Chapter 4: Strategies for follow-up
Post-death family meetings
“It was very useful for us to go back and have a follow-up meeting, revisit my time in ICU, and retell the story with someone who was well informed about the case and answered my preoccupying questions”. - Family member
A positive and constructive family meeting before death can make an enormous difference for families at risk of or experiencing psychological trauma and can help them better cope with their bereavement. Families report great appreciation for the chance to ask questions of the team as they try to make sense of their experience and rebuild their lives. Unsurprisingly, many have expressed the wish for a similar meeting after death has occurred.
Purpose of a post-death family meeting
It’s important to determine why a family is seeking a meeting. It may be helpful to ask the family in advance of the meeting if they could indicate what they would want to talk about or send a list of specific questions (if applicable) to help staff prepare answers. The following are some typical reasons:
To get some kind of “closure”, whatever that may mean to them.
To try to make sense of what happened (e.g., getting answers to pre-occupying questions about an event).
To express appreciation to the team.
To repair a relational rupture with the team.
To express dissatisfaction. (If the main purpose of the meeting is to register a complaint about the care provided to the deceased, it would be best to meet in conjunction with a representative from patient relations or management. It may be almost impossible to explore grief and provide support in a meeting with this focus).
Planning and conducting a good family meeting
Find a suitable environment to conduct the meeting that is quiet, with places to sit, as well as tissues and water on hand.
Gather the most involved care team members at the meeting.
Welcome the family back and offer condolences. “I’m sorry we are meeting under these circumstances”.
Allow the family to set the agenda by saying, “We have X amount of time to spend together. How would you like to use that time?” We recommend that you plan no more than one hour for the meeting.
If possible/applicable, encourage family to share their questions and concerns with a member of the ICU team before the meeting in order to help the team prepare/best address their concerns.
Try to start with medical topics. Psychosocial issues are better addressed in the latter half of the meeting because they are more sensitive and easier to talk about.
Sometimes families will have very specific medical questions that can be answered straightforwardly. There may also be existential questions that can’t be answered. You can acknowledge that these are unanswerable.
Families may want to be reassured that everything was done to prevent the patient from suffering (or dying).
Families may need to hear that the right end-of-life choices were made.
Families often appreciate the opportunity to express their emotions.
Your team can assess how the family is coping with their grief and trauma, offering a referral to local resources as needed.
Before concluding the meeting, take a few moments to assess the impact. Ensure that everyone feels they have a clear understanding. Don’t end abruptly or fail to address all the items on the agenda, as agreed upon at the outset. A poor ending to a family meeting can undermine the good work you’ve done.
Responding to anger, criticism, or complaints
Occasionally, a family will be angry or question medical decisions. Whether or not you think there are any grounds for this, it’s important that you make a sincere effort to listen. Remember that they are vulnerable in their grief and are trying their best to make sense of their experience. Below are some additional tips to help you in these family meeting situations.
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Avoid power struggles: Do your best to avoid entering into a power struggle or an us versus them dynamic. By listening, you’ll be showing a willingness to explore their perspective with them, to “stand in their shoes” for awhile.
Offer a simple apology. Depending on the situation, it may be good for you to offer a simple apology, such as “We are very sorry this happened. This is obviously not what any of us wanted for your loved one.”. This often has the effect of shifting the conversation so that you can move forward.
Set boundaries. If necessary, be gentle but firm in setting boundaries. Maintaining a good boundary with a family in conflict will help them feel safe and help keep things contained, without establishing a power dynamic. “We really wanted to talk with you about what happened to your loved one. Please understand that there are some rules that we have to follow here, and we are not supposed to continue a meeting in certain circumstances, such as threats or shouting. But we really don’t want to stop the meeting if that can be avoided.”
Remain calm. Remain calm in the face of aggression but make clear that it’s not acceptable. If the family member remains dissatisfied with your responses, you can refer them to Patient relations/Patient & Family Experience or the Office of the Ombudsman of the hospital if it seems appropriate.
