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

2. 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

3. 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”

4. 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

5. 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

6. 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?

7. 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

8. 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: ………..

9. How to Conduct a Family Conference  Establish contact person and attendees  Establish rationale  Hypotheses and goals for conference, strategy  Consider preparing a genogram

10. 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

11. Phases of the Family Conference 1. Socialize 2. Set the goals 3. Discuss the problem or issue 4. Identify resources 5. Establish a plan

12. 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

13. 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

14. Post-conference Tasks  Revise hypotheses, genogram, plan  Write up report of meeting  Follow-up