“Standing Shoulder to Shoulder to Tell the Family What Was Really Going On”: A Qualitative Study Exploring Palliative Care Clinicians' Perceptions of “Patient-Centered Family Meetings”

Abstract

Background:

Family meetings are often conducted in palliative care, but there is no universal agreed or accepted model. A new model of Patient-Centered Family Meetings is proposed whereby the patient sets the agenda.

Aim:

To seek palliative care clinicians' perceptions and experiences of Patient-Centered Family Meetings (“Meetings”) and their acceptability and feasibility in the inpatient specialist palliative care setting.

Design:

A qualitative study used semistructured interviews. Theoretical and procedural direction was taken from grounded theory with thematic content analysis using the constant comparative method.

Setting/Participants:

Interviews were conducted with clinicians (n = 10) at the intervention site who had participated in a Meeting.

Results:

Four themes were identified: (1) a patient-set agenda gives patients a “voice”; (2) a patient-set agenda and the Meeting model enhances clinicians' understanding of patients and families; (3) the Meeting model was perceived to be acceptable; and (4) the Meeting model was perceived to be only feasible for selected patients.

Conclusion:

Clinicians perceived that a patient-set meeting agenda with defined questions enhanced their knowledge of the patient's issues and their understanding of the patient and their family's needs. The patients' most important issues often differed from the clinicians' expectations of what might be important to individual patients. There were contrasting views about the acceptability and feasibility of these Meetings as standard practice due to clinician time constraints and the Meeting not being required or relevant to all patients. Given the perceived benefits, the identification of patients and families who would most benefit is an important research priority.

Introduction

Palliative care emphasizes a multidisciplinary team (MDT) approach to improve the quality of life of patients and their families facing end-of-life concerns.¹ Effective communication is central to adequately address patient and family needs and issues.^2,3 Bringing the patient, family, and MDT members together for a purposeful discussion promotes enhanced patient–family–team communication in the specialist palliative care setting.^4–7 These conversations are often termed “family meetings” or “family conferences.”^5,6

Family meetings are defined as a single meeting attended by clinicians, family members, and the patient (if possible) to discuss the patient's illness and care, and topics relevant to the family.⁸ Family meetings aim at facilitating discussion about care choices and end-of-life decision making.^5,9–11 The “family” is defined as whomever the patient designates as being “family” and may include close friends and/or carers.⁸

A few studies have examined the outcomes of family meetings.^12,13 Hannon et al. found that unmet family needs improved as a result of family meetings, but they recommended further studies to review the family and clinician perspectives. An evaluation¹³ of the Guidelines for Conducting Family Meetings in Palliative Care⁶ found that clinicians supported routine family meetings for newly admitted patients. However, they raised concerns about the clinical resource implications and time involved to attend such meetings.¹³

Patient-centered family meetings

A quality improvement project undertaken in an inpatient specialist palliative care service found qualitative evidence that routine patient-centered family meetings improved communication, decision making, and discharge planning.¹⁴ The authors recommended further research to better understand patient and clinician outcomes.¹⁴

Given the significant resource and time costs associated with family meetings, and the lack of clear evidence to demonstrate their efficacy, a Valuing Opinions, Individual Communication and Experience (VOICE) study was initiated.¹⁵ The VOICE study aimed at determining the acceptability and feasibility of providing routine Patient-Centered Family Meetings in specialist inpatient palliative care and understanding the benefits and burden of participating in Patient-Centered Family Meetings from the patient, family, and clinician perspective. Details of the protocol have been published.¹⁵ The study is registered on the Australian New Zealand Clinical Trials Registry (https://www.anzctr.org.au—ACTRN12616001083482), and St Vincent's Hospital Human Research and Ethics Committee has approved the study (reference no.15/SVH/33).

The proposed intervention was designed to be “patient-centered” to reflect the importance of patient-centered care in the Australian and global health contexts. “Patient-centered care” is health care that respects and responds to the unique preferences, values, needs, and expectations of individual patients and of their families or significant others.¹⁶ Engaging effectively with the patient's family and significant others is a key strategy to enhance patient-centered care.¹⁶ In this family meeting model, the patient sets the agenda in advance by identifying his or her concerns and issues to ensure that these are addressed in the meeting. This contrasts with family meetings where the agenda is primarily focused on meeting the needs of the health care team and those of the family.⁶ The patient also identifies which family member(s) he/she wishes to attend the Patient-Centered Family Meeting.

