FAMILY MEETING TO ADDRESS “DON’T TELL”
6 STEPS TO ADDRESS “DON’T TELL” WITH FAMILY Common Root Causes of “Don’t Tell” Requests: Love, protection, fear, denial, anticipated loss, cultural and/or religious beliefs Understand patient-centered vs. family-centered decision-making. Use a professional translator whenever necessary. GOAL: UNDERSTAND why the family says, “Don’t Tell” 1. S ETTING ‒Gather all important family members. Private. Be prepared. Sit down. Have tissues, water. 2. P ERCEPTION ‒What do they know? “Tell me what you understand?” “What do you believe the patient understands?” “How do you typically make decisions in your family? 3. I NVITATION ‒Why don’t you want me to tell the patient? What are you worried about, afraid of, hoping for, expecting…? 4. K NOWLEDGE ‒Reassure family that you want to provide the best possible care for the patient and the family. Remind them it is your duty to tell truth IF the patient wants to know. 5. E MOTION ‒Use NURSE to Respond to Emotion. Look for the root cause. “It sounds like you love her very much”, ”You want to protect him”, “You don’t want to hurt her” 6. S UBSEQUENT ‒“Let’s go to the patient together” “May I ask: What does the she know? What does the he want to know? Does she have any questions?” Be clear with the family: If the patient asks questions, You have an obligation to reply honestly, with the truth.
47 NB: These Reference Cards do not replace careful clinical judgment specific to each patient / family situation. PCIC: Palliative Care Interdisciplinary Curriculum is a collaborative effort of OhioHealth, The Ohio State University Wexner Medical Center, and Nationwide Children’s Hospital in Columbus, Ohio, USA, and other contributors. Permission to reproduce any or all of these PCIC Reference Cards is granted for non-commercial educational purposes only, provided that the attribution statement and copyright are displayed. To reproduce for all other purposes, contact Frank D. Ferris at info@pallmed.us. Copyright © Frank D Ferris 2013-2024. All rights reserved. V14.1, 2024 Adapted from S.P.I.K.E.S. Baile WE, Buckman R, Lenzi R et al. Oncologist 2000. PMID 10964998. And from www.VitalTalk.com. Used with permission.
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