Do NOT turf discontinuation of treatment to nursing
- Continuity: Maintain contact with family and medical team. Schedule follow-up meetings as needed
See related Fast Facts: Delivering Bad News (#6, #11); Responding to Patient Emotion (#29); Dealing with Anger (#59).
References
- Ambuel, B. Conducting a family conference. In DE Weissman & B Ambuel and Hallenbeck J, Improving End-of-Life Care: A resource guide for physician education 3 rd Ed. The Medical College of Wisconsin, Milwaukee, 2001.
- Quill TE. Initiating end-of-life discussions with seriously ill patients. JAMA 2000; 284:2502-2507.
- Baile WF et al. Discussing disease progression and end-of-life decisions. Oncology 1999; 13:1021-1028.
- Weissman DE. Decision making at a time of crisis near the end of life. JAMA 2004; 292: 1738-1743.
Fast Facts were edited by David Weissman MD, Palliative Care Center, Medical College of Wisconsin until January 2007. For comments/questions write to the current editor, Drew Rosielle MD: drosiell@mcw.edu. The complete set of Fast Facts is available at EPERC: www.eperc.mcw.edu
Copyright/Referencing Information: Users are free to download and distribute Fast Facts for educational purposes only. Citation for referencing. Fast Facts and Concepts #16 Ambuel B and Weissman DE. Moderating and end-of-life family conference. August, 2005. 2nd Edition. End-of-Life Palliative Education Resource Center www.eperc.mcw.edu.
Disclaimer: Fast Facts provide educational information, this information is not medical advice. Health care providers should exercise their own independent clinical judgment. Some Fast Fact information cites the use of a product in dosage, for an indication, or in a manner other than that recommended in the product labeling. Accordingly, the official prescribing information should be consulted before any such product is used.
Creation Date: 6/2000; August, 2005. 2nd Edition
Purpose: Instructional Aid, Teaching
Audience(s)
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Training: 1st/2nd Year Medical Students, 3rd/4th Year Medical Students, PGY1 (Interns), PGY2-6, Physicians in Practice |
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Specialty: Anesthesiology, Emergency Medicine, Family Medicine, General Internal Medicine, Geriatrics, Hematology/Oncology, Neurology, OB/GYN, Ophthalmology, Pulmonary/Critical Care, Pediatrics, Psychiatry, Surgery |
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Non-Physician: Clergy/Chaplains, Lawyers, Nurses, Social Workers |
ACGME Competencies: Interpersonal and Communication Skills, Patient Care
Keyword(s): communication