Family meetings in palliative care: Multidisciplinary clinical practice guidelines

Abstract

BackgroundSupport for family carers is a core function of palliative care. Family meetings are commonly recommended as a useful way for health care professionals to convey information, discuss goals of care and plan care strategies with patients and family carers. Yet it seems there is insufficient research to demonstrate the utlility of family meetings or the best way to conduct them. This study sought to develop multidisciplinary clinical practice guidelines for conducting family meetings in the specialist palliative care setting based on available evidence and consensus based expert opinion.MethodsThe guidelines were developed via the following methods: (1) A literature review; (2) Conceptual framework; (3) Refinement of the guidelines based on feedback from an expert panel and focus groups with multidisciplinary specialists from three palliative care units and three major teaching hospitals in Melbourne, Australia.ResultsThe literature review revealed that no comprehensive exploration of the conduct and utility of family meetings in the specialist palliative care setting has occurred. Preliminary clinical guidelines were developed by the research team, based on relevant literature and a conceptual framework informed by: single session therapy, principles of therapeutic communication and models of coping and family consultation. A multidisciplinary expert panel refined the content of the guidelines and the applicability of the guidelines was then assessed via two focus groups of multidisciplinary palliative care specialists. The complete version of the guidelines is presented.ConclusionFamily meetings provide an opportunity to enhance the quality of care provided to palliative care patients and their family carers. The clinical guidelines developed from this study offer a framework for preparing, conducting and evaluating family meetings. Future research and clinical implications are outlined.

Family conference in palliative care: concept analysis

“…Studies (3)(4) show that, with the proximity of death, issues such as fear of the unknown, myths, uncertainties due to the prognosis related to a life-threatening disease, and doubts about the modifying therapy of the disease, and if this brings benefits or only protects the process of dysthanasia. This is corroborated by the studies analyzed (8,(12)(13) , which show, among the indications for a family reunion, that of the need to identify what the family already knows about the patient's prognosis and whether there are gaps and doubts to be resolved.…”

“…With the family conference it is possible, through active listening, to clarify doubts, discuss feelings and reduce the psychosocial anxieties present (8) . To address the doubts of patients and their families is to respect the autonomy of the other and to offer them the possibility of choices, fulfilling what is proposed in the philosophical principles of palliative care presented by WHO in meeting the effective needs of support to families (12)(13) .…”

“…• Decision-making process (13)(14)17) • Definition of a care plan (3)(4)8,14,18) • Intrafamilial conflicts (3)(4) • Doubts (advantages and disadvantages of therapy) (3)(4)8,(12)(13)(14)(19)(20) • Clarification on goals (8,12,(19)(20) • Anguish (3)(4)17) • Perspectives vis-à-vis illness and death (3)(4)15,17) • A Worsening of the clinical picture (3)(4) • Proximity of death (3)(4)17) • Difficulty in communication (16)(17) • Need to support the family (3)(4)7) • Working instrument (3)(4)8,12,17) • Integration strategy (8,12) • Method of communication (7,15) • Family intervention (3)…”

“…Thus, the need to hold a family conference, a therapeutic instrument used by the palliative care team, emerges as a moment of planned dialogue between patient, family and team (7) . Although it is of particular importance, the family conference is still less widespread among health professionals (7)(8) . And, in the case of publications by nursing professionals, none was found in the databases visited, during the survey of excellence on the subject, nor was there evidence of already completed revisions focusing on this theme.…”

Improving Healthcare Provider Communication in End of Life Decision Making

“…Effective communication can improve family experiences and family satisfaction and may affect the timeliness of decision-making for the dying patient [8]. Providing a family meeting in a structured format is one method to deliver a consistent framework for conducting the family meeting in a critical care setting [9]. A structured format, such as a checklist used in this project, can provide a more comfortable, standardized approach to address difficult communication situations and can offer education and experience for providers.…”