Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

Tips for Conducting a Family Conference
**After the Pre-conference, proceeds either to 2 or 3.
 
1.      Pre-conference:
a.      Clarify conference goals and roles with the health-care team.
b.      Identify participants (health-care team, individual and family).
c.      Organize date, time and location (private space when available).
 
2.      Conference with individual capable to make decisions and family if desired:
a.       Introduce self and others.
b.       Review meeting goals; clarify if specific decisions need to be made.
c.       Determine urgency of decision-making.
    • Establish ground rules: Each person will have an opportunity to ask questions and express views without interruption; a legal decision-maker will be identified; and the importance of supportive decision-making will be described.
d.      Review health status:
                          i.      Determine what the patient and their family already know: “Tell us      
                                  what you understand about your current situation.”
                         ii.      Review current health status.
                         iii.     Ask individual and family members if they have any questions about
                                  the current situation.
e.      Clarify expectations
f.       Clarify beliefs and values to determine what goals are most important to avoid or
         achieve.
g.      Discuss practical implications of preferences and expectations (i.e. are goals
          realistic and achievable?).
h.      Allow time for private discussion.
i.       Review and/or set goals of care.
 
3.      Conference with substitute decision-maker(s) and others as identified:
a.      Introduce self and others.
b.      Clarify role of substitute decision-maker(s) and confirm willingness to participate in
         decision-making.
c.      Review meeting goals; clarify if specific decisions need to be made.
d.      Determine the urgency of decision-making.
e.      Establish ground rules: Each person will have an opportunity to ask questions and
         express views without interruption; a legal decision-maker will be identified; and
         the importance of supportive decision-making will be described.
f.       Review health status.
                          i.      Determine what the substitute decision-maker(s)/family already
                                  know: “Tell us what you understand about the individual’s current 
                                  situation.”
                         ii.      Review current health status.
                         iii.      Ask the substitute decision-maker(s) and family members if they
                                   have any questions about the current situation.
g.      Clarify expectations:
                          i.      Ask substitute decision-maker(s): “What do you believe the individual
                                  would choose if he/she could speak for him or herself?”
                          ii.     Based on what the substitute decision-maker(s) understand about
                                  what the individual would have wanted, ask he/she: “What do you
                                  think should be done?”
h.      Clarify beliefs and values to determine what goals are most important to avoid or
         achieve.
i.        Discuss practical implications of preferences and expectations (i.e. are goals
          realistic and achievable?).
j.        Allow time for private discussion.
k.      Review and/or set goals of care.
 
4.      Wrap-up:
a.       Summarize consensus, disagreements, decisions and goals of care.
b.      Caution against unexpected outcomes.
c.       Identify family spokesperson for ongoing communication.
d.      Document in the health care record: who was present, goals of care, what
         decisions were made, follow-up plan.
e.       Maintain contact with individual, substitute decision-maker(s), family and
          health-care team.
f.       Schedule follow-up meetings as needed.
 
N.B. When there is no consensus:
  • Determine unmet needs for information and support.
  • Assist the individual/substitute decision-maker(s) to access resources to address unmet needs.
  • Reinforce role of substitute decision-maker if applicable.
  • Schedule a follow-up conference.
 
Adapted from Ambuel B and Weissman DE. Moderating an end-of-life family conference, 2nd Edition. Fast Facts and Concepts. August 2005; 16. Available at: http://www.eperc.mcw.edu/fastfact/ff_016.htm