Planning
Plan for a family conference within 24–48 hrs of ICU admission First meeting is preferably an informational meeting and done early enough that major decisions can be introduced as well as discharge planning Decide who should be present (family, care team which may include other services such as limited to social work, chaplaincy, and palliative care) and anticipate if interpreter is needed If patients have decision making capacity, they should be included in the meeting or have main points discussed with them Arrange convenient time and private setting
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Preparation
Review data, imaging, likely diagnosis and treatment to date, options Meet with care team members Confirm everyone’s understanding of care plan, goals for meeting (information gathering, information distributing, goals of care, prognosis, etc) Decide who will lead and answer questions Decide what clinical treatments, interventions, therapies are appropriate to the patient and how they will be presented in terms of risks and benefits Anticipate potential conflicts or challenges beforehand If appropriate, electronic devices should be shut off
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Meeting
Provide and ask for introductions Provide a succinct summary in easy to understand language Allow families to make any corrections to clinical summary or add missing information Allow for questions Ask about patient’s values and what family understands about prestated wishes Ask family what their concerns and fears are and address them Summarize what the medical plan is going forward and elicit any questions about the plan and clarify any misconceptions Anticipate future meetings and agenda for these meetings
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Advice for Meeting
Actively listen by acknowledging, rephrasing, and affirming family statements Acknowledge that conversations and decisions are difficult even painful during these times Inform families about ICU resources available to them for counseling and information Be direct and be willing to acknowledge uncertainty Acknowledge that patient’s wishes are the centerpiece of discussion and that decisions are ultimately consistent with patients’ values Assure the family that any clinical change will be conveyed to them whether they are in the hospital or not Assure families that patient’s needs including pain relief are being constantly assessed Provide the family information on how to reach the care team 24/7 with any questions or concerns
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Post Meeting
Debrief with care team members about their thoughts about meeting Discuss what went well or what did not go well and why Discuss any challenges or goals moving forward and how to address Document what was discussed at the meeting in the medical record so that others will have access to the information Place any orders for the patient that resulted from the meeting If family had concerns or requests that arose during meeting, start to address those tasks
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