Family Conference Research Articles

A Seat at the Table: Family Conferences for Infants with Neurological Conditions.

Objective: We aimed to characterize parents' perspectives on the value of and opportunities to improve conferences between parents of critically ill infants and the health care team. Background: The parent perspective on the value of family conferences in the intensive care unit is not well characterized. Methods: In this descriptive qualitative study, parents of infants with neurological conditions in the intensive care unit at a U.S. academic medical center completed longitudinal semi-structured interviews about their experiences making decisions and communicating with clinicians. Parents were included if they had an upcoming family conference to discuss goals of care or neurological prognosis. This secondary data analysis targets interview content about family conferences. Parent responses were characterized using a conventional content analysis approach. Results: Fifty-two parents of 37 infants completed 123 interviews. Parents described valuing when clinicians (1) provided space to process emotions, (2) prioritized "big picture" discussions about serious decisions, (3) dedicated time to parent questions, and (4) responded to parent concerns and made an effort to foster consensus. Parent-identified opportunities for improvement included: (1) having the team assume responsibility for calling regular meetings, (2) prioritizing attendance of consistent and supportive team members, and (3) summarizing meeting content for parents and documenting discussions for clinicians. Conclusions: These findings demonstrate that parents of infants with neurological conditions value family conferences as an important venue for communicating with the health care team. Future studies should explore the feasibility and impact of regularly scheduled family conferences, attendees dedicated to parent support, and accessible meeting summaries on therapeutic alliance, parent well-being, and communication quality.

A month of diagnostic imaging studies in an acute supportive/palliative care unit.

The aim was to assess the characteristics of patients who required imaging studies during admission to an acute supportive palliative care unit (ASPCU). A consecutive number of patients who performed imaging studies during ASPCU admission in a month period were assessed. Epidemiological data, ongoing anticancer treatment, cancer diagnosis, reasons for admission, referral, and type of imaging study were recorded. Indications, findings, consequent actions for treatment, prognosis, and discharge were also collected. Twenty-one of 56 patients admitted to ASPCU in the period taken into consideration were assessed. Pain and deterioration of the general condition were the most frequent indications for admission. Computed tomography (CT) was the most frequent imaging study performed. Indications for performing imaging studies depended on individual clinical needs. Findings suggested different clinical decisions, after a comprehensive oncological and palliative care assessment and family conference, the most frequent of which was to withdraw oncological treatments. The majority of patients underwent transition to palliative care and were discharged home or to hospice. Imaging studies were of paramount importance for clinical treatment and decision-making process in an intensive ASPCU. There is the need to explore the need and the possible outcomes of imaging studies, as well cost-effectiveness in any ASPCU.

European Society of Intensive Care Medicine guidelines on end of life and palliative care in the intensive care unit.

The European Society of Intensive Care Medicine (ESICM) has developed evidence-based recommendations and expert opinions about end-of-life (EoL) and palliative care for critically ill adults to optimize patient-centered care, improving outcomes of relatives, and supporting intensive care unit (ICU) staff in delivering compassionate and effective EoL and palliative care. An international multi-disciplinary panel of clinical experts, a methodologist, and representatives of patients and families examined key domains, including variability across countries, decision-making, palliative-care integration, communication, family-centered care, and conflict management. Eight evidence-based recommendations (6 of low level of evidence and 2 of high level of evidence) and 19 expert opinions were presented. EoL legislation and the importance of respecting the autonomy and preferences of patients were given close attention. Differences in EoL care depending on country income and healthcare provision were considered. Structured EoL decision-making strategies are recommended to improve outcomes of patients and relatives, as well as staff satisfaction and mental health. Early integration of palliative care and the use of standardized tools for symptom assessment are suggested for patients at high risk of dying. Communication training for ICU staff and printed communication aids for families are advocated to improve outcomes and satisfaction. Methods for enhancing family-centeredness of care include structured family conferences and culturally sensitive interventions. Conflict-management protocols and strategies to prevent burnout among healthcare professionals are also considered. The work done to develop these guidelines highlights many areas requiring further research.

