Background 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 is 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. See Fast Facts # 222 on Preparing for the Family Meeting and #223 on The Family Meeting: Starting the Conversation.
Family Conference Process Steps
- Why are you meeting: Clarify conference goals of what you hope to accomplish?
- Where: A room with comfort, privacy and circular seating.
- Who: Patient (if capable); 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 and which 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, what is important in her or his life, 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, 224).
7. Family Discussion with a Decisional Patient
- Ask the 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 with a Non-Decisional Patient
- Ask each family member in turn What do you believe the patient would choose if the patient could speak for him or herself?
- 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: What would the patient say if they could speak? Ask: Have you ever discussed with the patient what he or she would want in a situation like this?
- If you, as a clinician, have a firm opinion about the best plan of care, recommend it simply and explicitly, and explain why.
- 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.
- 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.
- Don’t turf discontinuation of treatment to nursing.
- Continuity – Maintain contact with family and medical team. Schedule follow-up meetings as needed.
See additional related Fast Facts: Delivering Bad News (#6, 11); Dealing with Anger (#59), Conflict Resolution (#183, 184, 225), Helping Surrogates Make Decisions (#226); End of Life Goal Setting (#227); .
- Ambuel, B. Conducting a family conference. In: Weissman DE, Ambuel B, Hallenbeck J, eds. Improving End-of-Life Care: A resource guide for physician education. 3rd Ed. Milwaukee, WI: The Medical College of Wisconsin; 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.
Version History: This Fast Fact was originally edited by David E Weissman MD. 2nd Edition published August 2005; 3rd Edition May 2015. Current version re-copy-edited May 2015.
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