5.1 PDR - Family Conference

Question 0

Patients and family members will NOT define their experience by _____.

Answer 0

whether or not we know the literature.

Question 1

Patients and family members will define their experience by our ability to _____ and ______.

Answer 1

1) Understand

2) Listen

Question 2

According to Hudson et al., There is a consensus in the literature that family meetings are _____ and _____.

Answer 2

1) necessary

2) valuable

Question 3

T/F: According to the article by Griffith et al., Family meetings help plan interventions and set goals, so that an older person, family members, and the multidisciplinary team are all striving for the same goal.

Answer 3

TRUE

Question 4

Consumers continue to ask for (3):

Answer 4

1) Improved communication with healthcare providers
2) To be informed
3) To be empowered to make decisions

Question 5

T/F: incidence of post-traumatic stress, anxiety, and depression symptoms in patients during the ICU stay and after discharge are higher versus in their relatives.

Answer 5

FALSE. There is a higher incidence of these symptoms in RELATIVES of patients.

Question 6

Family members of patients who are sedated, unconscious, and ______ feel uncertainty, _______, and ______; they need guidance and counseling.

Answer 6

1) comatose
2) helplessness
3) fatigue

Question 7

% of family members with PTSD (developed after a traumatic event such as illness of a loved one) 30 days after the incident.

Answer 7

40%

Question 8

There is an incidence rate of 30-35% of family members with PTSD (developed after a traumatic event such as illness of a loved one) __#__ days after the incident.

Answer 8

90

Question 9

Families experience these “torments of hospitalization”:

Answer 9

1) psychological
2) emotional
3) physical

Question 10

of people that are estimated to die of ARDS (Acute Respiratory Distress Syndrome)

Answer 10

1 of 2

Question 11

In the graph illustrating the reasons for calling a family conference, the 3 most common reasons are:

Answer 11

1) prognosis
2) options
3) procedures (like surgery, dialysis, and re-intubation)

Question 12

In the graph illustrating the reasons for calling a family conference, the least common reason is:

Answer 12

Ethics

Question 13

Enumerate multiple purposes for family meetings.

Answer 13

1) Sharing of info and concerns.
2) Clarifying the goals of care
3) Discussing DX, TX, prognosis
4) Developing a plan of care for the patient and family carers.

Question 14

T/F: Family conferences should be called exclusively to get a DNR order or to disclose disease conditions such as cancer.

Answer 14

FALSE. This should NOT be done.

Question 15

Mean/Avg. family conference time:

Answer 15

32 mins

Question 16

Speech Proportion (%) in family meetings.

Answer 16

71% clinician; 29% family.

Question 17

T/F: Increased proportion of family speech is significantly associated with Increased family satisfaction and Increased conflict with the physician.

Answer 17

FALSE. Decreased conflict with physician

Question 18

7 Step Approach to Communication

Answer 18

1) Prepare for the discussion.
2) Establish what the patient/family knows.
3) Determine how information is to be handled.
4) Deliver the information.
5) Respond to emotions.
6) Establish goals for care and TX.
7) Establish a plan.

Question 19

In Step 2 of the 7-Step Approach to Communication, you should ask ______ type questions

Answer 19

Open-ended

Question 20

T/F: In Step 4 of the 7-Step Approach to Communication, you should not overstate/understate the implications of the news.

Answer 20

TRUE

Question 21

In Step 5 of the 7-Step Approach to Communication, you should listen to _____, which conveys ____ and support, and ______ the relationship.

Answer 21

1) reactions (verbal and non-verbal cues)
2) respect
3) strengthens

Question 22

3 Commonly missed opportunities during family conferences:

Answer 22

1) listening and responding to family.
2) acknowledging and addressing emotions.
3) pursuing principles of medical ethics.

Question 23

In terms of the frequency of physicians of particular specialties who hold family conferences, ______ hold the conduct the highest # of meetings.

Answer 23

Oncologists

Question 24

In terms of the frequency of physicians of particular specialties who hold family conferences, ______ hold the conduct the least # of meetings.

Answer 24

Endocrinologists

Question 25

In a proactive communication strategy, intervention involved focused family meetings within _____ hours of admission.

Answer 25

72

Question 26

T/F: Intervention demonstrated reduction in the time spent in ICU and earlier withdrawal of advanced supportive technology.

Answer 26

TRUE

Question 27

When to talk about withdrawal of Mechanical Ventilation (3 discussed scenarios):

Answer 27

1) When the benefit to the patient has been exhausted.
2) When MV no longer meets Tx goals.
3) When the topic is rendered for discussion by the patient, family, or surrogate.

Question 28

In a survey of “Attitudes of family members in the decision-making process”, the % of family members who experienced anxiety.

Answer 28

73%

Question 29

In a survey of “Attitudes of family members in the decision-making process”, the % of family members who did not want to share in the decision-making process.

Answer 29

About half (~53%)

Question 30

T/F: Reduction in ICU length of stay for patients who ultimately die is done by increasing focus communication with family members through routine ICU family conference.

Answer 30

TRUE

Question 31

In regards to “Elements of effective discussion of the management plan”, when a patient is encouraged to ask more questions, the outcomes affected are:

Answer 31

Anxiety levels, role limitations, and physical limitations

Question 32

In regards to “Elements of effective discussion of the management plan”, when the physician and patient agree about the nature of the problem and the need for a follow-up, the outcomes affected are:

Answer 32

The problem and symptom resolution.

Question 33

In regards to “Elements of effective discussion of the management plan”, when a physician asks the patient about his or her feelings, the outcome affected is:

Answer 33

Psychologic distress

Question 34

Outcomes in a patient who will likely improve and get well (3):

Answer 34

1) Likely to trust and believe in you.
2) Likely to adhere to plans.
3) More confidence in the physician.

Question 35

Physician competence in end-of-life care requires the following skills:

Answer 35

1) Communication
2) Decision-making
3) Building Relationships

Question 36

Identify the Role of the family member: background; knows everything about the patient; quiet about wishes; usually unrelated.

Answer 36

Caregiver

Question 37

Identify the Role of the family member: respected and confident

Answer 37

Spokesperson

Question 38

Identify the Role of the family member: direct relative; foreign; on a schedule

Answer 38

Out-of-Towner

Question 39

Identify the Role of the family member: spouse; most vulnerable and emotional; knows values of patient

Answer 39

Patient wishes expert

Question 40

Identify the Role of the family member: recognizes vulnerability of spouse, assigns somebody else (but not self)

Answer 40

Protector

Question 41

Identify the Role of the family member: has the capacity to overrule and represent everyone, single out, come to terms with.

Answer 41

Primary Decision-Maker

Question 42

Identify the Role of the family member: influential; friend or foe

Answer 42

Health Expert (family member or unrelated)

Question 43

Conrad’s Favorite Ice Cream Flavors (2)

Answer 43

Cookies and Cream or Strawberry Cheesecake