Family meetings in palliative care
Family meetings are helpful to provide information, discuss the concerns and needs of both the patient and family members, and plan care. They can be beneficial for both healthcare professionals and the family, especially if held early in the course of a patient’s illness.
Formal family meetings are often held in specialist palliative care services, but can be held in any community or hospital setting, and by any healthcare professional (eg general practitioner). A suggested process for conducting a family meeting is outlined in How to conduct a family meeting in palliative care.
Preparation
Obtain permission from the patient to have the meeting and to share their personal information.
Ask the patient if they wish to attend the meeting, and which family members or others they would like to attend.
Decide which members of the healthcare team will attend; they should not outnumber or overwhelm the family members present.
Choose a quiet venue free from interruptions.
Nominate a chairperson before the meeting and decide on a time limit.
If an interpreter is attending, arrange where they will sit in relation to the patient and family.
Brief team members before the family arrives.
Greeting and introductions
Introduce team members and ask family members to introduce themselves.
Explain the purpose of the meeting and ask participants what they would like to discuss. Agree on the items for discussion and a rough time limit.
Content (varies depending on information needs, patient consent to share information, and context of meeting)
Determine what the patient and family already know.
If appropriate, provide an update on the patient’s current medical condition and prognosis.
Allow each family member time to ask questions and express any concerns.
Clarify the goals of care and discuss treatment and care options, taking account of the patient’s preferences; acknowledge that there is uncertainty in the way the situation may unfold.
Deal with any specific issues (eg location of care, realistic options for long-term care if the patient cannot stay at home, children).
Check on the patient and family’s understanding along the way.
Offer written or other resources if relevant.
Closing
Thank family members for their attendance and advise them that they can raise concerns that they may have forgotten, or that arise subsequently, with team members at a later date.
Document the details of the meeting and offer the patient and family notes on key points from the meeting.
Debrief and reflect with other team members and the interpreter on how the meeting went.
Develop a plan of action, including each team member’s tasks, and arrange other interventions if needed (eg referral).
Nominate a case manager if the case is complex.
Family meetings can be challenging—ideally a healthcare professional with the appropriate experience and skills should convene the meeting and lead the discussion. If possible, more than one healthcare professional should be present, preferably from different disciplines (eg doctor, nurse, social worker); however, healthcare professionals should not outnumber or overwhelm the patient and family members present. Healthcare professionals who are trusted by, and well known to, the family should conduct difficult conversations, if possible.
Before meeting with a family, a multidisciplinary case conference may be needed so that the healthcare professionals involved understand the clinical situation and, if necessary, resolve any differences of opinion; this should not be done with the family present.
For advice on breaking bad news and discussing prognosis, see Communicating with and supporting patients with palliative care needs. A request from a family to withhold information from a patient is discussed in Requests to withhold information from a patient.
Detailed clinical practice guidelines on family meetings in palliative care are available from the Centre for Palliative Care; see Family meetings in palliative care: Multidisciplinary clinical practice guidelines.