Background     A cornerstone procedure in serious illness care is leadership of family meetings to establish goals of care, typically completed at a time of patient change in status, where the value of current treatments needs to be re-evaluated.  As with any procedure, preparation is essential to ensure the best outcome.  This Fast Fact reviews how to prepare for a family meeting.  See Fast Fact #16 for an overview of a family meeting, as well as Fast Fact #223, Fast Fact #224, Fast Fact #225, Fast Fact #226, and Fast Fact #227 for additional aspects of family conferences.

Data review 

• Review the medical history relevant to the current medical situation (e.g. history of disease progression, symptom burden, past treatments, treatment-related toxicity, and prognosis). 
• Review all current treatments (e.g. renal dialysis, artificial nutrition, antibiotics) and any positive and/or negative treatment effects. 
• Review all treatment options being proposed. 
• Determine prognosis with and without continued disease-directed treatments. Prognostic information should include not just data on time/longevity, but the patient’s future function (physical/cognitive) and symptom burden as well. 
• Solicit and coordinate medical opinions about the utility of current treatments among consultants and the primary clinician. If possible, families need to hear a single medical consensus—all relevant clinicians should be contacted, and consensus reached prior to the meeting.  If the consultants do not agree, then prior to the family meeting they should meet to negotiate these differences and attempt to reach consensus regarding the plan. If there is no consensus, a plan should be developed for how to describe these differences to families. 
• If the patient lacks capacity, review any Advance Directive(s), with special attention to discover if the patient has named a surrogate decision maker, and if the patient has indicated any specific wishes (e.g. DNR status, ‘no feeding tubes’).   
• Seek out patient/family psychosocial data.  Focus on psychological issues and family dynamics (e.g. anger, guilt, fear) potentially impacting decision making.  These issues may be long-standing, or due to the current illness. Note: talking to the patient’s social worker, bedside nurses, and primary and consulting teams can help you get a better sense of the family and how they make decisions.
  • Review what transpired in prior family meetings.
  • Learn about cultural/religious values and/or social/financial issues. 

Information synthesis     Based on your review of the medical and prognostic data, make an independent determination of which current and potential tests/treatments will improve, worsen, or have no impact on the patient’s function/quality of life (physical/cognitive) and time (longevity).   

Meeting leadership     Leading a family meeting requires considerable flexibility to ensure that all relevant participants can have their points of view expressed.  Though it is useful to have one person designated as the main orchestrator and coordinator of the meeting, the essential skills for making a family meeting successful can come from more than one participant.  These skills include: 

• Group facilitation skills.
• Counseling skills.  
• Knowledge of medical and prognostic information. 
• Willingness to provide leadership/guidance in decision making. 

Invitations    A decisional patient can be asked who they want to participate from their family/community, including faith leaders. In general, it is wise not to set any arbitrary limits on the number of attendees.  The medical care team should likewise decide who they want to participate.  Note: it is important not to overwhelm a family with too many health professionals. On the other hand, a clinician from the primary team as well as a nurse and social worker should attend when possible; these individuals can help ensure the consistency of information as well as help deal with complicated dynamics.  If the patient has a long-time treating clinician whom he/she trusts, this person should ideally be present. 

Setting    The ideal setting is private and quiet, with chairs arranged in a circle or around a table. Everyone should be able to sit down if they wish.  For non-decisional patients, the clinical team should negotiate with the surrogate whether to have the meeting in the presence of the patient. 

There may also be family members unable to be present in-person but can join by phone or video.  Video is more ideal to allow for more non-verbal communication.  Virtual participation in family meetings can be an effective alternative for helping family members ask their questions, express their thoughts, better understand their loved one’s care and help build their trust in the clinical team.  Inquire about whether there will be family members who wish to participate prior to the meeting so the team can plan to minimize wasting time dealing with technological issues.

The pre-meeting meeting (aka ‘the huddle’) Clinicians should meet beforehand to confirm: 

       a) the goals for the meeting (e.g. information sharing, specific decisions sought)
       b) who will be the meeting leader to start the meeting
       c) likely sources of conflict and initial management strategies.

See Fast Fact #368 and Fast Fact #485 for more information.

References 

1. Back A, Arnold R, Tulsky J.   Mastering communication with seriously ill patients: balancing honesty with empathy and hope.  New York, NY: Cambridge University Press; 2009.
2. Curtis JR, Patrick DL, Shannon SE, et al. The family conference as a focus to improve communication about end-of-life care in the intensive care unit: opportunities for improvement. Crit Care Med. 2001; 29(2 Suppl):N26-33.
3. Lautrette A, Ciroldi M, Ksibi H, Azoulay E. End-of-life family conferences: rooted in the evidence. Crit Care Med. 2006; 34(11):S364-S372.
4. King DA, Quill T. Working with families in palliative care: one size does not fit all. J Pall Med. 2006; 9:704-715.
5. Weiner JS, Roth J. Avoiding iatrogenic harm to patient and family while discussing goals of care near the end of life. J Pall Med. 2006; 9:451-463.
6. Weissman DE. Decision making at a time of crisis near the end of life. JAMA. 2004; 292:1738-1743.
7. Kuntz JG, Kavalieratos D, Esper GJ et al.  Feasibility and acceptability of inpatient palliative care e-family meetings during COVID-19 pandemic.  J Pain Symptom Management.  2020;60;e28-32.

Version History:   Originally published October 2009; copy-edited August 2015; reviewed and updated again in March 2025 by Heidi Ludtke MD.
Conflicts of Interest: None to report.