Discussion of Spirituality in Family Conferences of Infants With Neurologic Conditions

IntroductionSpirituality serves as a mechanism to understand and cope with serious illness, yet little is known about how families and clinicians incorporate spirituality in pediatric family conferences. ObjectivesWe sought to characterize the frequency and nature of spiritual statements in conferences between families and clinicians caring for infants with neurologic conditions. MethodsIn this descriptive qualitative study, we used an existing dataset of audio-recorded, de-identified, transcribed family conferences of infants with neurologic conditions. Inclusion criteria for infants were 1) age < 1 year, 2) presence of a neurologic condition, and 3) planned conversation about neurologic prognosis or goals of care. We used a content analysis approach to code the data. Results68 family conferences were held for 24 infants and 36 parents. Most parents (n = 32/36, 89%) self-identified as spiritual. References to spirituality occurred in the 32% of conferences (n = 22/68). Spiritual discussion included three domains: 1) Spiritual beliefs and practices, 2) Spiritual support, and 3) Parent-child connection as sacred. Clinicians’ responses to family member spiritual statements were inconsistent and included providing affirmation, exploring goals of care, and continuing discussion of clinical information. ConclusionsSpirituality was discussed in approximately one-third of family conferences. Clinician engagement with spirituality discussion was variable. These findings highlight a need for training on when and how to discuss spirituality in conversations with families of seriously ill infants.

ECG findings are poor predictors for adverse events and cardiac death in Barth syndrome

BackgroundPatients with Barth syndrome (BTHS) can present with cardiomyopathy. BTHS subjects are at risk for cardiac adverse outcomes throughout life, including malignant arrhythmias and death. Electrocardiogram (ECG) parameters have never been assessed as a tool to predict adverse outcomes in individuals with BTHS. ObjectivesThe purpose of this study was to identify any ECG parameters, including QRS fragmentation, presence of arrhythmia, or abnormal intervals, that could predict adverse outcomes and cardiac death among the BTHS population. MethodsWe performed a retrospective case referent study on subjects with BTHS (n = 43) and compared them with our reference group, subjects with idiopathic dilated cardiomyopathy (DCM) from a single institution (n = 53) from 2007 to 2021. BTHS data was obtained from subjects attending the biennial Barth Syndrome Foundation International Scientific, Medical, and Family Conferences (BSFISMFC) from 2002 to 2018. ECG data from the first and last available ECGs prior to an adverse event or cardiac death was analyzed. Then, multivariable regression was performed to determine odd ratios between ECG characteristics and adverse events/cardiac death. ResultsNo ECG variables were statistically significant predictors of adverse events or cardiac death in the BTHS group. Last ECG QRS fragmentation trended to statistically significance (OR 13.3, p = 0.12) in predicting adverse events in the DCM group. ConclusionNo ECG parameters, including QRS fragmentation, presence of arrhythmia, or abnormal interval values, predict adverse events or cardiac death among BTHS patients. QRS fragmentation may be a predictor of adverse events in the DCM population.

Supporting High-Risk Families Through a Pregnancy Family Conferencing Model: Experiences of Professionals

ABSTRACT Effective child protection responses in the perinatal period can reduce the need for long-term service intervention. A Pregnancy Family Conferencing (PFC) initiative was established in one Local Health District in Sydney, New South Wales, Australia, by child protection and health services to facilitate strengths-focused planning with families identified as high risk. This qualitative study explores the experiences of professionals engaged with PFC. Findings highlight the importance of hope, building trust in difficult circumstances, and ensuring transparency, with benefits for interagency partnerships and finding meaning in the work. Findings have implications for services seeking to support families engaged with statutory child protection services during the perinatal period. IMPLICATIONS PFC provides an alternative model for child protection and health systems, promoting collaborative decision making through a strengths-based framework to benefit families and children. The findings show that PFC participation also can benefit professionals through the formation of trusting interagency and interdisciplinary collegial relationships, and working effectively with families to reduce risks.

