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Family Meetings with Vulnerable Patients-An Exploration of Multidisciplinary Team Practices and Communication

Family meetings are intended to encourage active participation and empowerment of older people and their families in decision making however, doubts exist as to whether they effectively carry out this role*. The aim of this study is to observe and describe in rich detail the communication, language and behaviours of older patients, their family members and members of the multidisciplinary team (MDT) within family meetings in a hospital setting.

The study design incorporates a 3 stage action research cycle. This is used to develop a framework which will recommend ways of improving practice through partnership in working with the MDT as ‘co-researchers’. The study explores the experiences of participants in family meetings in a clinical setting using an ethnographic approach. Cycle I included a convenience sample of ten family meetings with inpatients of a Department of Geriatric Medicine.

Cycle II includes a convenience sample of ten family meetings with inpatients under the care of the Stroke Service who were assessed as having a cognitive/communication difficulties. A mixed method study design is adopted which includes participant observations of family meetings, questionnaires and staff focus groups.

- All patients >65. 7 men,3 women.- 7 patients assessed as having a level of cognitive impairment.- 4 out of 7 assessed as being ‘without capacity’ and did not attend the family meeting.- Family member attendance varied between 2-7 attendees- Staff attendance varied between 3-6 attendees.•Consistently good eye contact maintained between staff and family members.•Eye contact poor with patients, particularly those with a cognitive impairment.•Older people with higher levels of cognitive impairment had noticeably lower participation levels than family caregivers •Participation levels of family members was much higher than patient participation •In half of all meetings observed, no final decision was made.•All older people who attended and eight families believed they had been included in the decision-making process.•Two families believed decisions had already been made by staff unilaterally but they still felt the meeting process had been useful.•Patients with a cognitive impairment were observed to be ‘talked over’ with usage of the 3rd person by both staff and family members.

Acknowledgements-Special thanks to Atlantic Philanthropies for part-funding PhD degree.

Donnelly, S; Cahill,S; Carter-Anand,J; Gilligan,R; Mehigan,B and O’Neill,D.

•Care Planning Meetings within hospital setttings are an important forum for older people, their families and the MDT.•Low participation levels of cognitively impaired patients is a concern given their vulnerability and supports literature findings which argue that the voice of the older patient may get lost within the meetings process.•This study’s findings demonstrate the importance of finding new ways of communicating with vulnerable cognitively impaired patients in meetings. Results have implications for developing more creative methods of communication between patients and health care professionals in hospital settings.

References;*Efraimsson et al. J Clinical Nursing,2004;13:562-57

Introduction

Methods

Results- Cycle 1

Conclusions

CONTACT DETAILS: Sarah Donnelly, Research Social Worker/PhD Student, School of Social Work and Social Policy, TCD. Ph-01 8963369Email-donnels1@tcd.ie