1. Getting the Most from Family Meetings Anthony Galanos MD, MA Jennifer Gentry APRN BC Duke Center for Palliative Care Department of Medicine Division of Geriatrics

2. Physician-Family Conference Patients/surrogates want an opportunity to discuss Big Picture Patients/surrogates want an opportunity to discuss Big Picture Goal Setting Goal Setting Emotional volatile Emotional volatile Little formal training for nurses and physicians as a skill Little formal training for nurses and physicians as a skill

3. The Anatomy of An Explosion… Conflict “I call ethics/palliative care when the family is mad” Conflict “I call ethics/palliative care when the family is mad” Mismatched expectations Mismatched expectations Poor preparation Poor preparation Uncertainty Uncertainty

4. Before the Meeting Review history, treatment options, prognosis Review history, treatment options, prognosis Who should be there? Who should be there? Who is going to lead? Who is going to lead? The meeting before the meeting The meeting before the meeting

5. The Setting Location, location, location Location, location, location Is the patient able to participate? Is the patient able to participate? Seating arrangements Seating arrangements

6. Open the Meeting Introduce everyone Introduce everyone Establish the goal of the meeting Establish the goal of the meeting “Today, I’d like to make sure that everyone understands how (the patient) is doing and answer questions you may have” “Today, I’d like to make sure that everyone understands how (the patient) is doing and answer questions you may have” Ask family what their goal for the meeting is Ask family what their goal for the meeting is Establish ground rules Establish ground rules Is there a time limit? Is there a time limit? Everyone will have a chance to ask questions Everyone will have a chance to ask questions Acknowledge that this is a difficult time/situation Acknowledge that this is a difficult time/situation

7. What Do They Understand? Make no assumptions Make no assumptions What do you understand about your What do you understand about your condition? condition? What have the doctors told you? What have the doctors told you? How do feel things are going? How do feel things are going?

8. When There is Conflict…. When you hear conflict, think emotion, When you hear conflict, think emotion, rather than assume an understanding problem. Clarify any misunderstanding Respond to the emotion

9. Emotion Handling Skills (NURSE) Name “I can see how distressing this is…” Name “I can see how distressing this is…” Understand Understand “I can imagine that this must be difficult” Respect “You are asking a lot of really good questions” “I can see that you want to respect your dad’s wishes” Support “ We will continue to talk and answer your questions”, “I (or whoever) will check in with you tomorrow” Explore “Tell me more about what you are thinking”

10. When There is No Consensus… Each family member may be in a different place Each family member may be in a different place Prior family conflicts, especially concerning alcohol, drugs, or abusive relationships, may make decision making a challenge Prior family conflicts, especially concerning alcohol, drugs, or abusive relationships, may make decision making a challenge Time limited trials can be helpful Time limited trials can be helpful Schedule a follow up meeting Schedule a follow up meeting Other options (ethics consult, spiritual advisor) Other options (ethics consult, spiritual advisor) Summarize areas of agreement and disagreement Summarize areas of agreement and disagreement

11. Its Your Turn Now….