Start of a Family Meeting

by Mark Hughes, MD, MA

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    00:01 So, that's preparation for the meeting and then, you know, you're going to actually, you know, have the meeting, start the meeting. It's important for everyone to introduce themselves.

    00:11 So, everybody that's in the room that's participating in the meeting should say who they are, how they are connected to the patient, if it's family members, saying what the relationship is.

    00:23 If it's team members saying what their role on the team is.

    00:29 It's always important for whoever's leading the meeting or, you know, the other supporting members of the team to set a tone that is non-threatening, show that they appreciate everyone for participating in the meeting, for coming to the meeting and really try to be, you know, friendly and cordial in starting the meeting.

    00:49 You want to, whoever the lead person is going to be, to explain the agenda of the meeting, see if that requires modification.

    00:57 So, as I said, the pre-meeting from the healthcare team, they might have set certain agenda or things that they want to accomplish but you need to check in with the patient and the family, are there other things that need to be addressed during the meeting? Is there something going on clinically with the patient that you need to attend to first before you can get to your meeting agenda? So, there's always an opportunity for modification of the agenda based on those initial interactions.

    01:27 And then, it's also important, especially if it's family members that you haven't met before, you need to determine how information is to be handled.

    01:35 Is there going to be some amount of information that some family members shouldn't hear? Does the respect for patient mean that they want to keep some information private? So, you need to be clear, maybe that's happening on a pre-meeting with the patient or, you know, the family member that you've been communicating with, how you're going to handle information during the meeting. You want to start with the patient perspective.

    02:02 So, what does the patient or their family member understand about what's going on? So, the questions are really the ask-tell-ask framework where you're asking them what they're understanding.

    02:17 Why you're having the meeting, what's going on clinically, what the treatment decisions need to be, you know, what's their knowledge base so that you can then fill in details, provide clarifications, and then, go on to the rest of the agenda. Part of, you know, setting the tone is setting expectations.

    02:42 So, you want to, over the course of the meeting, talk about what are the hopes of the patient, what are their fears, you know, the patient and/or their family. What do they view as important? So, you want to do that both in the ongoing discussion during the meeting but also, at the outset of the reason we're having this meeting is to find out what's important to you as we make treatment decisions.

    03:08 It's always important to, you know, check in with the team members and make sure they're clear that we need to give adequate time for the patient and/or their family to speak.

    03:18 It shouldn't be a, you know, monologue by team members.

    03:21 It should be a dialogue between all participants and making sure the patient and their family have the opportunity to share their viewpoint.

    03:33 Periodically, over the course of the meeting, there should be this, you know, throwing back to them what questions do you have, what more information do you need? It shouldn't be, "Do you have questions, yes or no?" But, "What questions do you have?" That sort of, unconsciously, gives the viewpoint of they should have questions.

    03:53 They should be asking you and you want them to ask those.

    About the Lecture

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

    Included Quiz Questions

    1. Have everyone introduce themselves.
    2. Set the tone of the meeting and show appreciation.
    3. Explain the agenda of the meeting.
    4. Ask everyone to take notes.
    5. Ask the family to withhold prognostic information from the patient.
    1. Ask the family to conduct a group prayer.
    2. Check the understanding of the disease with the patient.
    3. Ask for questions.
    4. Provide adequate time for attendees to speak.
    5. Check the patient's hopes and fears.

    Author of lecture Start of a Family Meeting

     Mark Hughes, MD, MA

    Mark Hughes, MD, MA

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