Family Discussions and Updates

Introduction

Updating family members is a common task for doctors and multidisciplinary team members (MDT). This guide will outline the necessary steps and tips for effectively communicating with patients’ relatives.

Different MDT members will update families on different aspects of the patient’s journey. For example, occupational therapists and physiotherapists will liaise with family members regarding discharge planning and any adaptations that may need to be made. Nurses may update family members with daily general updates.

There must be clear communication within the MDT so all members are up to date with all aspects of the patient’s care. This is why board rounds are helpful, as all MDT members are usually present, and each patient is discussed.

This general guide can be used to help develop your own manner and style. Observing these conversations in practice is very useful as you observe more senior clinicians having these conversations. 

Preparation

Before any family discussions, read the patient’s notes first to know what has been happening with the patient while in hospital. It is also helpful to read the notes for the last family update to check what has already been discussed.

Types of updates

Examples of types of updates:

• General update: adult patients who have capacity usually liaise with their family members for general updates, and nursing staff can also provide day-to-day updates
• Deteriorating patient: you may have to call the family out of hours to come into hospital if concerned the patient may not survive through the night
• Breaking bad news: usually more appropriate to ask family members to come in and have the conversation face-to-face in a quiet room; it makes it more personal than delivering the news over the phone
• Explaining a new diagnosis
• Complex circumstances: sometimes, there can be disagreements regarding patient care and discharge planning. In these instances, it is appropriate for an appointment to be made with family members, relevant members of the MDT and the responsible consultant

Consent

Before sharing information with a family member, you must ensure you have consent from the patient. 

If the patient has capacity, you need to ask them: 

• How much information would they like you to tell the family member?
• Which family member would they like you to update? (check their Next of Kin is up to date and you have the correct name and phone number)

If the patient does not have capacity:

• Capacity needs to be re-assessed for different situations, so make sure to assess the patient’s capacity for each situation, including consenting for a family update
• Find out if the patient has a Lasting Power of Attorney and if the Lasting Power of Attorney is for health or finances. It is the medical team’s responsibility to check this and ensure the relative brings in the documents to confirm that they have lasting power of attorney. This is important because they must be involved in making decisions.
• We tend to call the Next of Kin unless told otherwise.

Confirming patient details 

Before starting your update, ensure you are talking to the correct person. You can do this by asking them to confirm their full name and their relative’s full name, date of birth, and first line of address. After you have confirmed patient details, you can start your update.

Updates

General update

Firstly, it is always helpful to check what the relative knows about what has been happening while their loved one has been in hospital.

Sometimes, they are up to date, and it is a case of just updating them on what has happened that day, and other times, the relative has not yet been called and has no clue about what has happened so far. Establishing this in the first instance is really helpful and will allow you to gauge how much information you need to explain to them. 

When delivering your update, make sure to deliver it at the right level. Sometimes, relatives are healthcare professionals who want specific details about investigation results. Other times, relatives may not understand medical jargon, so check understanding along the way.

It is always helpful to ask at the end of the update what the relative has understood from the update, or you can ask them to summarise. This will help to avoid confusion, and you can re-explain what they haven’t entirely understood.

Deteriorating patient

You may have to inform a family member that their relative is deteriorating. This may be done over the telephone, especially if out of hours or outside visiting time.

It is kind to ask where the relative is and if they have anyone with them. If the relative is driving, it may not be the most suitable time to update them, and you can always say you will call them back once they have reached their destination. Or you can ask them to pull over when it is safe if the patient is deteriorating quickly.

It is important to be realistic in your update and not overly optimistic. Sometimes, you will have to ask the relative to come and see the patient (e.g. if giving an update overnight) as you are unsure if they will recover. It is always better to give the relative the chance to come and visit the patient rather than being overly optimistic about the prognosis, and the relative may not have the chance to say goodbye. 

Breaking bad news

If you need to break bad news to a family regarding a new diagnosis (e.g. cancer) or if a patient has a poor prognosis, it is usually best to do this face-to-face during visiting hours if possible.

There is usually a family room on the ward which can be used for updates. A quiet room is a better place to break bad news, rather than in a corridor or busy ward area. Sometimes, a senior doctor or other members of the MDT should attend to discuss the next steps moving forward, as it may not be something you are comfortable doing as the FY1.

Sometimes, it may not be possible for family members to come in for an update, as they may live far away or cannot get the time off work. In this instance, you may have to break bad news over the phone.

When breaking bad news over the phone, try to make sure the relative is in a comfortable place, sat down, and with someone else with them for support. Then you can use a ‘warning shot’ so they can probably tell you are about to deliver bad news. Leave a pause to give the relative time to gather their thoughts and then deliver the bad news clearly and concisely.

The relative may be emotional on the phone. It can be challenging to show empathy when you can’t use body language and eye contact, but you can use empathetic terms.

Closing the conversation

After you have delivered your update and checked the relative’s understanding, you should close the conversation and ask the relative if they have any additional questions. This helps the relative feel listened to and that you are not rushing them.

It can be challenging to manage long conversations when you are busy on the ward, but it is essential to deliver adequate updates as having a loved one in hospital can be very distressing for family members. A good update can help them feel like they are on the same page with what is going on and helps to build a good rapport with the family.

Conclusion

Updating family members is an important task and, when done well, can help to reduce a family’s stress and anxiety about their relative being in hospital.

Observing other clinicians first will help you develop your skills in updating family members. If you are not comfortable delivering the update, especially if it is bad news, then you should escalate to a senior clinician who will be able to do it.

After you have spoken to family members regarding a patient’s care, you should document the discussion clearly in the notes. This will be helpful if you are not in for the next update, and a colleague can read what has already been discussed.