Palliative Medicine Family Conferences Reduce Spokesperson Distress and Enhance Communication in Advanced Cancer.

INTRODUCTION: Family conferences (FCs) may be important in communication. There is limited evidence about their value in palliative medicine. We examined specific information needs of patient-identified spokespersons (SP) and if the needs were met by a subsequent FC. Further data were collected on FC attendee characteristics, changes in SP distress, and SP assessment of FC value. METHODS: We conducted a prospective observational study of the family SP perspective of consecutive first time palliative medicine FCs for cancer patients. The SP completed standardized questionnaires and a Distress Thermometer pre- and post-FC. RESULTS: Seventy-eight FCs were eligible. Daughters/sons were the largest single attendee group. The median FC duration was 45 minutes (range 30-100). The location was usually at the bedside. Distress thermometer (DT) scores fell in 51%, rose in 26%, were stable in 23%, and were unaffected by patient presence. On average, there was a one-unit reduction in DT scores post compared to pre (p = 0.0059, 95% CI -1.5 to -0.3). The SP wanted information on a median of 15 (range 13, 17; 83%) questionnaire items beforehand; a median of 12 (range 10-14; 67%) were discussed. Overall, 62% of the total items were "needs met" in ≥50% of the SP. CONCLUSIONS: The FC attracted multiple participants; usually sons and daughters. Duration was typically 45 minutes and usually at the bedside. Nearly all SPs found the concept valuable both before and after the FC. Distress decreased or remained stable in most SPs. Most of their self-identified information needs were met. Thematic analysis of qualitative data supported the value of FC. Formal FCs are powerful and important communication tools in advanced cancer.

A prospective study of the clinical content of palliative medicine interdisciplinary team meetings.

Structured interprofessional communication should improve the structure and clarity of the plan of care. The interdisciplinary team meeting (IDTM) is an opportunity for shared information on patients' and family care needs. We report a prospective observations study of palliative medicine IDTM, which recorded the clinical issues discussed. One hundred and forty-five disparate clinical items were identified for 59 patients and were discussed by the IDTM in about 240 minutes. By content analysis and research meeting consensus, they were grouped into 9 agreed interdisciplinary themes. The 9 themes were then subjected to biostatistical analysis and 3 communication clusters identified. Themes consisted of 3 major communication clusters: (1) clinical services, (2) psychosocial, and (3) care plan. Two themes (information exchange and clinical transitions) did not cluster. The IDTM identified patient care need, reported concerns, and supported collaboration in proactive patient care plans. Future research projects with more patients and a large number of meetings can confirm our findings. This should also examine specific contributions by professional discipline.

The family conference in palliative medicine: a practical approach.

A family conference (FC) is an opportunity for the family and their physician to share their knowledge and concerns about the physical and psychosocial dimensions of care. Appropriate communication principles and practice are both important for an effective FC. The FCs guided by common sense principles and sound clinical practice (good structure, content, and process) have beneficial outcomes. (1) Creation of a therapeutic partnership so the family and medical team collaborate in the difficult task of sophisticated medical and psychosocial care of a complex illness. (2) Enhanced therapeutic management through education and support of the patient and primary caregiver (and other family members) to facilitate self-efficacy and convey realistic hope with careful sequencing of key messages. (3) Easier patient transitions from cure- to care-oriented management, with a formal (yet thoughtful and gentle) introduction to the principles and practice of modern palliative medicine.

The family conference in oncology: benefits for the patient, family, and physician.

The family conference (FC) is a forum for communication with both the patient and family to discuss essential information about medical, educational, and psychosocial needs. It ensures appropriate decision-making, which is integral to comprehensive cancer care. Inclusion of the family creates opportunities and challenges. The main opportunities are for the family to share support for the patient and collaborate with the medical team. This can ease adaptation throughout the illness course with better adherence to recommended treatment plans and greater satisfaction with medical care. The challenge is to manage communication to evolve understanding when treatment outcomes are not curative, and to meet the medical information and psychosocial needs of the patient and family. The FC aim is to give the family confidence by: (1) providing a calm discussion and understanding the illness and treatment; (2) offering a sense of safety that patient's goals will be balanced by the impact on the family caregivers; (3) affording the opportunity to connect and sustain each other; (4) sharing hope and mutual empathy; and (5) maintaining self-efficacy to manage their needs. Using the FC to discuss the plan of care and at the same time assisting the family to process the impact of the illness optimizes benefit for the patient, family, and physician.

Family distress in palliative medicine: a pilot study of the family APGAR scale.

The family is essential to patients with advanced cancer. Family and caregiver distress, however, can impair optimal care and support of the patient. A five-item questionnaire, the Family APGAR Scale, was evaluated to determine family functioning levels of selected patients. The APGAR Scale has five components for measuring family functioning: Adaptation, Partnership, Growth, Affection, and Resolve. Fifty consecutive patients admitted to a palliative medicine inpatient unit were reviewed for a pilot study. Eligibility requirements included admission to the unit for the first time, and the ability to speak English and give informed consent. Fifteen patients and 11 primary caregivers participated. Despite the small sample, some significant family functioning issues were identifed. Completing the study later with a larger sample will provide information that will help the multidisciplinary team better meet the needs of both patient and family.