Beth Israel Deaconess Medical Center Department of Medicine Principal Investigator: Julie T. Irish, PhD Effective clinician-family communication is essential in all healthcare settings, but particularly in acute care settings such as the intensive care unit (ICU). In the ICU, patients are usually unable to speak for themselves and family members become their surrogate decision-makers. The challenges are many. Information must be shared clearly so family members can understand the nature of their loved one’s illness, as well as the diagnostic and treatment plans under consideration by the ICU team. Beyond content, there is much more to convey – assurances that the doctor, nurse or social worker is truly listening and responsive, that their understanding goes beyond that of the disease per se and includes empathy for the patient’s and family’s situation and feelings, that the professionals caring for the patient seek to work together and with the family as partners on behalf of the patient’s best interests, and have the requisite competence to do so.

1. FAMILY MEETING COMMUNICATION SKILLS
TASK HELPFUL PHRASES & TIPS
PREPARE FOR MEETING □ Review clinical details
□ Decide who should be present at the □ Consider family dynamics
meeting □ Arrange pager coverage
□ Agree on agenda with other □ Take a minute to focus your thoughts
members of the team
SET THE STAGE • The ICU team may change from day to
□ Ensure everyone introduces day but it always includes a supervising
themselves and their roles physician, a resident physician/intern,
□ Arrange physical setting to maximize and the nurses. We share information to
comfort & privacy–and to minimize coordinate the care your father receives.
‘us’ vs. ‘them’ • When you enter in the room you will
□ Prepare family for ICU setting see things that may make you feel
uncomfortable. You may hear alarms. Your
father will have a tube placed…
BUILD THE RELATIONSHIP Respond to Emotion – Use the ‘PERLS’
□ Show interest in patient’s and • Partnership – We work as a team in the
family’s psychosocial issues ICU and we see you as part of that team.
□ Listen and encourage family’s • Empathy – I am sorry that this is
participation happening to your loved one.
□ Respond to family’s concerns and • Reflection – I hear you saying…
emotions • Legitimize – I know that this is a difficult
□ Adjust your ‘nonverbals’ to meet experience for you and your family.
family members’ needs • Support – How are you coping? Would you
like to speak to an ICU social worker?
OPEN THE DISCUSSION • We wanted to meet to update you on your
□ Explain the reason for meeting father’s condition.
□ Elicit full set of concerns family • What questions or concerns would you like
members want to discuss to be sure we discuss today?
□ Explain and/or negotiate an agenda • We have ½ hour today, if we cannot cover
for the meeting everything we will schedule another
meeting soon.
GATHER INFORMATION • Tell me what you father was like before he
□ Elicit family’s understanding of was sick? What was important to him?
patient’s situation • Can you help me understand what he was
□ Elicit information about family able to do on his own 3 months ago…
members’ issues & concerns could he get out of bed, walk, bathe,
prepare food independently?

2. FAMILY MEETING COMMUNICATION SKILLS
TASK HELPFUL PHRASES & TIPS
GET PATIENT’S PERSPECTIVE • Did your father have special interests? Was
□ Ask about patient’s psychosocial he a religious person? What were his major
context concerns about being critically ill?
□ Ask about kind of treatment patient SUBSTITUTED JUDGMENT
would want • Imagine he was sitting in this room
watching us. What would he want if he
could speak for himself?
SHARE INFORMATION • Just so we know where to begin, can you
□ Use words family can understand tell us what your understanding is of your
□ Remember: ASK-TELL-ASK father’s current situation?
□ Give accurate and comprehensive PROGNOSIS
explanation about patient’s condition • We can’t know the future for any individual
including prognosis person. We do know that if we see 100
□ Explain diagnostic and treatment patients who are about as sick as your
options father, about 30-50 of them would die
before they leave the hospital. He is
□ Explain time frame for treatment
critically ill and we’re very worried about
□ Verify family’s understanding of him. While we still have hope, we also want
information and options to be prepared for the possibility that he
may not do well.
REACH AGREEMENT • We need to make some decisions together
□ Discuss pros and cons of options about your father’s care.
□ Discuss uncertainties associated with • We’ll work together to be sure your father is
the decisions comfortable and does not suffer.
□ Negotiate differences in preferences WITHDRAWAL OF LIFE SUPPORT
for treatment among family members Tell family that withdrawal of life support
□ Propose mutually agreeable decision does not mean withdrawal of care.
It is moving from aggressive life prolonging
□ Use reflective listening
care to aggressive comfort care.
Reassure family that patient will not suffer.
PROVIDE CLOSURE • I’m sure you have many questions, please
□ Restate the decisions ask me.
□ Summarize what will happen next • We should have more information
□ Ask if any further questions tomorrow. Let’s meet on Saturday to
discuss your father’s progress.
□ Let the family know how to reach
you if they have questions • I would like to give you some time to
process what we’ve discussed. If you think
□ Tell them who else is on the team
of more questions, please have me paged.
and how to reach them