The family meeting is an essential part of care, especially when the patient is declining, goals are unclear, and there is conflict or confusion about the next steps.
Usually, these meetings occur with regularity in the ICU and also on oncology units when the patient is too ill to participate, though at times the group may move to the bedside to have the meeting. Nurses are often in a key position to give important information at these meetings, but often they are not included or are too busy to take much time away from other patients.
So what happens at these meetings? As a member of a palliative care consult service, I have participated in hundreds of these meetings. Of course no two are the same, but here are some common threads I have seen:
- The healthcare professionals should have a goal for what they hope to accomplish.
- Appropriate people need to be invited as well as appropriate location and timing arrangements made.
- Inform the family of the goal of the meeting. Identify their goals.
- Often these meetings start with a doctor summarizing the patient's condition, treatment, and future options. Family members should be asked what they understand about the patient's condition. They should have ample opportunity to ask questions.
- The leader of the meeting tries to focus on the decisions that need to be made.
- The family participates in discussion and shares their knowledge of the patient's wishes and values.
- Decisions are made.
- Follow-up arrangements are made.
In reality, many family meetings get sidetracked and the time together is taken up by many details that are not part of the goals of the meeting.
Barriers to a successful family meeting:
- Healthcare professionals talk in medical jargon and family members may feel intimidated to ask basic questions, especially if the meeting becomes more of a lecture. (Billings, 2011)
- Healthcare professionals may talk too much and families stop listening because they are anxious to tell their story.
- Conflict between family members and the healthcare team disrupts communication.
- Time gets away before the "real" purpose of the meeting, such as code status, addressing end of life issues, future interventions, and discharge planning are addressed.
How can the nurse's presence contribute to a more useful family meeting?
Staff nurses often have a great sense of what family members want to know and maybe can't verbalize to the doctors. Staff nurses often recognize when the family doesn't understand what is being said or the implications of what is said.
The nurse is comfortable and skilled in saying, "I am wondering if the family has questions about what you just said about the disease progression." The nurse often knows the family's fears and questions. The nurse can coach them on speaking up. In addition, the nurse sees the patient differently than other team members and can give vital information on quality of life issues.
Example: The daughter of a patient refused to believe that the patient, her mother, was declining. The nurse very gently described specific quality of life issues such as that her mother could not turn on her own, her skin breakdown required painful dressing changes, and that the patient was refusing to eat. The nurse had more credibility on these issues than anyone else. The daughter was able to acknowledge for the first time that things weren't going well and that maybe her mother would not want this.
When a family meeting is planned, the team should include the nurse for a specific time period. Perhaps by encouraging the nurse to sit in the meeting for a specific time period to make his or her valued contribution, the nurse's time gets used effectively and the nurse is more likely to participate.
How many family meetings have you attended?
What has been your role?
What suggestions do you have about attending family meetings?
Reference:
Billings, J. A. (2011). The end-of-life family meeting in intensive care part I: Indications, outcomes, and family needs. J Palliat Med, 14(9), 1042-1050. doi: 10.1089/jpm.2011.0038
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