The Patient-Centered Family Meeting (“Meeting”) was the intervention offered to eligible patients during the first 10 days of an inpatient admission at the intervention site, a specialist palliative care service. Before the Meeting, patients formulated with the researcher on-site (P.J.C.) their agenda based on three key questions: (1) How do you see your health problems at the moment? (2) What do you expect from this admission? (3) Do you have any concerns about what is happening to you for which you would like help? This patient-set agenda was integral to the intervention, and it was circulated to MDT participants before the Meeting. This study reports on the clinicians' experience and perceptions of the Meetings they attended. Intervention site clinicians were exposed to the Meeting, which was guided by the patient-set agenda.

Aim

The two aims of this study were to: (1) determine the acceptability and feasibility of implementing Patient-Centered Family Meetings in the inpatient specialist palliative care setting; and (2) understand the clinicians' experiences and perceptions of participating in a Patient-Centered Meeting.

Materials and Methods

Design

Semistructured individual interviews were used to elicit an in-depth understanding of the clinicians' experience of the Meetings. The report aligns with the COnsolidated criteria for REporting Qualitative research (COREQ).¹⁷

Setting

The Meeting intervention was offered in a 22-bed specialist palliative care ward in a metropolitan hospital in Sydney, New South Wales, Australia. Two members of the research team (P.J.C., C.R.S.) provided education and a Meeting Manual to clinicians about the key components of the Meeting model before the patient's recruitment and the clinician's participation in a Meeting.

Recruitment/participants

Purposive sampling was used. Clinicians were eligible if they had participated in at least one Meeting involving a patient for whom they had provided care and had consented to the study. At least one representative from each clinical discipline was interviewed. All clinicians approached by an e-mail invitation or face-to-face provided written informed consent and agreed to digital-taping and transcription of their individual interview (n = 10).

Methodology

A semistructured interview schedule of 14 questions was used (Table 1). The schedule was based on questions developed for the clinician focus group in the Patient-Centered Family Meeting study.¹⁴

Table 1.

Semistructured Interview Schedule

1. Did you think there was sufficient balance of staff to patient/family ratio?

2. Do you think the Meeting was facilitated well? Please tell me why….

3. How do you think the patient experienced the Meeting?

4. Did you get any feedback from the patient and/or family about the Meeting?

5. Did other staff comment about the Meetings?

6. Did you think the Meeting was an efficient use of your time?

7. From your perspective were there positive aspects of the Meeting? If so, what were these?

8. From your perspective were there negative aspects of the Meeting? If so, what were these?

9. Were there specific benefits for you in participating in the Meeting? If so, what were these?

10. Was there anything about the Meeting that was uncomfortable or negative for you?

11. Can you comment about the acceptability of these Meetings to the ward routine?

12. Do you think it is feasible to provide these Meetings as part of standard care?

13. Is the Meeting an acceptable model to you as part of standard care for patients?

14. Do you have any suggestions or improvements, or any further comments or feedback or future challenges you wish to make about the Meetings?

Research team

The interdisciplinary research team comprised: an experienced palliative care researcher (J.L.P.) and Director of a Research Center focused on palliative, aged, and chronic disease research; an experienced qualitative and palliative care researcher (E.A.L.); and an experienced palliative care doctor and researcher (C.R.S.). The main researcher (P.J.C.) was a PhD student with tertiary education in qualitative and quantitative research.

Data collection process

Clinician (“participants”) interviews were undertaken (P.J.C.) between August and December 2018. They were conducted according to the clinician's availability and in a quiet space to ensure minimum disruption and effective recording. The semistructured interview schedule guided the interviews. Data were digitally recorded and transcribed verbatim. The researcher (P.J.C.) checked all transcripts by listening to the original digital recordings. Field notes were documented at this time. There were no repeat interviews. Due to the participants' competing clinical demands, the transcripts were not returned for comment.

