Goals of care are often established in a structured meeting with the person with a life-limiting illness, their family and all relevant healthcare providers.[1, 2] These meetings provide an opportunity to express and share concerns, questions and feelings within a safe and structured environment. The aim of the family meeting is to ensure everyone is ‘on the same page’ to achieve the best outcome for the person with a life-limiting illness. Discussions can involve:[2-5]
- Establishing, clarifying and reviewing goals of care
- Provision of information and resources
- Supports that are in place for the person with a life-limiting illness and their family
- Explanation of care pathways and different strategies of care available to both the person and their family.
Since the person’s needs, goals and priorities can change as they deteriorate – or due to changes in their attitude or situation – it is essential that these conversations are revisited.
Family meetings: [3, 5, 6]
- Require a skilled facilitator
- Are based on family need
- Promote a proactive approach to care
- Can provide a clearer picture of the goals of care
- Are mutually beneficial to all stakeholders.
Family meetings are documented in the clinical record to maintain communication among health professionals. Record who attended and provide a clear summary of significant conversations and decisions.
Family meetings are not:
- A platform for clinical debate about a person’s illness
- A tool saved for crisis situations only.
When supporting the family, it is important to remember that some family members:[5-7]
- Will not be able to make decisions because of their current level of grief or shock
- Do not always get along with other family members – understanding the family structure and dynamics can help
- Will have difficulty in communicating effectively or contributing to decision-making, which can lead to difficult situations.
In the first instance, it is useful to seek an understanding of the family structure, the dynamics involved and any cultural differences that you need to take into account. The family group involved can vary considerably in size depending on cultural background and community connections. Acknowledge that there can be tensions or conflict within a family but be realistic about the support that can be provided – and the results that can be achieved.
Consider the way that the family is coping and adapt the situation to their needs. Referral to counselling or other specialised support can be required. Contact your local specialist palliative care service for information on the services available locally. In some instances, you will need to ask the family to appoint a spokesperson to lead discussions and to aid with any conflict or underlying tension.[5-7]
- How can a family meeting assist with deciding on goals of care?
- How can you manage often-competing interests in a family meeting?
- Rome, R.B., et al., The Role of Palliative Care at the End of Life. The Ochsner Journal, 2011. 11(4): p. 348-352.
- Joshi, R., Family meetings: an essential component of comprehensive palliative care. Canadian family physician Medecin de famille canadien, 2013. 59(6): p. 637-639.
- Therapeutic Guidelines Ltd, Support for families and carers in palliative care. 2019: Melbourne.
- The University of Queensland and Blue Care Research and Practice Development Centre, The Palliative Approach Toolkit. 2012, The University of Queensland: Queensland.
- Sanderson, C.R., et al., Patient-centered family meetings in palliative care: a quality improvement project to explore a new model of family meetings with patients and families at the end of life. Ann Palliat Med, 2017. 6(Suppl 2): p. S195-s205.
- Joshi, R., Family meetings: An essential component of comprehensive palliative care. Canadian Family Physician, 2013. 59(6): p. 637-639.
- Sharma, R.K. and S.M. Dy, Cross-Cultural Communication and Use of the Family Meeting in Palliative Care. American Journal of Hospice and Palliative Medicine, 2011. 28(6): p. 437-444.