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Multidisciplinary Family Meetings in the ICU Facilitate End-of-Life Decision Making

Department of Medicine, Division of Pulmonary and Critical Care Medicine, Thomas Jefferson University Hospital Philadelphia, Pennsylvania

Amy Callahan, , MSN, RN, CNE, APRN-BC

Department of Nursing, Thomas Jefferson University Hospital Philadelphia, Pennsylvania

Galia Paganelli, MD

Division of Geriatrics and Palliative Care Service Jefferson University Philadelphia, Pennsylvania

Barbara Reville, MS, APRN, ACHPN

Division of Geriatrics and Palliative Care Service Jefferson University Philadelphia, Pennsylvania

Susan M. Parks, MD

Division of Geriatrics and Palliative Care Service Jefferson University Philadelphia, Pennsylvania

Paul E. Marik, MD, FCCP

Department of Medicine, Division of Pulmonary and Critical Care Medicine, Thomas Jefferson University Hospital Philadelphia, Pennsylvania, paul.marik{at}jefferson.edu

Objective: The aim of this study was to assess the feasibility of establishing a multi-disciplinary family meeting (MDFM) program and the impact of such a program on the end-of-life decision making in the setting of an ICU. Methods: During the study period MDFMs were scheduled for patients requiring mechanical ventilation for 5 or more days. The meeting followed a structured format. The pertinent details of the meeting as well as the treatment goals were recorded. Results: Twenty-nine patients were enrolled in this study. Thirty-five MDFM’s were held on 24 patients. A meeting could not be arranged for four patients. All meetings addressed patient’s diagnosis, prognosis and goals of care. Fifteen (52%) patients (9 of whom had metastatic malignancy) had life support withdrawal and died a mean of 4.8 + 4.2 days after the first family meeting. In the remaining 9 patients (3 with localized cancer and 6 with non-cancer diagnoses), the plan following the family meeting was to continue supportive care; all of these patients survived to hospital discharge. Conclusions: Proactive MDFM’s improve communication and understanding between patients’ family and the treating team and facilitates end-of-life decision making.

Key Words: palliative care • family meeting • multidisciplinary • ICU • critical care • end-of-life

This version was published on August 1, 2009

American Journal of Hospice and Palliative Medicine®, Vol. 26, No. 4, 295-302 (2009)
DOI: 10.1177/1049909109333934


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