Dealing with Death & Dying in Medical Education and Practice
© 2001 Kirsti A. Dyer, MD, MS
AMSA Convention March 30, 2001
7 Step Guide to the Family Meeting

1. Set-up the meeting

  • Arrange a time and quiet, private place to meet
  • Invite all providers—MD’s, Consultants, RN’s, Chaplain, SW’s, RT’s etc. 
  • Invite all family members. Be sure decision-maker is present.
  • Determine beforehand who will lead the meeting.
  • Have medical team discuss goals of meeting and recommendations beforehand. 
2.  Start the meeting with introductions
  • Have each person introduce him/herself.
  • 3. Assess the family’s understanding of the patient’s medical condition
    • Ask family to give their sense of the situation. "I was wondering if you could tell me what you understand of the situation…."
    • Start from where the family is.
    4.  Provide a short summary of the patient’s medical condition
    • Explain the medical situation generally. Don’t dwell on small details.
    • Try to give an overall sense starting from where the family is.
    5. Inquire as to what the patient would want in this situation
    • Ask if the patient had made any prior statements about preferences for care in a situation like this one.
    • Try these phrases:
      •  "Did your ___ ever say anything about what kind of care he/she would want if he/she ever got seriously ill?"
      •  "Did your ___ ever see a relative or friend in a situation like this, or see it on TV, and say anything about what he would want if he/she was in a similar situation?"
      •  "What would your ___ say if he could sit up and tell us what he/she thinks about what is happening to him right now?"
      •  "What do you think it is like for him/her now?"
      •  "What do you think he/she would want under these circumstances?"
      •  "What were his/her fears about serious illness, dying?"
    • Avoid:  "Do you think we should intubate, withdraw care, stop antibiotics….?"
    6. Determine who is the surrogate, whether the patient appointed one, or  if the family agrees about who is the right person
    • Be sure that the decision-maker is present
    • Need to uncover any family disagreements or conflicts
    • Address conflicts tactfully—the Columbo Approach. 

    • "I’m a bit confused here, maybe you can help me understand…." 
    7. Summarize and make a recommendation
    • "Based on what you have told me about __ and what we know about the medical circumstances, we would recommend…"
    • Ask if there are questions.
    • Arrange follow-up, who will talk to whom, when and how.
    • Document clearly in the chart the meeting, decisions made and plans.

    Pantilat S. Block S. Communicating with Families of Dying Patients: The Family Meeting.  Presented at UCSF’s "End of Life Care for the Hospitalized Patient, October 2000.

    Compilation of resources for this presentation and Website © 2001 Kirsti A. Dyer, MD, MS.
    Journey of Hearts,