Data analysis

Data analysis was informed by procedural direction from grounded theory. Key components of thematic analysis^18,19 were used to develop the themes from the coded datasets. An initial blinded coding of 40% of the transcripts was undertaken by three of the researchers (P.J.C., E.A.L., and C.R.S.) to identify preliminary codes. Open and selective coding was used to analyze the data.²⁰ Open coding involved repeated reading of clinicians' interviews and a line-by-line analysis of the data. Selective coding was then used to link the data together. These codes were discussed, and consensus was reached. The main researcher (P.J.C.) then coded the remaining transcripts based on the preliminary coding.

Themes were derived from the data by using the constant comparative method.²¹ Themes were constantly compared and contrasted to identify recurring regularities and identify discrete categories. These resultant themes were discussed and agreed on by the three researchers (P.J.C., E.A.L., and C.R.S.). The authors did not use a coding tree nor software to manage data. Data saturation was achieved with definitive themes being identified for the coded data.²² Quotations to illustrate themes have been de-identified.

Results

Ten participants (eight females and two males) were interviewed with representation from the clinical fields of medicine (n = 5), social work (n = 3), physiotherapy (n = 1), and occupational therapy (n = 1). The medical cohort included palliative care physicians (n = 2), trainee palliative care physicians (n = 2), and a senior resident medical officer (n = 1). The median age range was 35–44 years and 2.5 years working in palliative care. The mean interview duration was 17.49 minutes (standard deviation = 4.48).

Four overarching themes were identified: (1) a patient-set agenda gives patients a “voice”; (2) a patient-set agenda and the Meeting model enhances clinicians' understanding of patients and their families; (3) the Meeting model was perceived to be acceptable; and (4) the Meeting model was perceived to be feasible only for selected patients.

A patient-set agenda gives patients “a voice”

Participants reported that the patient-set agenda guided by three key questions assisted patients in expressing their concerns:

… because they have … appropriate questions and they were all … relevant to their situation … they were able to use the meeting to voice their questions and concerns … (Palliative care physician).

The preparation of the patient-set agenda before the Meeting contributed to patients being able to voice their issues during the Meeting:

… gave the patient a chance to …. voice concerns, issues… well the first thing is that it let them voice them out beforehand (when preparing the agenda) (Senior Resident Medical Officer).

The patient-set agenda was observed to empower patients:

I sense that sometimes the family meeting can be us coming in, saying this, and even though we think it's an opportunity for them to ask questions, who knows if that's the case, but whereas this time around they had … an agenda that empowered them, so arguably it was probably more effective in getting to the bottom of what they wanted to talk about. (Trainee palliative care physician).

The empowered patients were also perceived to determine the issues that were of the most importance to them, in contrast to a discussion focused on a clinician-set agenda:

… because it's patient-initiated… they take control and …. they can prioritize their concerns whereas if we have our own agenda then the priorities might be slightly different. (Palliative care physician).

Enabling patients to determine the agenda, these Meetings focused on the patient's issues. This was in contrast to other family meetings where other people's agendas dominated the meeting:

… to have an actual Meeting where everyone comes in for their (the patient's) agenda rather than the doctor's agenda or clinician's agenda, I think that a really different experience and certainly I think all the patients appreciated being the center of attention with their own agenda. (Social worker).

During the Meeting, patients were able to express their concerns while being supported by the clinical team, whose role was to: listen; address the patient's issues; and, if required, to act as a patient advocate and speak honestly to families about the situation and the patient's wishes:

I think (the patient) saw us as her “army of allies.” We were there standing with her shoulder to shoulder to tell the family what was really going on and to tell them the things that she couldn't say but she just so desperately wanted them to understand. I really felt we were on M's (the patient) side. That we represented her worries, hopes, dreams, concerns and that we articulated those for her, … by just saying them out loud, and saying this is what we think is happening and she'd be “Yes, that's exactly what's happening.”(Trainee palliative care physician).

