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Case Conferences

Key Messages

  • Effective and consistent communication is central to adequately addressing patient and family needs and concerns during the palliative and end-of-life (EoL) phases of a life-limiting illness. [1-5]
  • A family meeting or case conference can assist with communication between patient-family-care team, and usually includes discussion of the illness experience, care preferences, and can be used to plan care [1-3,6-8] and make decisions relating to terminal care. [6,8]
  • Case conferencing supports Australian national and government initiatives to ensure that end-of-life care is consumer-centred, goal-directed and compassionate. [4,9]
  • Family meetings or case conferences are not clearly defined or described in the literature [1,7,10] Standardised guidance as to how to structure these meetings has not been evaluated. [2] More high-quality research is needed for case conferences to better assist older people receiving palliative care and the people who care for them. [1-3,7,8,10]
  • Case conferencing can improve the delivery of a palliative approach to care for residents with advanced dementia. [7,8] Case conferencing can improve medication management outcomes for residents with advanced dementia [7,10] and may help improve challenging behaviours and palliative outcomes of residents with dementia. [10]

Background

The terms ‘family meeting’, ‘palliative care case conference’, ‘family conference’ and ‘team meeting’ are used interchangeably in the literature. There does not appear to be a clear definition, and such meetings show considerable variation or are poorly described in the literature. [1,7,10] Usually in practice, a distinction between a family meeting and a case conference is made around the focus of the meeting. A family meeting is more focussed on the family needs and a case conference is more around the clinical goals of care.

Clinical guidelines for conducting family meetings within the context of the specialist palliative care setting were developed in Australia in 2008 [5] and have not been updated. Although certain end-of-life (EoL) guidelines recommend that family meetings should be routine part of palliative care, there is little standardised guidance as to how to structure these meetings. [2]

Evidence Summary

Various types of meetings can occur to discuss the palliative care of a person. Team meetings, multidisciplinary / interdisciplinary team meetings or consensus meetings discuss issues relating to the clinical domain of practice are usually restricted to the health care team. [11]

A family meeting or case conference can provide the basis for a discussion between a person (if possible), involved member(s) of the family, substitute decision-maker(s), and members of the care team. [1,2,7,8] These meetings can enhance communication between the patient, family, and healthcare team; share information regarding a person’s preferences; promote a shared understanding of the current clinical situation; be a safe and structured forum for the discussion of symptoms, goals of care, and current treatment; involve patients and families in decision-making. [1,2,6-8] They can provide an opportunity for a palliative approach to be adopted for residents with advanced dementia. [7] There is no defined frequency for these meetings but there is consensus that they should be held proactively so that care is planned and allow issues to be dealt with before they escalate. [1,5]

The evidence to support the use of case conferences to address patient and family needs in a palliative care context is, in general, low-level. [1,2,6]

Mentioned in numerous papers is the investment of time and resources by members of the healthcare team and the need for facilitators to have certain skills for the successful conduct these meetings. [1,2,6] Randomised Controlled Trials (RCTs) which have shown that case conferences lead to better maintenance of physical and mental health and decrease hospitalisations in the community palliative care setting, have highlighted that significant structure and support are needed to obtain these positive outcomes. [8]

Reimbursement items for GPs available through Medicare and administrative support have been noted as enablers for case conferences. [7] Tools such as meeting guides/agendas can help to structure the emotionally complex task of communicating about EoL care but more research is needed to standardise these tools and develop new tools to help family participants effectively engage in the process. [2,7] Electronic tools could also be beneficial. [2]

Family involvement in decision-making for people with dementia in residential care is challenging. [3] Substitute decision-makers often want to maintain a decision-making role once the person they have cared for moves to a residential care setting; and case conferences can support this in a collaborative and coordinated fashion. [3] Involvement of family in decision-making may increase their satisfaction with care. [7] Commonly, treatment and medical decisions are discussed with less attention being given to psychosocial, spiritual and emotional aspects of care. [3]

There is high-level evidence that case conferencing in residential aged care can improve medication management outcomes for residents with advanced dementia. [7,10] Lower level evidence suggests that case conferencing can improve challenging behaviours of residents with dementia and assist staff competencies in managing these behaviours. [10] Palliative care outcomes for residents with dementia particularly in the areas of: advance care planning; better physical symptom management; psychological support; family support; and terminal care, may also improve with case conferencing. [7] Qualitative evidence suggests that case conferencing is feasible and useful if barriers are addressed and facilitators optimised. [7]

High-quality research is needed into the effectiveness of case conferences to further inform their role in routine palliative care clinical practice for older people. [1]

