5.1 PDR - Family Conference Flashcards
Patients and family members will NOT define their experience by _____.
whether or not we know the literature.
Patients and family members will define their experience by our ability to _____ and ______.
1) Understand
2) Listen
According to Hudson et al., There is a consensus in the literature that family meetings are _____ and _____.
1) necessary
2) valuable
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.
TRUE
Consumers continue to ask for (3):
1) Improved communication with healthcare providers
2) To be informed
3) To be empowered to make decisions
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.
FALSE. There is a higher incidence of these symptoms in RELATIVES of patients.
Family members of patients who are sedated, unconscious, and ______ feel uncertainty, _______, and ______; they need guidance and counseling.
1) comatose
2) helplessness
3) fatigue
% of family members with PTSD (developed after a traumatic event such as illness of a loved one) 30 days after the incident.
40%
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.
90
Families experience these “torments of hospitalization”:
1) psychological
2) emotional
3) physical
of people that are estimated to die of ARDS (Acute Respiratory Distress Syndrome)
1 of 2
In the graph illustrating the reasons for calling a family conference, the 3 most common reasons are:
1) prognosis
2) options
3) procedures (like surgery, dialysis, and re-intubation)
In the graph illustrating the reasons for calling a family conference, the least common reason is:
Ethics
Enumerate multiple purposes for family meetings.
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.
T/F: Family conferences should be called exclusively to get a DNR order or to disclose disease conditions such as cancer.
FALSE. This should NOT be done.
Mean/Avg. family conference time:
32 mins
Speech Proportion (%) in family meetings.
71% clinician; 29% family.
T/F: Increased proportion of family speech is significantly associated with Increased family satisfaction and Increased conflict with the physician.
FALSE. Decreased conflict with physician
7 Step Approach to Communication
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.
In Step 2 of the 7-Step Approach to Communication, you should ask ______ type questions
Open-ended
T/F: In Step 4 of the 7-Step Approach to Communication, you should not overstate/understate the implications of the news.
TRUE
In Step 5 of the 7-Step Approach to Communication, you should listen to _____, which conveys ____ and support, and ______ the relationship.
1) reactions (verbal and non-verbal cues)
2) respect
3) strengthens
3 Commonly missed opportunities during family conferences:
1) listening and responding to family.
2) acknowledging and addressing emotions.
3) pursuing principles of medical ethics.
In terms of the frequency of physicians of particular specialties who hold family conferences, ______ hold the conduct the highest # of meetings.
Oncologists
In terms of the frequency of physicians of particular specialties who hold family conferences, ______ hold the conduct the least # of meetings.
Endocrinologists
In a proactive communication strategy, intervention involved focused family meetings within _____ hours of admission.
72
T/F: Intervention demonstrated reduction in the time spent in ICU and earlier withdrawal of advanced supportive technology.
TRUE
When to talk about withdrawal of Mechanical Ventilation (3 discussed scenarios):
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.
In a survey of “Attitudes of family members in the decision-making process”, the % of family members who experienced anxiety.
73%
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.
About half (~53%)
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.
TRUE
In regards to “Elements of effective discussion of the management plan”, when a patient is encouraged to ask more questions, the outcomes affected are:
Anxiety levels, role limitations, and physical limitations
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:
The problem and symptom resolution.
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:
Psychologic distress
Outcomes in a patient who will likely improve and get well (3):
1) Likely to trust and believe in you.
2) Likely to adhere to plans.
3) More confidence in the physician.
Physician competence in end-of-life care requires the following skills:
1) Communication
2) Decision-making
3) Building Relationships
Identify the Role of the family member: background; knows everything about the patient; quiet about wishes; usually unrelated.
Caregiver
Identify the Role of the family member: respected and confident
Spokesperson
Identify the Role of the family member: direct relative; foreign; on a schedule
Out-of-Towner
Identify the Role of the family member: spouse; most vulnerable and emotional; knows values of patient
Patient wishes expert
Identify the Role of the family member: recognizes vulnerability of spouse, assigns somebody else (but not self)
Protector
Identify the Role of the family member: has the capacity to overrule and represent everyone, single out, come to terms with.
Primary Decision-Maker
Identify the Role of the family member: influential; friend or foe
Health Expert (family member or unrelated)
Conrad’s Favorite Ice Cream Flavors (2)
Cookies and Cream or Strawberry Cheesecake
