Preventive Medicine- Family CEA o Somatization or unexplained medical

Using Active Listening Skills in Conducting Family Meetings conditions

Objectives
− To discuss Family Conference
o Why family meetings are important − Hospitalization
o When family meetings are required − End of life care
o Who should attend family meetings − Institutionalization
o What is done during family meetings − Family conflict or dysfunction that interferes with
o How family meetings are conducted patient care
− To apply active listening skills and CEA in Consider convening the family in:
convening the family − Compliance problem
− Poor control of a chronic illness
Why? − High utilization of medical services
− Family influence on health − Somatization, anxiety, depression
o Values, beliefs and attitudes are imbibed − Substance abuse
and behaviors are learned in the context − Marital and sexual difficulties
of family
o Family as resource Who?
− Family
 Therapeutic ally vs. obstacle to
o All emotionally significant people bound
health care
 Indecision together by enduring ties
 Poor illness understanding − Family intervention involves at least 2 members
 Misperceptions (ECMs)
− Family interventions are more effective than What?
individual approach − Educate
o Majority of patients can be handled o Illness understanding and management
individually but there will be times when o Assistance with problem solving/ decision
the physician will be more effective if the making
family is convened − Provide psychological support
o Empathy
Levels of Physician Involvement with Families o Opportunity to share feelings
- according to Doherty and Baird. Family Centered o Assistance in coping
Medical Care − These are tasks to accomplish during family
− Level 1: Minimal involvement of the family (focus meetings
on the individual) How?
− Level 2: Focus on Health Education of the patient − CEA
and family o Catharsis
− Level 3: Health Education + Impact of Illness  o Education
provision of emotional support o Action
− Level 4: Assessment of family dynamics and how it − Steps
affects the illness (intervention  restructuring) o Discuss the clinical problem
− Level 5: Family therapy o Define the clinical problem
o Correct misperceptions
When? o Address patient’s problem
− When is it imperative/essential to convene the o Closing and follow up
family? 1. Discuss the clinical problem
− Routinely: − Reasons for consult
o Obstetrical and well-child care − Medical history
o Diagnosis of a serious chronic illness − Family members serve as additional
o Non-compliance with treatment source to verify the medical history
recommendations 2. Define the Clinical Problem
− Catharsis
 − Explore the patient and family’s health  Switch from directive facilitator
understanding (biomedical physician) to non-
− Identify ECMs that causes: directive listener
 Greatest emotional upset 4. Address the patient’s problem (Action and
 Greatest obstacle in treatment Treatment)
− Leading skills/ probing/ Reflecting skills − Explain the recommended treatment and
− Catharsis of Patient and Family elicit their perceptions and feelings about
 What do you call the illness or it
disability? − Address ECMs about treatment
 What do you understand about − CEA for BOTH
the illness?  How do you feel about the
 What do you think has caused the treatment plan that I have just
illness? explained to you?
− Catharsis of the Patient  What important results do you
 What does your sickness do to expect from this treatment?
you? − CEA for Patient
 What can you no longer do that  What might make the treatment
you would like to do? difficult for you to follow?
 How do you feel about your  What would you like your doctor
sickness? to do for you?
 How does your family react to you − Lead, probe, reflect, summarize, address
because of your illness? ECMs
 How do you feel about their 5. Involve the Patient and the Family in the
reaction? Management Plan
− Catharsis of the Family − Explicitly state what each need from one
 How does his or her sickness another
affect you? − Agree about the things that they will do
 How do you feel about his or her for each other
illness? − For Patients
− Catharsis for both patient and family  What would you like your family
 What do you think will happen to to do for you?
the illness in the future? − For Family
 What do you fear most about the  What would you like him to do for
illness? you?
 What is the worst thing that could − For Both
happen?  Will each of you state what you
3. Identify and Correct Misperceptions are willing to do for each other in
− Education response to the needs expressed?
− Share your findings with the patient and − Include tasks of the patient and family
family members in relation to the behavioral
− Address the ECMs contract set during the meeting
− Provide other information that the patient  What are each family member
and the family needs willing to do for the other?
− Validate appropriate perceptions and 6. Closing and Follow-up
emotions − Do a feeling check
− Important Points − Set specific date and time for follow up
 Remain neutral
 Give equal time/ equal chance to How to convene the family?
speak − Involve the family as early as possible
 Reflect: Paraphrase or Perception − Explain that it is a routine procedure
Check − Emphasize the importance of family as a resource
 Summarize − Identify the obstacles if there are any
 Empathize and validate emotions − Stress the benefits of family meeting
− Instruct on who and how to invite