Transcript 7 Teaching Slides on Engaging Families in Advance Care

Learning objectives to meet the goals of knowledge to
practice:
 Define the term family
 Discuss issues of conflict which may interfere with
advance care planning
 Identify communication strategies to support the
individual’s
family
Lakehead
UNIVERSITY
WHAT IS FAMILY?
 in health care, the definition of family is broad and refers to the
‘family system’
 those closest to the person in knowledge, care and affection

Biological family



Family of acquisition


Related by blood
Related by adoption
Related by marriage/contract
Family of choice - a group of people who share
common attitudes, interests, or goals and, frequently,
live together


Outside of the traditionally defined family
May include friends
Lakehead
UNIVERSITY
WHAT IS BEHIND THE SOURCE OF CONFLICT
Be aware of family dynamics at times of stress - avoid labelling
 Conflict may arise in different situations and involve different people
 Pressure to understand the severity of the illness, treatment options
and making the ‘best’ decision
 Contributing social, emotional, cultural and personal factors
 Is there a subtext that underlies the words?
 Are reactions unrelated to the immediate issue at hand?
Lakehead
UNIVERSITY
THINGS TO CONSIDER
Stresses which may create conflict:
Things to remember:
 No two families are alike
 Intense feelings
 Uncertainty
 Many families have long histories of
troubled relationships
 Old family conflicts
 Avoid ‘taking sides’ – establish
boundaries
 Always attempt to foster communication
and understanding among family
members
 Changes in family roles
 Economic difficulties
 Remain non-judgemental – resist giving
advice
 Past experiences with loss or death
 Fluctuation from denial to acceptance
 Resist imposing personal standards and
values
Lakehead
UNIVERSITY
Consequences Resulting from Conflict
Conflicts may result in:
 Lack of treatment or over
treatment
Difficult situations may include:
 Not respecting advance directives
(i.e. not willing to accept the
person’s wishes)
 Lack of trust in health care
providers & system
 Loss of precious time
 Lack of agreement on care
 Emotional depletion
 Designated POA or SDM not
local
 Increased stress
 Shared POA without congruency
 Complicated bereavement
Lakehead
UNIVERSITY
KEEP IN MIND ....
 Don’t take it personally - anger is at the
situation
 Expect denial
 Give appropriate information
Is the reaction a result of
 Explore past methods of coping



what is being said
the timing of what is being said
what is represented by what is
being said
 Encourage discussions which provide
reasoning behind the decisions
 Recognize own limits
 Utilize the expertise of other team
members in helping with conflicts
 Focus on the goal to make decisions that
respect the person’s wishes, values and
goals
Lakehead
UNIVERSITY
HEALTH CARE PROVIDERS IN CONFLICT WITH SDM’S
 Values & experiences of healthcare providers – awareness of
impact on others (perceived power)
 Resolution is the responsibility of health care providers
 It is important for the entire health care team to show
caring, respect, and support for the acting SDM in order to
emphasize that they are working with him/her as part of
the team
 Show interest
 Inquire about their well-being
Lakehead
UNIVERSITY
BALANCED
COMMUNICATION
–NEGOTIATIONMEDIATION
Things to consider:
 Is the environment conducive for discussion
 SDM’s understanding of the situation
 SDM’s fear of making the wrong decision



Guilt
Sense of abandonment
Responsibility for ‘killing’ their loved one
Explore the Bigger Picture
• Why did the conflict arise?
• Identify changes in behaviours
of health care providers and the
system
 Broad range of reactions
 Unique challenge of communicating emotionally laden material



What do you hear?
Clarify ambiguous statements
Listen in balance with speaking
Lakehead
UNIVERSITY
Positive Conflict Resolution
 Reflect on ways you could be contributing to conflict
 Identify ways in which you can change your behaviour or make a conciliatory gesture
 Avoid labelling i.e ‘dysfunctional family’
 Try to understand the emotional meaning of the context of what is being said
 Work towards being unbiased
 Encourage self-awareness
 Remember the importance of non-verbal communication
 Recognize the cost of ignoring the problem
Note: family members may refuse to bring forth advance directives if
they disagree with the contents or out of fear of losing their loved one
when it is clear that imminent death is near
 acknowledge their emotions
 educate
Lakehead
UNIVERSITY
COMMUNICATION: QUESTIONS TO ASK TO GET THE
CONVERSATION STARTED WITH A SDM OR POA
 What can the health care team do to help you and your loved one? Help us understand
what your loved one would want if he/she could speak to us now.
 What are some of the things that make life worth living for your loved one?
 If your loved one were going to die soon, what are some of the personal things that would
be important for her/him to take care of?
 Do you and/or your loved one have religious or spiritual ways to get ready for death?
 Are there heath problems that your loved one would think are worse than death, such as
living with severe pain, with total physical dependency, or not being able to recognize or
communicate with family and friends?
Lakehead
UNIVERSITY
STEPS TOWARD RESOLUTION
 Acknowledge the goals, values, beliefs and wishes of
the person
 Work towards positive communication strategies
 Rely on strengths from members from the inter-
disciplinary team (i.e. Pastoral care, social work)
 Utilize structures within and external to the current
setting – inter-organizational supports e.g. ethics
committee, legal assistance, Public Trustee and
Guardian, capacity assessor
Lakehead
UNIVERSITY
The single biggest problem in
communication is the illusion
that it has taken place
George Bernard Shaw
REFERENCES
Centre for Education and Research on Aging & Health. (2008). Working with families.
Thunder Bay: Lakehead University, 3.1-3.34.
Educating Future Physicians in Palliative and End-of-Life Care (EFPPEC). (2008).
Facilitating Advance Care Planning: An Interprofessional Educational Program:
Curriculum Materials. Ottawa : EFPPEC, 42-50.