The Family Conference Victor S. Sierpina, MD Nicholson Professor of Integrative Medicine Associate Professor of Family Medicine UTMB.

The Family Conference

Victor S. Sierpina, MDNicholson Professor of Integrative Medicine

Associate Professor of Family Medicine

UTMB

Learning Objectives

Identify the important role of families in clinical decision making

Describe the purposes of a family conference Describe a five phase approach to facilitating

a family meeting

Why a Family Conference?

Families are your allies Families are your expanded information

source Families provide support, direction, action,

influence Families are a reality check on how your

plans are likely to be implemented in the “real world”

Appropriate Times to Convene a Family Conference

During a hospitalization or for discharge planning

Routine obstetrical or well-child care

Announcing a serious illness Terminal illness Making a difficult treatment

decision

Appropriate Times to Convene a Family Conference

High utilization of medical services Mental health or substance abuse problems Somaticization Placement in nursing home, other extended

care facility, or hospice Marital or sexual difficulties

Case Scenario:

Bill is a 63-year-old man admitted following a massive MI. In the ER he is stabilized, intubated and transferred to the ICU. By history he experienced an unknown period of anoxia prior to arrival of the EMTs. On exam he remains unresponsive to deep pain after 3 days. On the third day of hospitalization, Bill's wife Susan, and three children join you for a family conference to discuss his treatment. How do you run a family conference?

Why families are important in end-of-life decision making

The family knows best what the patient would have wanted

The family cares more about the patient’s well-being than anyone else

The patient wanted the family to make this decision and trusted their judgment (+/- a formal durable power of attorney for health care)

The family will live with the consequences of the decision more vividly than anyone else

Process

Why: Clarify conference goals in your own mind

Where: A room with comfort, privacy and circular seating

Who: Patient (if capable of participating); legal decision maker/health care power of attorney; family members; social support; key health care professionals

How:………..

How to Conduct a Family Conference

Establish contact person and attendees Establish rationale Hypotheses and goals for conference, strategy Consider preparing a genogram

When and How to Convene

Involve family members as soon as possible in patient’s care

Notify any available family members when you wish to have a conference and tell them why

Give specific instructions, emphasize importance of conference, acknowledge problems

Phases of the Family Conference

1. Socialize

2. Set the goals

3. Discuss the problem or issue

4. Identify resources

5. Establish a plan

Levels of Intervention

1. Minimal emphasis on family

2. Ongoing medical information and advice

3. Feelings and support

4. Systematic assessment and planned intervention

5. Family therapy

Potential Problems

Patient says family won’t come in Blaming the family Resistance to participation by family

members No show by family Too much attention to certain member Unknown Family Dynamics issues

Post-conference Tasks

Revise hypotheses, genogram, plan Write up report of meeting Follow-up Follow-up