Preparation of a Family Meeting

by Mark Hughes, MD, MA

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    00:01 I'm going to talk about family meetings in four phases.

    00:05 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.

    00:17 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.

    00:27 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.

    00:40 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.

    01:13 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.

    01:40 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.

    01:52 And it also may be that you're having some sort of preparation of the patient or their family about the meeting.

    01:58 So, you're setting a particular time and a date. You're making sure everyone can attend.

    02:04 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.

    02:21 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 accommodate everyone? Is it going to be in a quiet private space, you know, making sure that people are comfortable.

    02:41 Hopefully, there are chairs for everybody so people can sit down and make sure they're really invested for the length of the meeting.

    02:51 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.

    03:03 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.

    03:16 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.

    03:31 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.

    03:45 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.

    03:56 And what the role of each person is going to be during the meeting.

    03:59 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.

    About the Lecture

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

    Included Quiz Questions

    1. Review the patient's knowledge of the disease, its prognosis, and treatment.
    2. Review the pathophysiology of the disease.
    3. Review the patient's family tree.
    4. Call the patient's family.
    5. Ask the social worker for information about hospice.
    1. A thorough review of systems
    2. Examination of your own feelings
    3. Planning for the location and timing of the meeting
    4. Reviewing the patient's disease and prognosis
    5. Reviewing the disease trajectory and previous decisions

    Author of lecture Preparation of a Family Meeting

     Mark Hughes, MD, MA

    Mark Hughes, MD, MA

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