Fast Fact and Concept #16: Conducting a Family Conference

Title: Fast Fact and Concept #16: Conducting a Family Conference

Author(s): Ambuel, B.; Weissman, D.

This Fact Fact and Concept gives a detailed outline of the essential steps in running a family conference. The material can be used during rounds, to precept a trainee or as part of a teaching conference.

Educational Objective(s):
Learn the key steps in conducting a family conference.

Case scenario: Bill is a 63-year-old man admitted following a massive MI. In the ER he is stabilized, intubated and transferred to the ICU. By history he experienced an unknown period of anoxia prior to arrival of the EMTs. On exam he remains unresponsive to deep pain after 3 days. On the third day of hospitalization, Bill's wife Susan, and three children join you for a family conference to discuss his treatment. How do you run a family conference? What do you teach residents?

I. Why: Clarify conference goals in your own mind.

II. Where: A room with comfort, privacy and circular seating.

III. Who: Patient (if capable to participating); legal decision maker/health care power of attorney; family members; social support; key health care professionals.

IV. How:

A. Introduction

Introduce self and 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.

B. Review medical status

Determine what the patient/family already knows: "tell me you understanding of the current medical condition"
Review current status, plan and prognosis.
Ask each family member in turn if they have any questions about current status, plan and prognosis
Defer discussion of decision making until the next step

C. 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?

D. 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?
Leave room to let family discuss alone.
If there is consensus, go to V; if no consensus, go to E.

E. 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 legal decision maker
Identify resources: Minister/priest; other physicians; ethics committee.

V. Wrap-up:

Summarize consensus, disagreements, decisions and 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.

Key teaching points:

As moderator, your role is to promote the preconditions for discussion and decision-making. You can not produce a specific outcome from the conference. Recognize what you can control and what you can not control.
You can adjust the suggested format to fit unique circumstances, but strive to retain key elements. Ask the resident what they think the key elements are. My list includes: introductions; review of conference goals; review of medical condition; summary; documentation; continuity.
Strive to engage the family and the health care team.

References: Ambuel, B. Conducting a family conference. In DE Weissman & B Ambuel, Improving End-of-Life Care: A resource guide for physician education. The Medical College of Wisconsin, Milwaukee, 1999.

Fast Facts and Concepts are developed and distributed as part of the National Internal Medicine Residency End-of-Life Education project, funded by the Robert Wood Johnson Foundation.

Disclaimer Concerning Medical Information:
Health care providers should exercise their own independent clinical judgment. Accordingly, official prescribing information should be consulted before any product is used.

Contact: David E. Weissman, MD, FACP Palliative Care Program Director Medical College of Wisconsin (P) 414-805-4607 (F) 414-805-4608 [email protected]

Copyright Notice: Users are free to download and distribute Fast Facts for educational purposes only. Citation for referencing: Weissman, D. Fast Fact and Concepts #16: Conducting a Family Conference. June, 2000. End-of-Life Physician 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

Format: Handouts

Purpose: Instructional Aid, Teaching

Audience(s)

Training: 1st/2nd Year Medical Students, 3rd/4th Year Medical Students, PGY1 (Interns), PGY2-6, Physicians in Practice

Specialty: Anesthesiology, Emergency Medicine, Family Medicine, General Internal Medicine, Geriatrics, Hematology/Oncology, Neurology, OB/GYN, Ophthalmology, Pulmonary/Critical Care, Pediatrics, Psychiatry, Surgery

Non-Physician: Clergy/Chaplains, Lawyers, Nurses, Social Workers

ACGME Competencies: Interpersonal and Communication Skills, Patient Care

Keyword(s): Decision making capacity/surrogates, Discussing hospice care, Family conference, Giving bad news, Negotiating treatment goals, Prognosis, Treatment withdrawal, Treatment withholding

The Fast Facts series is distributed for educational use only and does not constitute medical advice. For the most current version of Fast Facts visit the EPERC web site at www.eperc.mcw.edu. This mirror version is provided subject to copyright restrictions for educational use within the Inter-Instutional Collaborating Network on End-of-Life Care (IICN).