Learning objectives to meet the goals of knowledge to practice: Define the term family Discuss issues of conflict which may interfere with advance.

Learning objectives to meet the goals of knowledge to practice:

Define the term family

Discuss issues of conflict which may interfere with advance care planning

Identify communication strategies to support the individual’s family

LakeheadU N I V E R S I T Y

WHAT IS FAMILY?

LakeheadU N I V E R S I T Y

WHAT IS BEHIND THE SOURCE OF CONFLICT

Be aware of family dynamics at times of stress - avoid labelling

Conflict may arise in different situations and involve different people

Pressure to understand the severity of the illness, treatment options and making the ‘best’ decision

Contributing social, emotional, cultural and personal factors

Is there a subtext that underlies the words?

Are reactions unrelated to the immediate issue at hand?

LakeheadU N I V E R S I T Y

THINGS TO CONSIDERThings to remember:

No two families are alike

Many families have long histories of troubled relationships

Avoid ‘taking sides’ – establish boundaries

Always attempt to foster communication and understanding among family members

Remain non-judgemental – resist giving advice

Resist imposing personal standards and values

LakeheadU N I V E R S I T Y

Stresses which may create conflict:

Intense feelings

Uncertainty

Old family conflicts

Changes in family roles

Economic difficulties

Past experiences with loss or death

Fluctuation from denial to acceptance

Consequences Resulting from Conflict

Conflicts may result in:

Lack of treatment or over treatment

Lack of trust in health care providers & system

Loss of precious time

Emotional depletion

Increased stress

Complicated bereavement

LakeheadU N I V E R S I T

Y

Difficult situations may include:

Not respecting advance directives (i.e. not willing to accept the person’s wishes)

Lack of agreement on care

Designated POA or SDM not local

Shared POA without congruency

KEEP IN MIND .... Don’t take it personally - anger is at the situation

Expect denial

Give appropriate information

Explore past methods of coping

Encourage discussions which provide reasoning behind the decisions

Recognize own limits

Utilize the expertise of other team members in helping with conflicts

Focus on the goal to make decisions that

respect the person’s wishes, values and

goalsLakehead

U N I V E R S I T Y

Is the reaction a result of

what is being said

the timing of what is being said

what is represented by what is being said

HEALTH CARE PROVIDERS IN CONFLICT WITH SDM’S

BALANCED COMMUNICATI

ON –NEGOTIATION-

MEDIATION

Values & experiences of healthcare providers – awareness of impact on others (perceived power)

Resolution is the responsibility of health care providers

It is important for the entire health care team to show caring, respect, and support for the acting SDM in order to emphasize that they are working with him/her as part of the team

Show interest Inquire about their well-being

LakeheadU N I V E R S I T Y

Things to consider:

Is the environment conducive for discussion

SDM’s understanding of the situation

SDM’s fear of making the wrong decision Guilt Sense of abandonment Responsibility for ‘killing’ their loved one

Broad range of reactions

Unique challenge of communicating emotionally laden material What do you hear? Clarify ambiguous statements Listen in balance with speaking

LakeheadU N I V E R S I T Y

Explore the Bigger Picture

• Why did the conflict arise?

• Identify changes in behaviours of health care providers and the system

Reflect on ways you could be contributing to conflict

Identify ways in which you can change your behaviour or make a conciliatory gesture

Avoid labelling i.e ‘dysfunctional family’

Try to understand the emotional meaning of the context of what is being said

Work towards being unbiased

Encourage self-awareness

Remember the importance of non-verbal communication

Recognize the cost of ignoring the problem

LakeheadU N I V E R S I T Y

Positive Conflict Resolution

Note: family members may refuse to bring forth advance directives if they disagree with the contents or out of fear of losing their loved one when it is clear that imminent death is near

acknowledge their emotions educate

COMMUNICATION: QUESTIONS TO ASK TO GET THE CONVERSATION STARTED WITH A

SDM OR POA

LakeheadU N I V E R S I T Y

What can the health care team do to help you and your loved one? Help us understand what your loved one would want if he/she could speak to us now.

What are some of the things that make life worth living for your loved one?

If your loved one were going to die soon, what are some of the personal things that would be important for her/him to take care of?

Do you and/or your loved one have religious or spiritual ways to get ready for death?

Are there heath problems that your loved one would think are worse than death, such as living with severe pain, with total physical dependency, or not being able to recognize or communicate with family and friends?

STEPS TOWARD RESOLUTION Acknowledge the goals, values, beliefs and

wishes of the person

Work towards positive communication strategies

Rely on strengths from members from the inter-disciplinary team (i.e. Pastoral care, social work)

Utilize structures within and external to the current setting – inter-organizational supports e.g. ethics committee, legal assistance, Public Trustee and Guardian, capacity assessor

LakeheadU N I V E R S I T Y

The single biggest problem in communication is the illusion

that it has taken place

George Bernard Shaw

REFERENCES

Centre for Education and Research on Aging & Health. (2008). Working with families. Thunder Bay: Lakehead University, 3.1-3.34.

Educating Future Physicians in Palliative and End-of-Life Care (EFPPEC). (2008). Facilitating Advance Care Planning: An Interprofessional Educational Program: Curriculum Materials. Ottawa : EFPPEC, 42-50.