family conferences or family meeting is an essential part to the provision of holistic care to patients especially those who are critically ill

1. FAMILY CONFERENCE
RHEA ANGELICA P. JAYMA, MD
PALLIATIVE MEDICINE
NATIONAL CHILDRENS HOSPITAL

2. Objectives:
At the end of the session, the participant is able to:
1.Understand the elements of a good family conference
2.Identify scenarios wherein this must be initiated
3.Apply these to selected case scenario

3. CHRONICALLY ILL
CRITICALLY ILL

5. PFC MATRIX
P
• Patient centered
• understanding of the interplay of biomedical psychosocial factors disease in order to implement
management that is tailor-fitted to the needs and values of the patient
F
• Family Focused
• utilizes family assessment to generate assumptions on how the family dynamics affect or
facilitate the prescribed management of the patient’s disease.
C
• Community Oriented
• enables the family physician to use social determinants of health and health systems as a lens to
understand how larger systems support or hinder the provision of care.

6. P
• Patient centered
F
• Family Focused
C
• Community Oriented
Respect and Dignity
Information sharing,
participation and
collaboration

7. FAMILY CONFERENCE
Respect and Dignity
Information sharing,
participation and collaboration

8. FAMILY CONFERENCE
the patient’s condition, prognosis, and care preferences;
for listening to the family’s concerns;
for decision-making about appropriate goals of treatment.

9. ELEMENTS OF
A GOOD
FAMILY
CONFERENCE
V: Value family statements
A: Acknowledge Family Emotions
L: Listen to the Patient and Family
U: Understand the patient as a person
E: Elicit family questions

10. FAMILY CONFERENCE
The S-P-I-K-E-S Strategy

11. The S-P-I-K-E-S Strategy
• Setting, Listening Skills
• Patient’s Perception
• Invite patient to share Information
• Knowledge transmission
• Explore Emotions and Empathize
• Summarize and Strategize

12. 1.SETTING UP the meeting and getting the physical context
right
 Arrange for some privacy
 Involve ALL significant family members/surrogate decision
decision maker
 Pre meeting of the medical team
 Manage time constraints and interruptions
 Look attentive and calm
 Use your active listening SKILLS
The S-P-I-K-E-S Strategy

13. 1.SETTING UP the interview
and getting the physical
context right
 Arrange for some
privacy
 Involve significant
others
 Sit down
 Look attentive and calm
calm
 Manage time
constraints and
interruptions
 Use your active listening
listening SKILLS
The S-P-I-K-E-S Strategy
ACTIVE LISTENING:
Lean forward
Open stance
Verbal / Voice of compassion
Eye contact
Relaxed
Seating arrangement

14. 1.SETTING UP the interview
and getting the physical
context right
 Arrange for some
privacy
 Involve significant
others
 Sit down
 Look attentive and calm
calm
 Manage time
constraints and
interruptions
 Use your active listening
listening SKILLS
The S-P-I-K-E-S Strategy
2. Assessing the patient’s/families’
PERCEPTION
 Determine how much the they know
 “Before you tell, Ask”
 Use open-ended questions
 Ascertain their current understanding
 to identify emotionally critical
misperception (ECMs)

15. The S-P-I-K-E-S Strategy
2. Assessing the patient’s/families’
PERCEPTION
 Determine how
much the they
know
 “Before you tell,
Ask”
 Use open-
ended
questions
 Ascertain their current
understanding
 to identify
emotionally
critical
misperception
3. Obtain the patient’s INVITATION
 Find out how much INFORMATION the patient wants
to know
“ARE YOU THE KIND OF PERSON WHO PREFERS TO
KNOW ALL THE DETAILS ABOUT WHAT IS GOING ON?”
“HOW MUCH INFORMATION WOULD YOU LIKE ME TO
GIVE YOU ABOUT WHAT IS GOING ON?”
“WOULD YOU LIKE ME TO GIVE YOU DETAILS OF WHAT
IS GOING ON OR WOULD YOU PREFER THAT I JUST TELL YOU
ABOUT TREATMENTS I AM PROPOSING?”

