How I conduct the family meeting to discuss the limitation of life-sustaining interventions: a recipe for success

Abstract

The meeting with the family of a hospitalized patient dying with advanced cancer or hematologic disease in which the limitation of life-sustaining interventions is discussed can be a challenge, particularly for junior physicians. A successful conclusion to this discussion involves an outcome in which the family, without coercion or manipulation, comes to accept that the appropriate care has been provided to their loved one, while the caregivers are enabled to provide care that is goal-directed and patient-centered.

Family conference in palliative care: concept analysis

“…Support in the decision-making process was another antecedent evidenced in the studies (13)(14)(15) . It was possible to confirm that, in order to provide due support for decision-making, negotiation is an essential element in a family conference, as a component of the communication process and assimilation from the point of view of the other, favoring a decision with respect, especially to patient autonomy (13) .…”

“…In addition to the need for negotiation, a study (15) shows that empathy is an essential element for the identification of the antecedent "decision-making process" because it allows detecting the emotions and feelings expressed by the patient and family, as well as recognizing the need for family conference.…”

“…It should be noted that the family conference is not an occasion for family therapies (7) . Nonetheless, it is an opportunity for the patient and the family to share their concerns, ask questions, raise doubts about the dying process and death, as well as provide information that may contribute to the individualization of care (15) . The family reunion as an essential attribute of the family conference enables to emphasize this concept as a therapeutic intervention strategy that allows patients and families to express their ideas, clarify and validate information in an interactive process of communication among team, patient and family, as well guide the individualized assistance, based on the identification and validation of needs, especially through appropriate questioning and use / understanding of non-verbal signals (3)(4)7,(13)(14)(16)(17)(18)(19)(20) .…”

“…Family meetings are recognized as a working tool for palliative care staff to support families and maximize the success of their interventions proposed by the palliative care team. It reveals itself as a useful therapeutic tool for information sharing and care planning, with evidence of efficacy in daily clinical practice (12,15) . In order for the family conference to be considered a therapeutic instrument, a preliminary preparation by the team, including the definition of who will attend the meeting, is essential.…”

“…• 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)…”