ICU studies supported the benefit of a family conference to the family, health care team, and hospital administration. The family conference in other clinical areas was not supported by a strong evidence base. Well-designed prospective studies are needed in multiple medical settings to assess the proposed and observed patient and financial benefits of the family conference, and determine their generalizability.

A family conference (FC) is an opportunity for the family and their physician to share their knowledge and concerns about the physical and psychosocial dimensions of care. Appropriate communication principles and practice are both important for an effective FC. The FCs guided by common sense principles and sound clinical practice (good structure, content, and process) have beneficial outcomes. (1) Creation of a therapeutic partnership so the family and medical team collaborate in the difficult task of sophisticated medical and psychosocial care of a complex illness. (2) Enhanced therapeutic management through education and support of the patient and primary caregiver (and other family members) to facilitate self-efficacy and convey realistic hope with careful sequencing of key messages. (3) Easier patient transitions from cure- to care-oriented management, with a formal (yet thoughtful and gentle) introduction to the principles and practice of modern palliative medicine.

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This paper describes the application of an empirically-derived psychosocial assessment for use in advanced cancer. The patient population selected for this study was those patients no longer pursuing aggressive antitumour treatment, and the focus of care was on management of major symptoms and complications, and psychosocial support of the patient and family. The physical, cognitive, social and emotional dimensions were the framework for the assessment of both patient and caregiver functioning. Through this assessment of all patients admitted to our inpatient palliative medicine unit, care needs were identified and psychosocial interventions planned. The results of 150 assessments are reported, as well as observations of the process, implications for psychosocial care and modifications of the assessment based on this experience.

The family is essential to patients with advanced cancer. Family and caregiver distress, however, can impair optimal care and support of the patient. A five-item questionnaire, the Family APGAR Scale, was evaluated to determine family functioning levels of selected patients. The APGAR Scale has five components for measuring family functioning: Adaptation, Partnership, Growth, Affection, and Resolve. Fifty consecutive patients admitted to a palliative medicine inpatient unit were reviewed for a pilot study. Eligibility requirements included admission to the unit for the first time, and the ability to speak English and give informed consent. Fifteen patients and 11 primary caregivers participated. Despite the small sample, some significant family functioning issues were identifed. Completing the study later with a larger sample will provide information that will help the multidisciplinary team better meet the needs of both patient and family.