As a result of the patient-set agenda informing the Meeting discussion, a sub-theme emerged of families gaining an enhanced understanding of the patient's needs. There was a perception that the Meeting was potentially transformational for the patient's family:

(The patient's) family cried when they heard the answer to a few of her questions and … I think it changed their approach to her… it was a release. (Social worker).

Overall, the structured approach of the meetings and the preset agenda were seen as a positive point of difference compared with the “ad hoc” family meetings that are currently so often held in palliative care:

I think these are so superior. Because a normal family meeting…is loose with its boundaries … I was quite delighted with this approach because there was structure. …I've noticed they (patients) speak more in the Meeting than the relatives because of the questions… (Social worker).

A patient-set agenda and the Meeting model enhances clinicians' understanding of patients and families

Participants considered the patient-set agenda pivotal in understanding the issues and concerns that were of most importance to the patient:

So I think it was really helpful to hear what was the priority from the patient's perspective and I think because there was a written agenda it then meant that everyone as a team discussed it a bit afterward, you know, “wasn't it interesting that this patient was worried about X” and I think that therefore put it on all of our agendas. I think that was a really sort of beneficial side effect.’ (Palliative care physician).

The patient-set agenda enabled families to contribute and prioritize their issues:

… it does bring up things that…we might have missed…because it's patient-initiated or patient's family-initiated, they take control and … prioritize their concerns whereas if we have our own agenda the priorities might be slightly different. (Palliative care physician).

A sub-theme that emerged was that participants considered that these Meetings with the patient-set agenda differed from usual family meetings, because there was a greater appreciation of patients' psychosocial concerns:

… allowed us more insight and was more productive than probably we had often thought … most of those Meetings were not to discuss discharge planning, they were to get a sense of the patient, their fears, their concerns and so that was quite different … (Palliative care physician).

Another sub-theme was that the patient-set agenda sometimes identified patient issues that deviated from the participants' expectations. Participants were sometimes surprised by the emphasis that patients placed on issues that differed from what the participants had envisaged. These insights were considered valuable:

I think because the questions were defined. It was really interesting to see what patients asked about; they often weren't what I would have covered in a family meeting because they would be, just things that I wouldn't necessarily have put as much emphasis on as the patient did and I think that is really important. (Palliative care physician).

Further, the patient-set agenda provided participants with a better understanding of what information the patient needed from the clinical team:

It was time and humanity and being there and standing with her … that made her feel better which is pretty remarkable and I don't know if we would have got that had we set the agenda, in fact I don't think we would have … we would have gone in there (patient's room) done a medical update, said this, that, and the other, maybe even pussyfooted around her actual prognosis, I'm sure if that was what she wanted; when in fact … she wanted us to be realistic, pragmatic … and she gave us permission to do that by giving us the agenda. (Trainee palliative care physician).

Families also revealed information during these Meetings, which was unexpected but critical to understanding family issues:

It was a really good eye opener to see all the family there and we kind of could see what was happening… and we walked out saying, “Wow you know, there's a lot more to this story than we thought…” It made us aware earlier of the actual social situation. (Social worker).

It was unclear whether the information revealed was a factor of the Meeting model or the patient-set agenda, or both these elements of the Meeting model.

Participants also recognized that patients raised concerns that they had not previously articulated despite palliative care clinicians encouraging questions during prior patient consultations. This filled gaps in the participant's knowledge of the patient:

… often we don't really know what patients want to ask and the questions they want answered … and I always end a conversation with a patient saying “Do you have any more questions or concerns?” to try and make sure that I always open up that dialogue. And yet I feel like (the Meeting) brought through concerns they hadn't expressed to me. (Palliative care physician).

The Meeting model was perceived to be acceptable

Participants commented favorably about the Meeting model's acceptability:

I think it's (Meeting) easily transferrable and very acceptable. … you're getting straight to the heart of the issue and you're not skirting all around and then finding you're off target because they (patient/family) haven't actually voiced anything yet, so I think it's easily transferrable, it doesn't take really any more time or resources significantly at all… (Trainee palliative care physician).

However, there was a range of views expressed about these Meetings being acceptable as routine practice. The majority of participants supported this concept:

I think it's a great model…it's how we should model all of our interactions in palliative care…it seems to me like it's a time that patients only express what they truly think. (Trainee palliative care physician).

