Multidisciplinary Family Meetings in the ICU Facilitate End-of-Life Decision Making

Abstract

Proactive MDFM's improve communication and understanding between patients' family and the treating team and facilitates end-of-life decision making.

A Systematic Review of Family Meeting Tools in Palliative and Intensive Care Settings

“…27,29,42,43 All 4 templates were developed using literature review and expert panel opinion. They all included space to record meeting attendance, and some included the extent of patient participation in the meeting (eg, cognitive capacity), 27 free-text space to document the topics of discussion during the meeting, and a place to record advance directive information and code status.…”

“…Templates varied in all other elements of documentation. For example, one included space to record the patient’s problem list and symptom assessment information, 42 and others included free-text space to document family understanding of the family meeting content and the patient’s clinical situation. 27 Only 1 template included free-text space to document family concerns expressed during the meeting, 43 and another template included space to record decisions made and a follow-up plan.…”

“…Three used pre–post designs, 9,28,42 and 1 was a controlled clinical trial. 37 Two of the 4 described multiple tools that were tested together as part of comprehensive family meeting interventions.…”

“…37 Two of the 4 described multiple tools that were tested together as part of comprehensive family meeting interventions. 9,28 Three of the 4 showed significant impacts on process and outcome measures: life support withdrawal, 42 reduced ICU length of stay, 9 and a variety of ICU quality measures, including identification of medical decision maker and offer of social work support. 28 However, family meeting tools were only one of many components of the latter’s intervention.…”

Integrating Palliative Care in the ICU

“…For example, a series of studies has established the value of proactive clinician-family communication about appropriate care goals for critically ill patients, showing favorable impact on family psychological well-being, consensus among decision makers, and utilization of ICU resources. 16–20 An interdisciplinary approach to such communication is a standard of high-quality care. 11,14 Yet, timely and reliable performance of interdisciplinary family meetings remains the exception rather than the rule in many ICUs.…”