Abstract and Introduction
Abstract
Structured family meetings are ideally conducted based on a collaboration between the patient, family members, informal caregivers, and an interdisciplinary team of health care professionals to facilitate communication and end-of-life planning, thereby creating opportunities for shared decision making. Little evidence currently exists to guide the health care professional in conducting the meeting. The purpose of this systematic review is to examine and synthesize the evidence available to inform our understanding of family meetings at the end of life. We conducted a systematic review of the literature and screened 1113 articles; 59 were assessed for eligibility with a full-text screening, and 24 were included in the final synthesis. Structured family meetings can be an effective means of communicating when preparing for the end of life and can potentially reduce suffering for patients and family members. Patients and family outcomes included satisfaction, enhanced psychological well-being, and well-planned decisions regarding life-sustaining medical interventions. Some evidence indicates that structured interventions transcend cultural and geographic boundaries; however, sociological aspects in some countries may restrict end-of-life planning. Future research needs to focus on the development of structured communication interventions, including assessment of emotional state, readiness to face the end of life, and explication of effective strategies for the provision of meaningful information and emotional support.
Introduction
In September 2014, the Institute of Medicine released recommendations emphasizing the need for improved communication between patients and clinicians surrounding preparation for end of life (EOL). Individuals and families may experience a variety of stressors when faced with a life-limiting illness, including financial challenges, isolation, threats to identity, role reversal, and spiritual or existential suffering. Caregivers are at risk for prolonged grief disorder, depression, anxiety, demoralization, and posttraumatic stress disorder. Surrogate health decisions made by an identified family member, loved one, or caregiver often occur in complex or urgent situations when the dying person is unable to participate in EOL decision making. Without clear guidance of the individual's preferences or goals of care, complex decisions such as whether to initiate tube feedings, resuscitation, and withdrawing or withholding life support may lead to distress and emotional suffering in the surrogate or family member.
Family communication at EOL is an important intervention to aid in the relief of suffering. Structured family meetings at the EOL enable nurses and other health care professionals to provide information, assess patient and family needs, and create opportunities for shared decision making. However, limited evidence exists to guide the health care professional in conducting the family meeting.