Communication with Families Facing Life-Threatening Illness: A Research-Based Model for Family Conferences

Context. In end-of-life care, delirium is often not recognized and poses unique management challenges, especially in the case of refractory delirium in the terminal phase.Objectives. To review: delirium in the terminal phase context, specifically in relation to recognition issues; the decision-making processes and management strategies regarding its reversibility; the potential refractoriness of delirium to symptomatic treatment; and the role of sedation in refractory delirium. Methods.We combined multidisciplinary input from delirium researchers and knowledge users at an international delirium study planning meeting and relevant electronic database literature searches (Ovid Medline, Embase, PsycINFO and CINAHL) to inform this narrative review.Results. The overall management strategy for delirium at the end of life is directed by the patient's prognosis in association with the patient's goals of care. As symptoms of delirium are often refractory in the terminal phase, especially in the case of agitated delirium, the judicious use of palliative sedation is frequently required. However, there remains a lack of high level evidence for the management of delirium in the terminal phase, including the role of antipsychotics and optimal sedation strategies. For the family and health care staff, clear communication, education and emotional support are vital components to assist with decision making and direct the treatment care plan. Conclusion.Further research on the effectiveness of delirium management strategies in the terminal phase for patients and their families is required. Further validation of assessment tools for diagnostic screening and severity measurement are needed in this patient population.

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“…1). Further studies exploring the effectiveness and optimal delivery of these strategies are required (44,76).…”

Section: Pharmacological Intervention With a More Sedating Approach Omentioning

confidence: 99%

End-of-Life Delirium: Issues Regarding Recognition, Optimal Management, and the Role of Sedation in the Dying Phase

Bush

Leonard

Agar

et al. 2014

Journal of Pain and Symptom Management

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“…Studies (3)(4) show that, with the proximity of death, issues such as fear of the unknown, myths, uncertainties due to the prognosis related to a life-threatening disease, and doubts about the modifying therapy of the disease, and if this brings benefits or only protects the process of dysthanasia. This is corroborated by the studies analyzed (8,(12)(13) , which show, among the indications for a family reunion, that of the need to identify what the family already knows about the patient's prognosis and whether there are gaps and doubts to be resolved.…”

Section: Discussionmentioning

confidence: 75%

“…Support in the decision-making process was another antecedent evidenced in the studies (13)(14)(15) . It was possible to confirm that, in order to provide due support for decision-making, negotiation is an essential element in a family conference, as a component of the communication process and assimilation from the point of view of the other, favoring a decision with respect, especially to patient autonomy (13) .…”

Section: Discussionmentioning

confidence: 96%

“…It was possible to confirm that, in order to provide due support for decision-making, negotiation is an essential element in a family conference, as a component of the communication process and assimilation from the point of view of the other, favoring a decision with respect, especially to patient autonomy (13) . In this negotiation scenario, nurses have a determining role in intermediating palliative care team, patient and family.…”

Section: Discussionmentioning

confidence: 97%

“…To address the doubts of patients and their families is to respect the autonomy of the other and to offer them the possibility of choices, fulfilling what is proposed in the philosophical principles of palliative care presented by WHO in meeting the effective needs of support to families (12)(13) . Thus, it is evident that the family should be cared for by the team as much as the patient.…”

Section: Discussionmentioning

confidence: 99%

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Family conference in palliative care: concept analysis

et al. 2018

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Objective: to analyze the attributes, antecedents and consequents of the family conference concept. Method: Walker and Avante's method for concept analysis and the stages of the integrative review process, with a selection of publications in the PubMed, Cinahl and Lilacs databases focusing on the family conference theme in the context of palliative care. Results: the most cited antecedents were the presence of doubts and the need to defi ne a care plan. Family reunion and working instrument were evidenced as attributes. With respect to consequents, to promote the effective communication and to establish a plan of consensual action were the most remarkable elements. Final considerations: the scarcity of publications on the subject was observed, as well as and the limitation of the empirical studies to the space of intensive therapy. Thus, by analyzing the attributes, antecedents and consequents of the concept it was possible to follow their evolution and to show their effi cacy and effectiveness as a therapeutic intervention. Descriptors: Palliative Care; Consensus Conference; Family; Communication; Concept Formation. RESUMO Objetivo: analisar os atributos, antecedentes e consequentes do conceito conferência familiar. Método: o estudo seguiu o Modelo de Análise de Conceito de Walker e Avante e os passos da revisão integrativa, com seleção de publicações nas bases de dados PubMed, Cinahl e Lilacs, com o foco na temática conferência familiar no contexto dos cuidados paliativos. Resultados: os antecedentes mais citados foram presença de dúvidas e necessidade de defi nição de um plano de cuidados. Como atributos foram evidenciados reunião familiar e instrumento de trabalho. Com relação aos consequentes, promover a comunicação efi caz e estabelecer um plano de atuação consensual foram os elementos mais marcantes. Considerações fi nais: possibilitou evidenciar a escassez de publicações sobre a temática e os estudos empíricos restritos ao espaço da terapia intensiva. Assim, analisar os atributos, os antecedentes e os consequentes do conceito possibilitou acompanhar sua evolução e evidenciar a sua efi cácia e efetividade enquanto intervenção terapêutica. Descritores: Cuidados Paliativos; Conferência de Consenso; Família; Comunicação; Formação de Conceito. RESUMENObjetivo: analizar los atributos, antecedentes y consecuentes del concepto conferencia familiar. Método: el estudio siguió el Modelo de Análisis de Concepto de Walker y Avante y los pasos de la revisión integradora, con selección de publicaciones en las bases de datos PubMed, Cinahl y Lilacs, con el foco en la temática conferencia familiar en el contexto de los cuidados paliativos. Resultados: los antecedentes más citados fueron presencia de dudas y necesidad de defi nición de un plan de cuidados. Como atributos fueron evidenciados reunión familiar e instrumento de trabajo. Con relación a los consecuentes, promover la comunicación efi caz y establecer un plan de actuación consensual fueron los elementos más marcados. Consideraciones fi nales: posibilitó ...

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Family Meetings and Caring for Family Members

Johnson¹

2015

Hospital‐Based Palliative Medicine

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Communication with Families Facing Life-Threatening Illness: A Research-Based Model for Family Conferences

Abstract: Physicians and other health care professionals can use the model as a guide for conducting family conferences and strengthening communication with patients, families and colleagues.

Cited by 52 publications

References 42 publications

End-of-Life Delirium: Issues Regarding Recognition, Optimal Management, and the Role of Sedation in the Dying Phase

End-of-Life Delirium: Issues Regarding Recognition, Optimal Management, and the Role of Sedation in the Dying Phase

Family conference in palliative care: concept analysis

Family Meetings and Caring for Family Members

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