Introduction to Family Meetings

by Mark Hughes, MD, MA

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    00:01 In this lecture, we're going to talk about conducting family meetings.

    00:05 Often, there is a need to meet not only with the patient but their family or loved ones or friends to talk about any goals of care or treatment decisions that need to be made.

    00:17 Often, this might involve other members of the interdisciplinary team.

    00:22 So, it's important to have this skill to know how to conduct these family meetings.

    00:28 So, the first realization is that this needs to be multidisciplinary approach.

    00:35 So, making sure that everyone is on the same page, making sure everyone's on board helps to avoid any confusion about the treatment goals.

    00:43 It also makes sure that you avoid any kind of splitting up the healthcare team or mixed messages that might be delivered by different team members.

    00:50 If each team member's meeting individually with the patient or family, they might say one thing and then, another team member says another thing and you never really get a clear message, a unified front about how you want to present the information.

    01:05 It's also important that you achieve, you know, consensus about what the goals are and that those are realistic goals.

    01:12 So, having everyone in a meeting together, make sure that those realistic goals are set and the expectations are realized about what's to be achieved.

    01:24 It's also an opportunity to make sure that there are, you know, team members that is with particular expertise that can serve the emotional and psychosocial support that the patient and/or family might need.

    01:37 And ultimately, you know, having a multidisciplinary approach, a teamwork approach, really improves the quality of care so everyone is clear about what the goals are and are working towards that goal.

    01:48 As I've talked about in other lectures in clinical ethics, communication is really important in how we show respectful communication with patients and their families, how we demonstrate that we are serving the best interest of the patient.

    02:03 So, the words that we use really do matter. So, for instance, I'm going to give you some praises.

    02:10 Again, these have to be delivered in a genuine fashion.

    02:13 You really have to feel these and mean these but they are important to show that you care about the patient and the family and what they're going through.

    02:23 It's important to recognize that, you know, it's a way to convey empathy to them.

    02:28 It's also a way to make sure that we're honoring the unique experience of the patient and the family in the illness perspective. So, things that you can say are, "I'm sorry".

    02:40 For instance, "I'm sorry that this has happened." I wish. "I wish things were different." That shows that you're in alignment with, you know, hoping for things that are going to have good outcomes, so, you're wishing the same things that they are.

    02:55 "It must be hard." For instance, it must be hard to see that your wish was not realized, so, conveying again that empathy that the regret that the patient might have that the goal wasn't achieved, for instance.

    03:08 "This must be incredibly difficult for you." So, again, putting yourself in the perspective of the patient, recognizing that it is challenging for them.

    03:18 "I cannot imagine since - I cannot imagine what you're going through." You really can't imagine what they're going through but saying that does at least, conveys to them, you recognize their unique experience.

    03:32 And lastly, "I will work with you. I will work with you to help you cope with this illness." Again, that partnership statement is really important.

    03:41 And it shows that it does matter that you're on board with them.

    03:47 Things that don't work in communication skills and really, you know, phrases or words that you should avoid, some of these are sort of the opposite of what I just said but I'll give you some examples of these.

    03:58 So, if you say, "I understand what you're going through." No, you can't really understand, you know.

    04:04 There may be patients that say, "No, you really can't understand my perspective." It's better to say, "I can't imagine or I can't understand what you're going through." To, again, recognize their unique experience.

    04:17 Things that you should avoid also is something like, "It's normal to feel the way you do." No, it's not normal. This is an abnormal feeling. They're ill. They have a diagnosis.

    04:28 They're dealing with, you know, hard treatment decisions.

    04:32 So, not normalizing it. That's words to avoid. Saying either to the patient or to the family, "Do you want us to do everything?" Well, what does that mean? You know, what is everything? That's really not achievable in a lot of circumstances and there have to be, you know, certain amount of limits that are placed on the treatments that are available or that are, you know, really going to serve the patient's best interest.

    04:58 And it's too nebulous a term of what everything counts as.

    05:02 You should also avoid something like, "We will refrain from aggressive measures." Well, aggressive, you know, there is a military metaphor that's used in medicine.

    05:12 You know, you're going to fight and, you know, so on. But we don't want to think about care as aggressive.

    05:19 We want to think about, you know, things that are going to serve the patient's best interest.

    05:23 So, reframing it in words that really speak to what you're trying to accomplish with the patient.

    05:32 Something like, "Do you think it's time to pull the plug?" You know, that kind of, you know, common everyday language, again, makes it more of an action rather than thinking about this is, you know, treatment.

    05:43 It has burdens and benefits. We're trying to remove burdensome treatments.

    05:48 It also, you know, objectifies the patient. You know, they're attached to a plug.

    05:54 It's not, you know, talking about the patient. It's talking about the machinery that might be used for the patient.

    06:00 Another phrase that you should avoid is something like, "It's time to withdraw care." Well, we never withdraw care. We always care. We might withdraw a treatment.

    06:10 We might withdraw life-sustaining treatment.

    06:13 We might say, you know, "We need to think about withdrawing the life sustaining treatment.

    06:18 But never that we would withdraw care.

    06:21 So, just keep these in mind and, you know, get comfortable with phrases that you should use and phrases that you should avoid.

    06:28 So, that you do have good communication skills in family meetings.

    About the Lecture

    The lecture Introduction to Family Meetings by Mark Hughes, MD, MA is from the course Surrogate Decision Making and Family Meetings.

    Included Quiz Questions

    1. It avoids confusion about treatment goals.
    2. It avoids sending a mixed message from the team.
    3. It develops a consensus about realistic goals.
    4. It improves the quality of care.
    5. It forces the family to make a decision.
    1. I'm sorry...
    2. I wish...
    3. It must be hard...
    4. I will work with you...
    5. I understand...
    1. I understand...
    2. It's normal to feel...
    3. Do you want us to do everything?
    4. I cannot imagine...
    5. I will work with you...

    Author of lecture Introduction to Family Meetings

     Mark Hughes, MD, MA

    Mark Hughes, MD, MA

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