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. 

Have each person introduce him/herself.

• 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.

• Explain the medical situation generally. Don’t dwell on small details.
• Try to give an overall sense starting from where the family is.

• 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….?"

• 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…." 

• "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.