P.047 Survey of caregivers of individuals with NBIAs to identify relevant quality of life outcomes

Background: Neurodegeneration with Brain Iron Accumulation (NBIA) is a heterogenous group of disorders with the common theme of iron accumulation in the basal ganglia. These disorders typically present in childhood with progressive neurodegeneration and neuropsychiatric symptoms. Caring for an individual with NBIAs is intensive, however it is unknown what factors impact caregiver well-being and quality of life. Methods: Common themes were obtained via literature review of quality of life surveys in children with neurological and chronic illnesses. Five domains were addressed: Diagnosis, Communication, Symptom Management, Clinical Experience and Resources/Support. The survey was approved by the Family Advisory Committee at the CHEO Research Institute and the CHEO REB. The survey was distributed via the Rare Connect Platform to Canadian caregivers. Results: Survey responses are being analyzed and will be presented at the CNSF. Within each domain, Likert scales will be analyzed. Domains will be ranked according to the caregiver responses. Conclusions: Results of this survey will assist in developing care management guidelines, resources for families and help with future advocacy for patients and families affected by NBIAs. The results will also help guide future NBIA Canada Family Conferences.

Improving Parental Knowledge of Medically Complex Neonates Through Scheduled Conferences.

Reports of parental dissatisfaction from incomplete or inconsistent information led to a quality improvement (QI) project to establish planned family conferences at 10 days and 1 month of life, for 50% of the medically complex neonates admitted to a neonatal intensive care unit within 1 year. A QI team instituted a system in which social workers scheduled family conferences and a neonatologist conducted the conferences. Team members tracked measures using statistical process control charts over 21 months. The QI team scheduled conferences for greater than 80% of eligible families, with an 86% completion rate on days 10 and 30, exceeding project goals of 50%. The majority of the families surveyed were satisfied with the meetings. Only 2% of parents surveyed found meetings burdensome, compared to 14% of physicians. A sustainable method for scheduling meetings and preparation for conferences, including the use of a template led to success.

Conducting family meetings on families with dementia: An integrative review.

To explore the role of family meetings for individuals living with dementia and their family caregivers. Integrative review. We conducted searches in the Cochrane Library, PubMed, CINAHL, and Embase databases (up to December 2022). Additionally, an ancestry search strategy was employed to supplement the retrieval of published literature related to family meetings or family conferences for people with dementia and their family caregivers. The review integrated 11 articles, comprising seven quantitative studies, two qualitative studies, and two case reports. The findings did not indicate a significant improvement in end-of-life quality for individuals with dementia in the family meetings group compared to those receiving usual care. Limited evidence suggested some improvement in mental health outcomes for family caregivers. Both intervention and control groups incurred high care costs. However, family meetings appeared to delay nursing home placements for individuals with dementia. Two qualitative studies provided insights into the experiences of families and healthcare professionals participating in family meetings, highlighting opportunities and challenges in implementing such meetings. Additionally, two case reports offered specific and illustrative accounts of typical family meetings. Family meetings can delay nursing home placements for elderly individuals with dementia. Families dealing with dementia perceive family meetings as an opportunity to collaborate with professionals in providing comprehensive care. Further research is needed to explore the effectiveness of family meetings in decision-making for families affected by dementia. Additionally, addressing timing and process coordination issues in family meetings is crucial for optimising their practices among families dealing with dementia. In order to make family meetings more accessible to families of individuals with dementia, we offer the following recommendations for future research and practice: Rather than a blanket rejection, the decision regarding the participation of individuals with dementia in family meetings should be based on their specific condition and the needs of their family. Coordination and harmonisation of opinions and perceptions among family members of individuals with dementia can sometimes be complex for healthcare professionals. The involvement of family coordinators may simplify this process. To determine the optimal timing for holding family meetings that can better assist families dealing with dementia, we propose that the right to initiate a meeting be granted to the family. This allows them to convene with healthcare professionals and address their concerns at their convenience.

