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

1. Why are you meeting? Clarify conference goals in your own mind. What do you hope to accomplish?
   
   
2. Where are you meeting? A room with comfort, privacy and circular seating.
   
   
3. 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.
   
   
4. 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.
     
     
5. 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.
   
   
6. 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)
     
     
7. 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?
     
     
8. 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.
     
     
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.
     
     
10. 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

1. 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.
2. Quill TE. Initiating end-of-life discussions with seriously ill patients. JAMA 2000; 284:2502-2507.
3. Baile WF et al. Discussing disease progression and end-of-life decisions. Oncology 1999; 13:1021-1028.
4. 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)

ACGME Competencies: Interpersonal and Communication Skills, Patient Care

Keyword(s): communication