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Communication in palliative medicine: a clinical review of family conferences.

AIM
Family conferences are an important forum for communication, particularly for those with serious illnesses.


DESIGN
The strength of evidence was assessed by patient, intervention, comparator, and outcome (PICO).


DATA SOURCE
We searched electronic databases (MEDLINE, CINAHL, PsycINFO, Embase, PubMed), published articles, and multidisciplinary resource textbooks.


RESULTS
Four areas investigated family conferences: acute care, family medicine/geriatrics, intensive care units (ICU), and oncology/palliative medicine. A unifying theme was the importance of improved communication. A single randomized controlled ICU study demonstrated that family conferences positively influenced bereavement outcomes. A prospective (but single-arm) ICU study and several family medicine/geriatrics cohort studies, found that family conferences reduced hospital length of stay and/or decreased resource utilization. Other articles proposed guidelines or methods for the practical conduct of family conferences.


CONCLUSIONS
ICU studies supported the benefit of a family conference to the family, health care team, and hospital administration. The family conference in other clinical areas was not supported by a strong evidence base. Well-designed prospective studies are needed in multiple medical settings to assess the proposed and observed patient and financial benefits of the family conference, and determine their generalizability.