Humanizing Communication Approaches to Family Conferences in Times of Pandemic

&lt;p&gt;家庭會議對醫療決策十分重要，特別在安寧緩和及加護病房照護等範疇，扮演重要的角色。健保署為鼓勵臨終安寧緩和，在2012年新增給付「緩和醫療家庭諮詢費」，並在2015年調整諮詢費及擴大給付範圍，使台灣民眾日益接受安寧緩和醫療的觀念。&lt;/p&gt; &lt;p&gt;不過，家庭會議面臨不少問題，當中醫師的溝通技巧對家庭會議成功與否，有著舉足輕重的影響，因此，一套有效的溝通模式必不可少。台大醫院致力將人性化溝通融入於家庭會議，例如，嘗試把VALUE及PLACE兩種溝通模式，應用在醫病共享決策(shared decision making,SDM)，成果顯示有助於在臨床實務實踐人性化溝通。未來，希望推動人性化醫病共享決策，成為醫療常規之一。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;Family conferences facilitate medical decision making, especially in the fields of palliative care and intensive care. Taiwan’s National Health Insurance started covering family conferences for palliative medicine in 2012 and has increased the coverage and budgets since 2015 with the goal of promoting general acceptance of palliative medicine in Taiwan. &lt;/p&gt; &lt;p&gt; However, there are many difficulties in holding family conferences whose success relies to a great extent on physicians&amp;rsquo; communication skills. However, better clinical outcomes of and patient satisfaction with shared decision-making can be achieved by humanizing communication with more empathetic approaches like VALUE (Value, Acknowledge, Listen, Understand, and Elicit) and PLACE (Prepare, Listen, Agree, Connect, and Explore). This is of particular significance during times of pandemic. It is our hope that, in the future, shared decision-making with the help of humanized communication approaches is advocated to be the standard medical practice in different fields, not restricted to palliative care.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

NURSING TECHNOLOGY SUPPORTING FAMILY INVOLVEMENT IN CRITICALLY ILL PATIENTS: A SYSTEMATIC REVIEW

Background: Family involvement in the care of critically ill patients positively impacts treatment outcomes and patient well-being. Nursing technology has become an essential tool in facilitating family engagement Aims: This study aims to conduct a systematic review of nursing technology that supports family involvement in critically ill patients. Methods: This article utilized a systematic review method. Articles were assessed using the JBI Critical Appraisal Checklist. The instruments were the JBI Critical Appraisal Checklist for Randomized Controlled Trials and the JBI Critical Appraisal Checklist for Cohort Studies. Literature from the past five years was obtained from four databases: Science Direct, Scopus, Springer Link, and ProQuest. Results: Out of 148 articles, 15 were analyzed. Various technologies (such as web-based platforms, tablets, SMS tools, and video conferencing) were used to provide information, enhance decision-making, and provide virtual access to family conferences. Although interventions varied, "Information sharing" and "Activation and participation" were most commonly implemented in the family involvement model. In studies that discussed the components of family involvement more comprehensively, interventions allowed for information adjustment through two-way communication and active family participation in the decision-making process. Conclusion: Based on the findings of this systematic review, it can be concluded that nursing technology has great potential in supporting family involvement in critically ill patients. This technology can significantly improve family well-being, communication, and decision-making. Further research can focus on a deeper understanding of the emotional impact experienced by families of critically ill patients due to the use of technology.

