Family Meeting
A family meeting is a scheduled conversation between the clinical team and a patient's family or surrogate decision makers, usually covering prognosis, the treatment options that remain, and what the patient would want in a situation where the patient cannot say so. In critical care it is often called the family conference, and it is the encounter where goals of care stop being an abstraction and get settled. Lautrette and colleagues tested a structured version of it in a randomized trial across 22 intensive care units in France, published in the New England Journal of Medicine in 2007, and families who received a proactive end of life conference and a bereavement brochure reported lower symptom scores on the Impact of Event Scale and the Hospital Anxiety and Depression Scale when interviewed 90 days after the death than families who received the customary conference.
Source: Lautrette et al., New England Journal of Medicine, 2007
The conference Lautrette's group tested gave the clinicians in the room five objectives, summarized by the mnemonic VALUE: value what the family members say, acknowledge their emotions, listen, understand who the patient is as a person, and elicit questions from the family. Four of the five are receptive rather than expressive, which is the half a checklist has the hardest time capturing.
A family meeting is difficult for reasons that have little to do with medical knowledge. The clinician is usually delivering information the family does not want, to people who have not slept, in a room where several relatives may disagree with each other and one of them may be the legal decision maker. The clinical content is often the easy part. The failure modes are procedural: opening with data before finding out what the family already understands, filling every silence, or answering a question about values with an answer about interventions.
The encounter is also where several distinct communication tasks collide inside one conversation. Breaking bad news, describing prognosis under real uncertainty, eliciting what matters to the patient, and making a recommendation are four different skills with four different published frameworks, and a single family meeting can require all of them in sequence. SPIKES covers the disclosure, and the Serious Illness Conversation Guide covers the values work, but nothing stitches them together except practice.
Where the family meeting is learned by watching one, the skill ends up dependent on whether a given rotation happened to have a good example and a senior willing to hand over the room. That is a poor way to distribute a competency that shows up in the intensive care unit, on the oncology service, and in the emergency department, and it is one reason a program can graduate a resident who has never led one.
What this looks like in a program
- Establish who is present and who holds decision-making authority before the medical content starts, since a meeting with five relatives and no identified surrogate rarely reaches a decision.
- Give a resident the chance to lead a family meeting before they are the senior clinician in the room rather than after.
- Score the receptive half of the encounter separately from information delivery, because a learner can be fluent on prognosis and still never find out what the family is afraid of.
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Last updated August 2026