Table 3.

Representative quotes describing strategies for “sizing up” families

Solicit input from nurses:

“[T]alking to nursing staff, who spend a bit more time with the family. Going into a meeting, it’s very helpful to get a better understanding of where the family is at emotionally and what they understand is going on.” (Physician 17)

Early “informational” meetings:

“I have an ‘early and often’ approach to family meetings in the ICU; the earlier you meet with the family and start to set expectations and establish a relationship with the family, the better it goes. Early family meetings help hugely; you get an early assessment of the family dynamic, competing factions, and understandings or interpretations within the family, how big [the] family is, who all needs to be involved in decision-making, and a quick assessment of health literacy and realism.” (Physician 12)

Informal bedside interactions:

“When you’re meeting the family ahead of time, you try to get a feel when you’re talking with them what kind of reaction you might get. Sometimes you can feel it when they first come in, when you first meet them and see them, as to how upset or accepting they are of what the circumstances might be.” (Physician 7)

Bedside rounds:

“My practice is to do bedside rounds in the ICU, and I ask any family members present to stay in the room, listen in, ask questions, and I find that really helpful in preparing for family meetings—what they say at the end.… I invite family to stay or tell them in advance when we’ll be rounding. I try to prepare them for follow-up family meetings during informal interactions at bedside or during rounds.” (Physician 5)

Definition of abbreviation: ICU = intensive care unit.