Author: Linh Nguyen, MD
Family meetings are an important strategy for communicating and negotiating goals of care in geriatric and palliative patients.
A family meeting is typically indicated when delivering bad news, prognosis discussions, withholding or withdrawing treatments, or hospice discussions.
Meetings should be proactive when possible and not reactive to crisis situations. Family meetings should be offered routinely and conducted at pertinent times thereafter.
Provide a safe environment that is mutually beneficial.
Six-step patient-centered goal(s) approach:
Another way to recall this approach is the "SPIKES" acronym:
Setting up the interview, assessing the patient's
Perception, obtaining the patient's
Knowledge and information to the patient, addressing the patient's
Emotions with empathetic response, and
Strategy and summary (Baile, Buckman, Lenzi, Glober, Beale, & Kudelka, 2000).
A good rule to follow - discuss what you can do for the patient and family before discussing what you cannot do (Quill, Holloway, Shah, Caprio, Olden, & Story, 2010).
In family meetings, family satisfaction is significantly associated with an increased proportion of time that the family speaks.(McDonagh, Elliott, Engleberg et al., 2004).
Baile, W.F., Buckman, R., Lenzi, R., Glober, G., Beale, E.A., & Kudelka, A.P. (2000). SPIKES-A Six-Step Protocol for Delivering Bad News: Application to the Patient with Cancer. The Oncologist, 5:302-311.
McDonagh, J.R., Elliott, T.B,. Engleberg, R.A., et al. (2004). Family satisfaction with family conference about end-of-life care in the intensive care unit: increased proportion of family speech is associated with increased satisfaction. Critical Care Medicine, 32:1484-1488.
Quill, T.E., Holloway, R.G., Shah, M.S., Caprio, T.V., Olden, A.M., Story, C.P. (2010). Chapter 6: Goal Setting, Prognostication, and Self-Care. In Primer of Palliative Care (5th ed., 109-137). Glenview, IL: American Academy of Hospice and Palliative Medicine.