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
understanding
− Identify ECMs that causes:
 Greatest emotional upset
 Greatest obstacle in treatment
− Leading skills/ probing/ Reflecting skills
− Catharsis of Patient and Family
 What do you call the illness or
disability?
 What do you understand about
the illness?
 What do you think has caused the
illness?
− Catharsis of the Patient
 What does your sickness do to
you?
 What can you no longer do that
you would like to do?
 How do you feel about your
sickness?
 How does your family react to you
because of your illness?
 How do you feel about their
reaction?
− Catharsis of the Family
 How does his or her sickness
affect you?
 How do you feel about his or her
illness?
− Catharsis for both patient and family
 What do you think will happen to
the illness in the future?
 What do you fear most about the
illness?
 What is the worst thing that could
happen?
3. Identify and Correct Misperceptions
− Education
− Share your findings with the patient and
family
− Address the ECMs
− Provide other information that the patient
and the family needs
− Validate appropriate perceptions and
emotions
− Important Points
 Remain neutral
 Give equal time/ equal chance to
speak
 Reflect: Paraphrase or Perception
Check
 Summarize
 Empathize and validate emotions
 Switch from directive facilitator
(biomedical physician) to non-
directive listener
4. Address the patient’s problem (Action and
Treatment)
− Explain the recommended treatment and
elicit their perceptions and feelings about
it
− Address ECMs about treatment
− CEA for BOTH
 How do you feel about the
treatment plan that I have just
explained to you?
 What important results do you
expect from this treatment?
− CEA for Patient
 What might make the treatment
difficult for you to follow?
 What would you like your doctor
to do for you?
− Lead, probe, reflect, summarize, address
ECMs
5. Involve the Patient and the Family in the
Management Plan
− Explicitly state what each need from one
another
− Agree about the things that they will do
for each other
− For Patients
 What would you like your family
to do for you?
− For Family
 What would you like him to do for
you?
− For Both
 Will each of you state what you
are willing to do for each other in
response to the needs expressed?
− Include tasks of the patient and family
members in relation to the behavioral
contract set during the meeting
 What are each family member
willing to do for the other?
6. Closing and Follow-up
− Do a feeling check
− Set specific date and time for follow up
How to convene the family?
− Involve the family as early as possible
− Explain that it is a routine procedure
− Emphasize the importance of family as a resource
− Identify the obstacles if there are any
− Stress the benefits of family meeting
− Instruct on who and how to invite