Prognostic Discordance Among Parents and Physicians Caring for Infants with Neurologic Conditions

To determine the frequency, degree, and nature of prognostic discordance between parents and physicians caring for infants with neurologic conditions. In this observational cohort study, we enrolled parents and physicians caring for infants with neurologic conditions in advance of a family conference. Parent-physician dyads completed a postconference survey targeting expected neurologic outcomes across 3 domains (motor, speech, and cognition) using a 6-point scale. Prognostic discordance was defined as a difference of ≥2 response options and was considered moderate (difference of 2-3 response options) or high (difference of 4-5 response options). Responses were categorized as differences in belief and/or differences in understanding using an existing paradigm. Forty parent-physician dyads of 28 infants completed surveys. Parent-physician discordance about prognosis occurred in ≥1 domain in the majority of dyads (n=28/40, 70%). Discordance was generally moderate in degree (n=23/28, 82%) and occurred with similar frequency across all domains. Of parent-physician dyads with discordance, the majority contained a difference in understanding in at least 1 domain (n=25/28, 89%), while a minority contained a difference of belief (n=6/28, 21%). When discordance was present, parents were typically more optimistic in their predictions compared with physicians (n=25/28, 89%). Differing perceptions about the prognosis of critically ill infants are common and due to differences in both understanding and belief. These findings can be used to develop targeted interventions to improve prognostic communication.

Exploring caregivers’ perceptions of community-based service requirements of patients with spinal cord injury: a qualitative study

BackgroundThe incidence of spinal cord injury is increasing worldwide. Patients with spinal cord injury and their families face many difficulties during the disease course. Caregivers are more involved with these patients than anyone else, so recognizing patients’ care requirements based on caregivers’ opinions can facilitate care provision to these people. The purpose of this study was to explore caregivers’ perceptions of the community-based services requirements of patients with spinal cord injury.MethodsThis qualitative research was conducted in Iran from Apr 2021 to Dec 2022 using the conventional content analysis method. The participants in the study included family caregivers and providers of home care services to patients with spinal cord injury, who were selected by purposeful sampling. Data were collected by conducting 14 face-to-face interviews and analyzed based on the method proposed by Lundman and Graneheim.ResultsData analysis led to the extraction of 815 primary codes, which were organized into two themes: community reintegration (with two categories, including the need to provide a suitable social platform and lifelong care) and palliative care (with two categories, including family conference and survival management).ConclusionSocial facilities and infrastructure should be modified in a way that patients with spinal cord injury can appropriately benefit from community-based care services and an independent satisfactory life. Palliative care should be continuously provided from the time of lesion development until the patient’s death.

Family Conferences to Facilitate Deprescribing in Older Outpatients With Frailty and With Polypharmacy

For older adults with frailty syndrome, reducing polypharmacy may have utility as a safety-promoting treatment option. To investigate the effects of family conferences on medication and clinical outcomes in community-dwelling older adults with frailty receiving polypharmacy. This cluster randomized clinical trial was conducted from April 30, 2019, to June 30, 221, at 110 primary care practices in Germany. The study included community-dwelling adults aged 70 years or older with frailty syndrome, daily use of at least 5 different medications, a life expectancy of at least 6 months, and no moderate or severe dementia. General practitioners (GPs) in the intervention group received 3 training sessions on family conferences, a deprescribing guideline, and a toolkit with relevant nonpharmacologic interventions. Three GP-led family conferences for shared decision-making involving the participants and family caregivers and/or nursing services were subsequently held per patient at home over a period of 9 months. Patients in the control group received care as usual. The primary outcome was the number of hospitalizations within 12 months, as assessed by nurses during home visits or telephone interviews. Secondary outcomes included the number of medications, the number of European Union list of the number of potentially inappropriate medication (EU[7]-PIM) for older people, and geriatric assessment parameters. Both per-protocol and intention-to-treat analyses were conducted. The baseline assessment included 521 individuals (356 women [68.3%]; mean [SD] age, 83.5 [6.17] years). The intention-to-treat analysis with 510 patients showed no significant difference in the adjusted mean (SD) number of hospitalizations between the intervention group (0.98 [1.72]) and the control group (0.99 [1.53]). In the per-protocol analysis including 385 individuals, the mean (SD) number of medications decreased from 8.98 (3.56) to 8.11 (3.21) at 6 months and to 8.49 (3.63) at 12 months in the intervention group and from 9.24 (3.44) to 9.32 (3.59) at 6 months and to 9.16 (3.42) at 12 months in the control group, with a statistically significant difference at 6 months in the mixed-effect Poisson regression model (P = .001). After 6 months, the mean (SD) number of EU(7)-PIMs was significantly lower in the intervention group (1.30 [1.05]) than in the control group (1.71 [1.25]; P = .04). There was no significant difference in the mean number of EU(7)-PIMs after 12 months. In this cluster randomized clinical trial with older adults taking 5 or more medications, the intervention consisting of GP-led family conferences did not achieve sustainable effects in reducing the number of hospitalizations or the number of medications and EU(7)-PIMs after 12 months. German Clinical Trials Register: DRKS00015055.

