A prospective study of family conferences (FCs) in a palliative care unit (PCU) at a comprehensive cancer center.

Abstract

9127 Background: TheFC provides the family information and emotional support in the transition to end-of-life care. There are a few, mainly qualitative, studies of FCs in a palliative care setting. A retrospective report suggested increased emotional expression by family members when patients were not present in the FC. The purpose of our study was to determine the characteristics of FCs and the effect of patient participation on emotional expression by family members. Methods: A prospective study was conducted during 18-month period with140 consecutive FCs conducted by an interdisciplinary team (palliative care physician, social worker, and others). Data collected included demographics, discharge disposition, number of participants, caregiver characteristics, expressions of emotional distress, conflict with healthcare providers, and topics discussed. Descriptive statistics and frequencies were calculated. Analysis was performed using a chi-square test. Results: 70 patients (50%) were female, 64 (46%) white, 127 (91%) with solid tumors and a median age of 59. In 68/140 family meetings (49%), patients actively participated. The primary caregivers were predominantly female (66%), white (49%), and either the spouse or partner (59%). A median number of 4 family members and 4 healthcare providers attended the FCs with median duration of 1 hour and median of 2 days prior to discharge. Questions concerning advanced directives, symptoms anticipated at death and caregiver well-being were infrequent. Patients verbalized distress frequently, (73.1%). Primary caregivers emotional expression of verbal distress were high but not significantly affected by patient presence (82% vs 82%, P:NS); however, verbal expressions of emotional distress by family were more common when patients were absent (87%) than when present (73%), p = 0.037. Conclusions: There was a high frequency of expression of emotional distress by patients and family members. Patient participation was associated with decreased verbal emotional expression by family members but not the primary caregiver. Further studies are needed on the benefits of allocating additional time to meet with family members without patient presence during a FC.