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9 - Conducting a Family Conference

Reading the Room Under the Light of Group Dynamics

Published online by Cambridge University Press:  05 April 2024

Robert M. Arnold
Affiliation:
The University of Pittsburgh School of Medicine, Pittsburgh
Anthony L. Back
Affiliation:
University of Washington Medical Center
Elise C. Carey
Affiliation:
Mayo Clinic, Minnesota
James A. Tulsky
Affiliation:
Dana-Farber Cancer Institute, Boston
Gordon J. Wood
Affiliation:
Northwestern Memorial Hospital, Chicago
Holly B. Yang
Affiliation:
Scripps Health, San Diego, California
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Summary

Multiple family members means multiple perspectives, agendas, emotions, and values. And, families are more than a collection of individuals. They have with their own way of functioning as a whole. When meeting with family about their loved one’s care, there are important steps similar to the maps we used with patients themselves. First, pre-meet to decide who’s going to be invited. The team should also agree upon a big picture headline. During the conference, introduce all participants and the purpose of meeting. Assess what the family knows and their different perspectives. Update the family using a headline, and address questions and concerns. Empathize and respond to the various emotions in the room. Prioritize the patient’s values. Align with the patient’s values and support the family. Finally, summarize and provide a concrete follow-up plan. An effective family conference can get everyone on the same page, ensure that the patient and family understand the medical situation, and help the family and care team come together to make treatment decisions that align with the patient’s values.

Type
Chapter
Information
Navigating Communication with Seriously Ill Patients
Balancing Honesty with Empathy and Hope
, pp. 136 - 154
Publisher: Cambridge University Press
Print publication year: 2024

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References

Further Reading

Curtis, J. R., and White, D. B., Practical guidance for evidence-based ICU family conferences. Chest, 2008, 134(4): 835–43.CrossRefGoogle ScholarPubMed
Goold, S. D., Williams, B., and Arnold, R. M., Conflicts regarding decisions to limit treatment: A differential diagnosis. JAMA, 2000, 283(7): 909–14.CrossRefGoogle ScholarPubMed
Hammond, S. A., Thin Book of Appreciative Inquiry, 3rd ed. Thin Book Publishing Company, Bend, Oregon, 2013.Google Scholar
Lautrette, A., Darmon, M., Megarbane, B., et al., A communication strategy and brochure for relatives of patients dying in the ICU. N Engl J Med, 2007, 356(5): 469–78.CrossRefGoogle ScholarPubMed
McDonagh, J. R., Elliott, T. B., Engelberg, R. A., et al., Family satisfaction with family conferences about end-of-life care in the intensive care unit: Increased proportion of family speech is associated with increased satisfaction. Crit Care Med, 2004, 32(7): 1484–8.CrossRefGoogle ScholarPubMed
October, T. W., Schell, J. O., and Arnold, R. M., There is no I in team: Building health care teams for goals of care conversations. J Palliat Med, 2020, 23(8): 1002–03.CrossRefGoogle ScholarPubMed
Schenker, Y., Crowley-Matoka, M., Dohan, D., Tiver, G. A., Arnold, R. M., and White, D. B., I don’t want to be the one saying “we should just let him die”: Intrapersonal tensions experienced by surrogate decision-makers in the ICU. J Gen Intern Med, 2012, 27(12):1657–65.CrossRefGoogle ScholarPubMed
Scheunemann, L. P., Arnold, R. M., and White, D. B., The facilitated values history: Helping surrogates make authentic decisions for incapacitated patients with advanced illness. Am J Respir Crit Care Med, 2012, 186(6): 480–86.CrossRefGoogle ScholarPubMed
Wendler, D. and Rid, A., Systematic review: The effect on surrogates of making treatment decisions for others. Ann Intern Med, 2011, 154: 336–46.CrossRefGoogle ScholarPubMed

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