In contrast, a minority of participants, while endorsing the acceptability of the Meetings, thought that offering these Meetings to all patients would be challenging due to clinical demands and limited resources:

I think they're very acceptable and possible to use … but I think it would have to be used judiciously … you couldn't be having multiples in a week because it just represents too much of your clinical time. (Palliative care physician).

Beyond the research setting, where the researcher organized the Meetings and circulated the patient-set agenda, other arrangements would need to be made:

It just needs to be organized. That's the only problem is that it does require some organizing but I thought the emails worked well, I like that I didn't have to organize it. (Trainee palliative care physician).

In considering the model's acceptability, participants raised the issue of effective timing of the Meeting:

I think it has to be timed with when they're (patients and families) kind of ready … and I think too early and you start to discuss things that aren't going to happen, too late and the family has kind of missed the opportunity to … get out what they need to say … (Physiotherapist).

The Meeting model was perceived to be only feasible for selected patients

Although there was in principle support, the majority of participants did not consider these Meetings feasible as standard practice for all patients. Rather, they endorsed their use for particular patients:

… in selected patients I think it is a very good thing to have as a standard of care. (Palliative care physician).

Participants perceived these Meetings as ideal for the management of patients with complex issues, which traditionally require multiple discussions with patients, families, and clinicians and are time consuming:

The patients that are difficult discharge planning, or really need comprehensive discussion and … difficult families that are perhaps separated and conflicting and … those issues take up a lot of time and resources so … this is a great investment for those patients. (Trainee palliative care physician).

Participants also identified other candidates for whom these Meetings may be indicated. Patients who had expressed suicidal thoughts or previously attempted suicide were seen as a patient cohort who might benefit from this intervention:

… being suicidal in the palliative care sphere often speaks of people who feel like they don't have options and don't have a voice. (Palliative care physician).

Another patient cohort (considered suitable for these Meetings) included women who had family members who were emotionally dependent. These were often adult children about whom the women were worried. Participants reported that this sub-group of patients expressed a desire to discuss their concerns about their family members at the Meeting. This provided a different focus for the Meeting:

… the four (patients) that I was involved with … were all middle-aged women with dependents, even though they weren't actual dependents … And … were worried about someone in their family… which I think changed the dynamic (of the Meeting) because quite a lot of the discussions were around, “I'm worried about my family member,” which is different to your usual family conferences which is, we, as a team are worried about how you're going to cope at home. (Palliative care physician).

There were also patient cohorts for whom these Meetings were not considered essential:

… there's a lot of patients who I think are a lot more straightforward that you probably don't need to do it … their family are a lot more straightforward … their family … doesn't have conflicting views, the patient's fairly clear about what they want, they're able to express it, and that's in line with what we think is appropriate so I don't think we need to do it for everyone. (Trainee palliative care physician).

Participants also raised lack of time as an issue in considering the Meeting's feasibility:

I would identify the subset of patients who I think it's going to benefit the most and try to work that model within the confines of the clinical time that's available. (Senior Resident Medical Officer).

In response to clinical time constraints, participants suggested the development of a triage strategy, whereby patients in the first week of admission could be screened by using designated criteria to identify who might benefit from this type of Meeting:

… whether you had a system by which if you ticked the certain number of criteria, it was flagged for the team that this would be considered a good intervention… (Palliative care physician).

Discussion

This study has demonstrated the value to clinicians of reframing family meetings so that the patient sets the agenda. Clinicians considered the insights invaluable and elicited an enhanced understanding of the patients' and families' issues. Despite the use of three key generic questions to guide the patient agenda, each patient's questions were frequently specific to them, and quite often were not anticipated by the clinicians.

An Australian qualitative study examined a list of possible questions for palliative care patients to ask clinicians.²³ The study provided evidence that clinicians do not necessarily appreciate the extent and breadth of patients' concerns. Clinician feedback indicated that although clinicians thought they could identify patients' information needs, they were not able always to do so. The clinicians' experience of these Meetings, including the use of a patient-set agenda, confirms the findings of this Australian study. The patient-set agenda appears to be essential to ensure that patients' concerns and issues are articulated, discussed, and potentially resolved.

