Conclusion of a Family Meeting

by Mark Hughes, MD, MA

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    00:01 What you're trying to do, so, you've had the discussion.

    00:03 What you're trying to do at the end when you're, you know, thinking about concluding the meeting is make sure that there's a common understanding of the disease and the treatment options.

    00:15 If it's a particular treatment that has, you know, uncertainty or, you know, significant challenges in regard to burdens and how it compares to the benefits of that treatment, it's also good to think about framing it as a best case, worst case, and most likely outcome of what the options are.

    00:36 So, you might provide a recommendation as to what the treatment might be.

    00:40 You suggest that the alternatives might be, you know, one or two other things.

    00:45 And then, you walk through with them what the best case would be for option one.

    00:50 What the worst case would be for option one.

    00:53 Option two, what the best case and worst case would be and what you think is most likely to happen in each of those options so they have a better understanding of how to you know, weigh one versus the other when they're considering what your recommendation is and how they should make their decision.

    01:16 And the recommendation you provide should really be based on the patient's values.

    01:20 So, hopefully, over the course of the meeting or the course of your relationship with the patient, you've learned about their values, what's important to them in their life, all the things that we've talked about in terms of, like, goals of care? You're basing your recommendation on those wishes, those values.

    01:41 And then, before you, you know, finish the meeting, before you conclude completely, you want to just check in again with the patient and/or the family, see if there are any lingering questions, you know, wait for, you know, pause to see if they have any, you know, additional things that they want to ask about or talk about and also to make sure you address those before stopping the meeting.

    02:04 Once that's done, maybe they reach the decision during the meeting.

    02:08 You've come to some consensus about what the plan is going to be.

    02:12 Maybe they're going to need more time to think about it, so, you're going to set a, you know, another meeting time to have them talk as a family, and then, come back to you.

    02:23 But you want to have a clear idea of what the goals of care are, you know, how they view the situation, what their treatment priorities would be.

    02:31 You want to show that you are going to support them in the process.

    02:36 So, each team member, you know, might have a different role in helping to support the patient or family.

    02:42 So, having them explicitly say how they can support the family.

    02:46 You want to have a basic plan as to follow up, you know, so, if decisions are made now, if those are implemented, what's going to be the follow up to see how that plan is playing out? If it's, "Well, we haven't made a decision yet but we're going to need to make a decision in the future." What needs to be decided? What's the timeframe for making that decision? I'm sure, at least, everyone has a clear understanding of a follow up plan.

    03:15 And then, making sure that they, the family and/or the patient have a way of reaching you.

    03:20 So, what's going to be the contract information for the team to reach them? For them to reach you in case there needs to be more discussion.

    About the Lecture

    The lecture Conclusion of a Family Meeting by Mark Hughes, MD, MA is from the course Surrogate Decision Making and Family Meetings.

    Included Quiz Questions

    1. Giving details about the best-case outcome, the worst-case outcome, and the most likely outcome
    2. Making recommendations based on your values
    3. Giving recommendations for hospice
    4. Focusing on the family's wishes and values
    5. Establishing yourself as the authority on ethics
    1. Decisions that still need to be made
    2. Contact information so that the family can be in touch with you
    3. Burial location
    4. Date and location for the celebration of life
    5. Anti-epileptic dosing

    Author of lecture Conclusion of a Family Meeting

     Mark Hughes, MD, MA

    Mark Hughes, MD, MA

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