16. The S-P-I-K-E-S Strategy
3. Obtain the patient’s INVITATION
 Find out how much
INFORMATION the patient wants
to know
“ARE YOU THE KIND OF PERSON
WHO PREFERS TO KNOW ALL THE
DETAILS ABOUT WHAT IS GOING ON?”
“HOW MUCH INFORMATION
WOULD YOU LIKE ME TO GIVE YOU
ABOUT WHAT IS GOING ON?”
“WOULD YOU LIKE ME TO GIVE
YOU DETAILS OF WHAT IS GOING ON OR
WOULD YOU PREFER THAT I JUST TELL
YOU ABOUT TREATMENTS I AM
PROPOSING?”
4. Giving the KNOWLEDGE and
information to the patient
Use ordinary language in giving
medical facts
 Give information in small pieces and
always assess if understood well
Avoid excessive bluntness
 Warn the patient that bad news is
coming (wish worry wonder)

17. The S-P-I-K-E-S Strategy
4. Giving the
KNOWLEDGE and
information to the patient
 Warn the patient
that bad news is
coming
 Use ordinary
language in giving
medical facts
 Avoid excessive
bluntness
 Give information
in small pieces and
always assess if
understood well
5. EXPLORING the patient’s EMOTIONS and
giving EMPATHY
 Acknowledge patient’s emotions as they arise and to
address them
 3 Step Empathic Response:
1. Listen for and identify the emotion
2. Identify the source or cause of emotion
3. Show that you have made the connection
between the above two steps

18. The S-P-I-K-E-S Strategy
4. Giving the
KNOWLEDGE and
information to the patient
 Warn the patient
that bad news is
coming
 Use ordinary
language in giving
medical facts
 Avoid excessive
bluntness
 Give information
in small pieces and
always assess if
understood well
5. EXPLORING the patient’s EMOTIONS and giving EMPATHY
 Acknowledge patient’s emotions as they arise and to address them
 3 Step Empathic Response:
1. Listen for and identify the emotion
2. Identify the source or cause of emotion
3. Show that you have made the connection between the above two steps
5. EXPLORING the patient’s EMOTIONS and giving EMPATHY
Validate or normalize his feelings
Let them know that showing emotion is perfectly
normal
Combine empathy and validation should show
the patient that you understand the human side of
the medical issue

19. The S-P-I-K-E-S Strategy
5. EXPLORING the patient’s
EMOTIONS and giving
EMPATHY
 Acknowledge patient’s
emotions as they arise
and to address them
 3 Step Empathic
Response:
1. Listen for and
identify the emotion
2. Identify the
source or cause of emotion
3. Show that you
have made the connection
between the above two steps
6. SUMMARIZE and STRATEGIZE
Ask the patient or family if ready to discuss
the prognosis and treatment options
Shared responsibility for decision making
Planning and following through further
meetings
Try to leave them with some hope

20. The S-P-I-K-E-S Strategy
FAMILY CONFERENCE
BREAKING THE BAD NEWS
• Explain the diagnosis in
clear and easily understood
• small information at a time
• checking comprehension
throughout.
• Acknowledge emotions as
they arise.
• NEWLY DIAGNOSED
PATIENTS
SERIOUS ILLNESS
CONVERSATIONS
• Share prognosis and tailor
information to patient
preference
• Explore key topics:
• Goals, Fears, worries,
Sources of strength,
Critical abilities, Tradeoffs
• Involvement of child &
siblings
• DISEASE
PROGRESSION/EOL
SETTING UP GOALS OF
CARE
• Set realistic goals
• Discuss Advance Care
Planning
• Place of Care
(Hospital/Home)
• Anticipatory Symptoms
• Symptom Management
Preferences
• Source of Support
• Encourage Memory
Making
• Siblings Support
• Spiritual Support
• Psychosocial Support

21. KEY TAKEAWAYS
FAMILY CONFERENCE
 Hold pre-meeting to collect patient info from clinical team.
 Make sure that every person in the room has an introduction.
 Assess family understanding of medical issues and allow all to speak.
 Ask family’s permission to give a medical update.
 Acknowledge individual concerns, then pick a focus for discussion.
 Notice and acknowledge emotions.
 Let the family talk to each other before you interject.
 Recognize that deep values influence planning discussions.

23. THANK YOU