Clinicians endorsed these Meetings as an acceptable model for family meetings. However, they did not consider that these Meetings were feasible as standard practice for all patients. Clinicians perceived that there were particular patient cohorts and families for whom this type of Meeting would be indicated or advantageous, for example, patients and/or families with complex needs. It was acknowledged that for some patients and families this intervention was pivotal in resolving end-of-life issues and it was important to ensure that these patients received the benefits of this Meeting.

Clinicians noted the issue of clinician time and availability to participate in the Meetings vis-a-vis competing clinical priorities as a key factor in the feasibility of implementing these Meetings routinely. This finding was analogous to the Hudson et al. study findings¹³ about the time and clinical resources required for family meetings. Trainee palliative care physicians embraced the model and considered the time constraints as less of a problem than qualified palliative care physicians. These more experienced palliative care physicians appeared more conscious of the clinical patient workload and recognized the need for careful identification of patients who would be most helped by this intervention.

The researcher on-site (P.J.C.) coordinated these Meetings for the purposes of the study. Alternative staffing arrangements would be required to enable this Meeting model to be considered as standard practice in the inpatient setting for appropriate patients and families.

It is important, therefore, to undertake further research to identify those patients and families who would benefit from these Meetings or for whom these Meetings are indicated. This research would add to the current limited body of knowledge and evidence regarding family meetings in the specialist palliative care context. When there is further clarity regarding the patients and families for whom these Meetings are indicated or not indicated, a triage process undertaken by social workers or medical staff could be considered.

Strengths and limitations

The use of a semistructured interview schedule for clinician interviews provided a consistent approach for seeking clinician feedback about the Meeting experience. As far as we are aware, this is the first study undertaken in a specialist palliative care setting to examine clinicians' experience of a patient-centered approach to planned family meetings.

A possible limitation was the number of clinicians interviewed. However, as the regular clinical workforce was reasonably constant (except for Senior Resident Medical Officers and Trainee Palliative Care Physicians), it was possible to interview almost all clinicians who had participated in the Meetings. Another limitation was that clinicians only participated in a small number of Meetings. The limited sample size of recruited patients and families precluded a robust examination of the clinicians' experience.

Implications for research and practice

Palliative care patients should be encouraged and supported to set the family meeting agenda, with consideration being given to using the three questions outlined in the Meeting model. Additional research should be undertaken to clearly define which patients would benefit from these Meetings, to ensure effective use of clinical resources, and to strengthen the understanding of the Model's feasibility in the palliative care context.

Conclusion

This study has highlighted that a family meeting where the patient sets the agenda provides palliative care clinicians with a deeper understanding and valuable insights about the patient's needs and preferences and family issues. Feedback from patients and families (to be published elsewhere) will add to the body of evidence.

Clinicians acknowledged the acceptability of this new Meeting model; however, they perceived that this Meeting model was not feasible for all patients. This observation was based on the recognition that there were finite clinical resources and time required to provide them as standard care, and that not all patients would require or be suitable for this Meeting model. Nevertheless, for some patients these Meetings were seen as critical for effective end-of-life care. To advance the implementation of this new model, it is vital to identify the patient cohorts that would most benefit from this type of Meeting.

Data Management and Sharing

Raw data are included in the article in the form of interview excerpts. All data were de-identified and the names, identification numbers, and completed digital tapes were saved on a password-protected computer at the sub-acute facility. The corresponding author may be contacted for further information.

Footnotes

Acknowledgments

The authors acknowledge and thank all members of the MDT for their participation in the individual interviews. The time and thoughtful responses given by each clinician provided invaluable insights into the experience and perceptions of the Patient-Centered Family Meeting model.

Funding Information

The Australian Government Collaborative Research Networks program funded the scholarship (P.J.C.) to support this work as part of the research project: Healthy People, Healthy Country.

Author Disclosure Statement

No competing financial interests exist.

References

World Health Organization: National Cancer Control Programmes: Policies and Managerial Guidelines, 2002.

