Background     Family meetings are designed to help the patient and family understand what is clinically wrong and what the future might bring. Armed with this information, the family and team can then discuss the patient’s values and develop a treatment plan that supports these values (1). This works best if the clinicians provide consistent and understandable information. In hospitals, seriously ill patients and families often hear different messages from various clinicians who are looking at the patient through their specialized lenses. When this occurs, patients and families can feel confused and perceive that the clinical teams are not communicating with each other. This can reduce trust in the clinical teams. Fast Fact #368 discusses the pre-family-meeting clinician huddle, in which clinicians meet to discuss the clinical information and decide how best to present it at the family meeting. This Fast Fact discusses in more detail one key aspect of this huddle — generating a shared “headline” – which can prove to be challenging especially when there is clinical uncertainty or disagreement among team members.

What is a clinical headline? Most communication experts espouse a short summary over a more detailed medical description of all the patient’s medical problems and treatments. A clinical headline is a 1-3 sentence summary of the medical issues and what they mean for a patient (2). This “headline” is typically communicated to the patient and family in the key section of the family meeting in which the clinician is communicating the medical synthesis.  

• The first part typically summarizes the medical condition (“Your mom was admitted with a very bad pneumonia. Despite everything we have done, her liver, kidneys, and heart are getting worse.”).  
• The last part summarizes what the medical data means for the patient (“I am worried that she is dying.”).  This requires a clinician to anticipate what information the patient and family really want to know, such as “Will they get better or not?  Are they dying?  Will they be able to golf, walk, or drive again? What would clinical recovery look like for them?” 

Negotiating a headline     This pre-meeting needs to have all relevant clinicians in attendance preferably face-to-face. In hospitals with learners, it is critical for the most experienced clinicians to be at the meeting. This decreases misinterpretation about what the senior clinician is saying (hearsay) and ensures that the team can “sign off” on a headline.  All clinicians should approach the conversation with an attitude of trust and curiosity and an acknowledgment that the goal is the same: to deliver the best care for the patient. The purpose of the pre-meeting is to merge different clinicians’ expertise and formulate a shared message. If disagreements occur between clinicians, often they are based on different perspectives about what treatment outcome and timeline is most relevant. For example, an oncologist may view the patient’s cancer as curable if she can receive more immunotherapy, while the intensivist is worried the patient will not survive the hospitalization. In this case, presenting both spectrums in the forms of hopes and worries will allow for a shared headline (see Table 1). In other situations, it may be helpful to get each clinicians’ impression of the best and the worst outcomes. The clinicians can then see if they can agree on how to tell if the patient is getting better (Table 2).

If there is no agreement     Rarely, the clinicians cannot agree about what would constitute a likely best and worst case. In those cases, the headline can focus on the uncertainty that the clinicians have about what the future will bring. Alternatively, the clinicians may describe their disagreements by saying, “Some [clinicians] think X, while others are thinking Y.” In these scenarios, clinicians should describe what specifically they are looking for to determine success/improvement, and in what time frame (3). 

References 

1. Chaitin E, Arnold RM. Communication in the ICU: Holding a family meeting, Part I and II. In: Rose, B. Uptodate. Boston MA. Accessed 2024. 
2. Childers JW, Back AL, Tulsky JA, Arnold RM. REMAP: A Framework for Goals of Care Conversations. J Onc Pract.  2017; 13(10): e844-e50. doi: 10.1200/JOP.2016.018796. Epub 2017 Apr 26. PMID: 28445100. 
3. October T, Wolfe A, Arnold RM. Putting prognosis first: A pilot study to develop and test an ICU team pre-meeting training program. ATS Scholar. 2021; 2(3): 386-96. DOI:10.34197/ats-scholar.2020-0063OC.

Disclosures:  The authors have not disclosed any relevant conflicts of interest.
Authors’ Affiliations: Icahn School of Medicine at Mt Sinai, NY, NY (RMA); Larner MD College of Medicine at the University of Vermont, Burlington, VT (SB); Children’s National Hospital, Washington, DC (TWO).