SOCIO-PSYCHOLOGICAL TECHNOLOGIES FOR THE PREVENTION OF DEVIANT BEHAVIOR AND DELINQUENCY AMONG ADOLESCENTS

This article deals with the actual problem of prevention of deviant behavior and delinquency among adolescents. To solve it, it is proposed to use socio-psychological technologies in working with deviant adolescents. The definition of deviant behavior and offense is given, their main forms and types are highlighted. Modern directions and types of prevention of deviant behavior are noted: personal, family, social prevention. Theoretical approaches to the prevention of socially dangerous, deviant behavior are highlighted. Various technologies for the prevention of deviant behavior are listed and characterized. According to the author, socio-psychological technologies are effective, and the prevention of deviant behavior of adolescents based on them implies the presence of several areas of socio-psychological activity and the necessary actions of a psychologist specialist. New and specific are the socio-psychological forms and technologies of preventive work related to the international experience and practice of "restorative justice”. These are technologies of “mediation, circles of care, family and school conferences”.

Perfil clínico-epidemiológico de crianças em cuidados paliativos de um hospital

Abstract This study analyzes the clinical-epidemiological profile of children assisted by the palliative care services of a reference hospital in Ceará, Brazil. A retrospective, quantitative, case series cohort study was conducted with 56 patients aged up to 2 years, 11 months and 29 days. Nervous system and circulatory system diseases, congenital malformations, deformities, and chromosomal anomalies were the most common illnesses. Severe and non-progressive disabling conditions were the main criteria for inclusion in palliative care. As for family conference, the mother was present in 94.6% of the cases. Death (58.9%) was the main outcome, being associated with circulatory system and nervous system diseases, use of respiratory device and mechanical ventilation, requesting sector and palliative care. In conclusion, pediatric palliative care aimed at non-cancer patients has generated new hospital demands, requiring a trained team sensitive to this new reality.

The virtual family conference in stroke rehabilitation: Education, preparation, and transition planning

Objective To examine the virtual family conference as an educational, preparatory, and transition planning intervention in stroke rehabilitation. Design Observational–cross-sectional study. Setting Inpatient stroke rehabilitation. Subjects Eighty-seven carers, participating in 48 conferences, were evaluated. Interventions The virtual family conference, involving the patient, carer(s), and interdisciplinary rehabilitation team, completed prior to community transition. The conference protocol and framework, consisting of nine primary themes and additional sub-themes, are outlined. Teleconferencing was the utilized virtual modality. Main measures Carers were assessed via questionnaires regarding pre- and post-conference rated: (1) stroke-related knowledge, (2) satisfaction with information provision, and (3) confidence, preparedness, and stress associated with community transition; by use of the Stroke Knowledge and Community Transition Preparedness Questionnaire, Mant et al. Information Satisfaction Questionnaire, and Kingston Caregiver Stress Scale. Results Significant improvement in post-conference carer-rating was noted for knowledge, pertaining to stroke nature/impairments, stroke management/prevention, functional status, and community services. Significant gains were demonstrated in post-conference satisfaction with information provided regarding stroke and discharge planning, across all assessed topics. There was also a significant increase in carer-reported confidence and preparedness for the community transition as well as a significant reduction in self-perceived stress for elements of the caregiving role. Organization of community follow-up care was consistently enabled within the proposed framework. Conclusions The virtual family conference intervention demonstrated efficacy in facilitating carer education and preparation, along with discharge planning prior to community transition from stroke rehabilitation. Thus, illustrating potential benefits of family conferences and feasibility of their virtual application in stroke rehabilitative care.

