I'm going to talk about family
meetings in four phases.
Similar to what we've talked about
in previous lectures with regard to,
like, how you break bad news or break serious
news, the idea that there's going to be -
need to be some preparation,
you're going to have to start a meeting.
You're going to have to have the bulk
of the meeting, the discussion,
you know, the information that is relayed to
and from the patient or their family.
And also, a conclusion to the meeting.
So, making sure all phases are properly
reinforced and done well is a way to
have a successful family meeting.
All right. So, thinking about preparation.
The first thing for you to do as the clinician
is make sure you review any previous knowledge
that the patient has of the disease,
what you've talked about previously about prognosis,
what the treatment options were that were offered,
so, have a clear recollection of what's been discussed before,
what do you anticipate the patient's understanding to be,
what information you're going to need to convey that's new during
this family meeting either to the patient or to the family.
You're going to want to look back,
especially, if this has been a disease process
that's been going on for a while,
what's been the disease trajectory,
what have been some of the
milestones that have happened,
what have been these previous discussions
or decisions that the patient made,
can you recall how the patient made the decisions?
Was family involved in those decisions before?
What was their input into the decision-making process?
Trying to recall all those details.
Again, you want to get a good firm
understanding of what the patient's knowledge base
is as you're then going to present new
information in this new family meeting.
And it also may be that you're having some sort of preparation
of the patient or their family about the meeting.
So, you're setting a particular time and a date.
You're making sure everyone can attend.
You're going to figure out who needs to attend
and ask the patient's permission
if they're able to acknowledge
who they want to be present to
to hear this information and the extent
of information that might be disclosed.
So, not only the location, you know,
the timing, how big, you know,
so, if it's going to be involving multiple team
members, you know, what the size of the room
is going to be and can it
Is it going to be in a quiet private space,
you know, making sure that people are comfortable.
Hopefully, there are chairs for everybody
so people can sit down
and make sure they're really invested
for the length of the meeting.
It's also important similar to what to do
when you are breaking serious news
is to examine your own feelings, your own attitudes, perhaps,
your own biases or opinions about what should be done.
So, if the patient is facing a particular
decision, you might say,
"Well, you know, I would never want that
or I would never want to pursue that treatment."
You have to check in with yourself before
you present information to the family.
So, if you are really presenting it in a way that
they can weigh the options based on their life circumstance,
not how you feel about it, your personal beliefs
about it but how they would think about it.
And then, within the healthcare team, you know,
it's important for there to be a pre-conference,
a pre-meeting amongst the clinicians. So, know who's
going to attend. Make sure you meet with them.
Have a consensus about what the plan
for the meeting is, what the messaging
is going to be during the meeting, what you're hoping
to accomplish, what the goals of the meeting are.
And what the role of each person
is going to be during the meeting.
So, there might be a lead discussant
but then, there might be other team members
that are going to be called upon to give
their perspective and making sure that's clear
before you go into the meeting of who's
doing what during the meeting.