Quality Statement

The few papers that focussed their attention on case conferences used in the care of older people receiving palliative care were specific to people with dementia. [3,7,8,10] Others investigated case conferences used in the palliative care context. [1,2,6] Most papers were of acceptable to high quality [1,2,7,8,10] and six additional references were included to give context to this subject. [3-6,9,11]

Page updated 23 October 2017
 
  • References

  • About PubMed Search

  1. Cahill PJ, Lobb EA, Sanderson C, Phillips JL. What is the evidence for conducting palliative care family meetings? A systematic review. Palliat Med. 2017 Mar;31(3):197-211. doi: 10.1177/0269216316658833. Epub 2016 Aug 19.
  2. Singer AE, Ash T, Ochotorena C, Lorenz KA, Chong K, Shreve ST, et al. A Systematic Review of Family Meeting Tools in Palliative and Intensive Care Settings. Am J Hosp Palliat Care. 2016 Sep;33(8):797-806. doi: 10.1177/1049909115594353. Epub 2015 Jul 26.
  3. Petriwskyj A, Gibson A, Parker D, Banks S, Andrews S, Robinson A. A qualitative metasynthesis: family involvement in decision making for people with dementia in residential aged care. Int J Evid Based Healthc. 2014 Jun;12(2):87-104. doi: 10.1097/XEB.0000000000000002.
  4. Australian Commission on Safety and Quality in Health Care (ACSQHC). National Consensus Statement; essential elements for safe and high quality end-of-life care. Sydney: ACSQHC; 2015.
  5. Hudson P, Quinn K, O'Hanlon B, Aranda S. Family meetings in palliative care: Multidisciplinary clinical practice guidelines. BMC Palliat Care. 2008 Aug 19;7:12. doi: 10.1186/1472-684X-7-12.
  6. Powazki R, Walsh D, Hauser K, Davis MP. Communication in palliative medicine: a clinical review of family conferences. J Palliat Medicine. 2014;17(10):1167-77.
  7. Phillips JL, West PA, Davidson PM, Agar M. Does case conferencing for people with advanced dementia living in nursing homes improve care outcomes: evidence from an integrative review? Int J Nurs Stud. 2013 Aug;50(8):1122-35. doi: 10.1016/j.ijnurstu.2012.11.001. Epub 2012 Nov 28.
  8. Agar M, Luckett T, Luscombe G, Phillips J, Beattie E, Pond D, et al. Effects of facilitated family case conferencing for advanced dementia: A cluster randomised clinical trial. PLoS One. 2017 Aug 7;12(8):e0181020. doi: 10.1371/journal.pone.0181020. eCollection 2017.
  9. Australian Government Department of Health. Single Aged Care Quality Framework, Draft Aged Care Quality Standards Consultation Paper (1.1MB pdf). Canberra: Australian Government Department of Health; 2017.
  10. Reuther S, Dichter MN, Buscher I, Vollmar HC, Holle D, Bartholomeyczik S, et al. Case conferences as interventions dealing with the challenging behavior of people with dementia in nursing homes: a systematic review. Int Psychogeriatr. 2012 Dec;24(12):1891-903. doi: 10.1017/S1041610212001342. Epub 2012 Aug 10.
  11. Low LF, Fletcher J, Goodenough B, Jeon YH, Etherton-Beer C, MacAndrew M, et al. A Systematic Review of Interventions to Change Staff Care Practices in Order to Improve Resident Outcomes in Nursing Homes. PLoS One. 2015 Nov 11;10(11):e0140711. doi: 10.1371/journal.pone.0140711. eCollection 2015.

Definition

Case conferencing is defined as an approach that brings together relevant health professionals and the residents’ primary decision-makers, usually family members, to discuss the current stage of illness and agree on a person-centred management plan based on best available evidenced-based practice. (Source: Abernethy AP, Currow DC, et al. A pragmatic 2 x 2 x 2 factorial cluster randomized controlled trial of educational outreach visiting and case conferencing in palliative care-methodology of the Palliative Care Trial [ISRCTN 81117481]. Contemp Clin Trials. 2006 Feb;27(1):83-100. Epub 2005 Nov 10.)

Searches

Final search

(case conferenc*[tiab] OR Family conferenc*[tiab] OR team conferenc*[tiab] OR group conferenc*[tiab] OR team meeting*[tiab] OR family meeting*[tiab] OR Team decision*[tiab] OR group meeting*[tiab] OR family discussion*[tiab] OR group discussion*[tiab])