Steinhauser

, Christakis

, Clipp

, et al.: Factors considered important at the end of life by patients, family, physicians, and other care providers. JAMA, 2000; 284:2476–2482.

Sullivan

, da Rosa Silva

, Meeker

: Family meetings at end of life. J Hosp Palliat Nurs, 2015; 17:196–205.

Zhukovsky

: A model of palliative care: The palliative medicine program of the Cleveland Clinic Foundation. A World Health Organization Demonstrations Project. Support Care Cancer, 2000; 8:268–277.

Fineberg

, Kawashima

, Asch

: Communication with families facing life-threatening illness: A research-based model for family conferences. J Palliat Med, 2011; 14:421–427.

Hudson

, Quinn

, O'Hanlon

, Aranda

: Family meetings in palliative care: Multidisciplinary clinical practice guidelines. BMC Palliat Care, 2008; 7:12.

Powazki

, Walsh

: The family conference in palliative medicine: A practical approach. Am J Hosp Palliat Med, 2014; 31:678–684.

Fineberg

, Bauer

: Families and family conferencing. In: Altilio

, Otis-Green

, Altilio

, Otis-Green S (eds): Oxford Textbook of Palliative Social Work. New York, NY: Oxford University Press, 2011, pp. 235–249.

Fineberg

: Preparing professionals for family conferences in palliative care: Evaluation results of an interdisciplinary approach. J Palliat Med, 2005; 8:857–866.

10.

Altilio

, Otis-Green

, Dahlin

: Applying the national quality forum preferred practices for palliative and hospice care: A social work perspective. J Soc Work End Life Palliat Care, 2008; 4:3–16.

11.

Kissane

, Hempton

: Conducting a family meeting. In: Kissane

, Bultz

, Butow

, et al. (eds): Oxford Textbook of Communication in Oncology and Palliative Care. Oxford: OUP Oxford, 2017, pp. 110–119.

12.

Hannon

, O'Reilly

, Bennett

, et al.: Meeting the family: Measuring effectiveness of family meetings in a specialist inpatient palliative care unit. Palliat Support Care, 2012; 10:43–49.

13.

Hudson

, Thomas

, Quinn

, Aranda

: Family meetings in palliative care: Are they effective?. Palliat Med, 2009; 23:150–157.

14.

Sanderson

, Cahill

, Phillips

, et al.: Patient-centered family meetings in palliative care: A quality improvement project to explore a new model of family meetings with patients and families at the end of life. Ann Palliat Med, 2017; 6:S195–S205.

15.

Cahill

, Sanderson

, Lobb

, Phillips

: The VOICE study: Valuing opinions, individual communication and experience: Building the evidence base for undertaking Patient-Centred Family Meetings in palliative care—A mixed methods study. Pilot Feasibility Stud, 2018; 4:51.

16.

Australian Commission on Quality and Safety in Healthcare: Patient-Centred Care: Improving Quality and Safety Through Partnerships with Patients and Consumers, 2011.

17.

Tong

, Sainsbury

, Craig

: Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. Int J Qual Health Care, 2007; 19:349–357.

18.

Terry

, Hayfield

, Clarke

, Braun

: Thematic analysis. In: Stainton Rogers W, Willig C (eds): The Sage Handbook of Qualitative Research in Psychology. London: SAGE Publications, 2017pp. 17–37.

19.

Braun

, Clarke

, Cooper

: APA Handbook of Research Methods in Psychology, Vol. 2: Research Designs: Quantitative, Qualitative, Neuropsychological, and Biological. Washington, DC: American Psychological Association, 2012.

20.

Corbin

, Strauss

: Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory, 3rd ed. Thousand Oaks, CA: Sage, 2008.

21.

Creswell

: Research Design: Qualitative, Quantitative and Mixed Methods Approaches, 4th ed. Los Angeles: Sage, 2014.

22.

Richards

: Handling Qualitative Data: A Practical Guide, 1st ed. London: Sage Publications, 2005.

23.

Clayton

, Butow

, Tattersall

, et al.: Asking questions can help: Development and preliminary evaluation of a question prompt list for palliative care patients. Br J Cancer, 2003; 89:2069–2077.