A new video – a collaboration between UC San Francisco and the New England Journal of Medicine – offers a roadmap for structured meetings between clinicians and family members when a patient has a serious or life-threatening condition.
When care teams and family members meet, it can lessen the likelihood of medical interventions that run counter to the goals of acutely ill patients and may result in less depression and anxiety for the relatives.
“Current evidence shows that we do not spend enough time talking to family members and when we do, we do most of the talking,” said Widera. “We have learned over the years that if we take a more structured approach that starts with understanding who the patient is and acknowledging how challenging this is from an emotional perspective, more can be accomplished than just conveying medical facts.”
To help clinicians, UCSF physicians collaborated with the New England Journal of Medicine on a video that features a UCSF doctor, a nurse and social worker, and two actors representing the spouse and son of “Angie,” a fictitious patient who has suffered a cascade of medical events culminating in a brain injury.
In an article that accompanies the video online, the authors propose that the meetings are held on a continuous basis for all patients with serious illness when there is a change in status, a need to make treatment decisions or when there is discord about prognosis, goals of care or treatments. When successful, the meetings may result in shorter hospital stays, and less depression and post-traumatic stress among family members, who carry the burden of making decisions on behalf of patients unable to make decisions for themselves.
“Ultimately, the goal of these meetings is providing treatments that are aligned to the wishes of the patient,” said Widera. “The risk of not having a meeting is that we revert to the default in medicine, which is to do everything possible to keep someone alive, even if it may not be what the patient would want.”