1. PALLIATIVE CARE
Enhancing Communication with
Patients and Families
Rama Kunkle, D.O.
Medical Director, Palliative Care Services
HonorHealth, John C. Lincoln Medical Center
3. Preparing for a Family Meeting
• Identify one clinician as meeting
leader
• Ensure team understands goals of
meeting
• Identify mpoa or surrogate decision
maker
• Arrange a private, quiet location with
seating for all
4. Starting the Meeting
• Have each person introduce
him/herself
• Ask family to give their sense of the
situation
• Start from where the family is
5. Giving Information
• Ask for permission
• Explain medical situation in simple
terms. Avoid jargon
• Don’t talk too much or focus on
technical matters
• Check frequently on what the family
has heard
• Be transparent about uncertainty
6. A Guide for Conducting a Family
Meeting: Empathy
• N-ame “you seem distressed, (or angry or
worried, etc.)”
• U-nderstand “this must be very difficult for
you”
• R-espect “You are asking a lot of very good
questions”
• S-upport “We can meet again tomorrow”
• E-xplore-“Tell me more about what you are
thinking/feeling”
7. Phrases to Avoid
• “There is nothing more we can do”
• “I wish there was something we could do to
make your lungs get better”
• “Would you like us to do everything
possible?”
• “How were you hoping you we could help
your mother?”
• “Withdrawal of care”
• “Stop the interventions that are no longer
helpful”
8. Wrapping Up the Meeting
• Ask for questions
• Arrange for a follow-up
• Summarize any decisions that were
made
• Document the meeting and plan in
the chart
9. Health Care Decisions
• If a patient can make his/her own
decisions, the patient should be
asked and their wishes should be
honored
• State of Arizona Surrogate list
1. Guardian
2. Health Care (Medical) Power of
Attorney
10. Surrogate List
• The patient’s spouse unless legally
separated
• An adult child of the patient, or a
majority of adult children
• A parent of the patient
• The patient’s domestic partner if the
patient is unmarried
• A brother or sister of the patient
• A close friend of the patient
11. Health Care Decisions
• If no one can be identified, the attending
physician can make a decision after
consulting with an ethics committee
• 2 physicians can make decisions
• Only the patient, a guardian or MPOA can
make the decision to withdraw the artificial
administration of food or fluid
• All other medical treatment decisions can
be made by the appropriate decision-
maker
12. Reference
• “A guide for conducting an ICU Family
Meeting When the Patient is Unable to
Participate.” Robert Arnold MD and Judith
Nelson, MD, JD