Adaptation of the Day100 Talk communication intervention for Spanish-speaking families of children with cancer.

The Day100 Talk (Day100) bridges communication gaps between parents and clinicians early in pediatric cancer care through an interprofessional family conference facilitated by structured tools. We aimed to understand communication challenges and facilitators and to adapt Day100 for Spanish-speaking parents. We interviewed Spanish-speaking parents with limited English proficiency, Spanish-English medical interpreters, and clinicians to gather communication experiences and adapt Day100. Results showed that communication difficulties were precipitated by linguistic and cultural differences, nonvisual technologies, and limited spontaneous communication. Interpreters enhanced communication as linguistic and cultural brokers. Nonverbal cues also facilitated communication. Participants offered recommendations to adapt Day100 for future study.

Development of a shared decision-making intervention to improve drug safety and to reduce polypharmacy in frail elderly patients living at home.

For patients with geriatric frailty, reducing inappropriate medication is an important goal to improve patient safety in primary care. GP-side barriers include knowledge gaps, legal concerns, and lack of communication between the actors involved. The aim was to develop a multi-faceted intervention to facilitate deprescribing and shared prioritisation among frail elderlies with polypharmacy living at home. Mixed methods study including: 1) scoping review on family conferences, expert panels; 2) group discussions with GPs, mapping of needs and challenges in Primary Care; 3) workshops and expert interviews with GPs, patient advocates, researchers as a basis for a theoretical intervention model; 4) piloting. A major challenge for GPs is to conduct a productive discussion with patients and family cares on deprescribing and drug safety. A guideline for a structured family conference with a medication check and geriatric assessment was developed and proved to be feasible in the pilot study. The intervention developed to facilitate deprescribing and shared prioritisation of drug therapy based on family conferences seems suitable to be tested in a subsequent cRCT. Adapting family conferences to primary care for frail patients with polypharmacy.

Characteristics of Prognostic Statements During Family Conferences of Critically Ill Children.

Discussion of prognosis is an essential component of decision-making family conferences in critical care. We do not know how clinicians convey prognosis to families of critically ill children. We, therefore, aimed to evaluate the frequency of prognostic statements and the message and meaning conveyed through each statement during PICU family conferences. Retrospective, mixed-methods study. PICU of a single quaternary medical center. Critically ill children and their families participating in PICU family conferences of critical medical decision-making. None. We analyzed 72 transcripts from audio-recorded PICU family conferences to identify prognostic statements. Descriptive, thematic content analysis was used to elucidate the message and meaning of each prognostic statement. Prognosis was not discussed in 26% (19/72) of family conferences. Of the other (53/72) conferences where prognostic statements were made, 60% (67/112) of statements conveyed a message (i.e., prognostic medical information) and a meaning (i.e., anticipated impact on patient/family). "Messages" of prognostic statements fell within eight themes: uncertain recovery, delayed recovery, progressive decline, escalation of support, attributable complications, no progress, irreversible, and probability of death. "Meanings" of prognostic statements fell within six themes: restoration of health, activities of daily living, additional equipment, prolonged care needs, brain dysfunction, and death. Broadly, clinicians discussed prognostic information in three categories: loss of Time (i.e., prolonged care needs), Function (i.e., additional medical equipment), or Cure (i.e., death). Nearly in half of discussions (32/72, 44%) where families were asked to make critical medical decisions, clinicians did not provide a prognostic statement including a message and meaning. When discussed, prognostic information was conveyed in three categories: loss of time, function, or cure. Providing families context in this framework, particularly in times of uncertainty, may improve the family's ability to make informed, value-driven medical decisions for their child.