Ethics, communication and palliative care

Family meetings and shared decision-making

Reviewed Nov 2026·4 references
New· views rounded down, updated weekly

Running a structured family conference (VALUE), handling disagreement and potentially inappropriate treatment requests.

Definition
A planned family conference within 24-72 h of ICU admission, and whenever the prognosis changes, improves family outcomes. VALUE: Value what the family says, Acknowledge emotions, Listen, Understand the patient as a person, Elicit questions.

At the bedside

  1. 1

    Prepare

    Agree the medical view among the team first (consultant-led); review prognosis, options and the patient's known values; invite nurse and social worker or counsellor.

  2. 2

    Open

    Introductions; purpose of the meeting; ask what they understand.

  3. 3

    Inform

    Clinical update in plain language; honest prognosis including uncertainty (time-limited trial if uncertain).

  4. 4

    Explore values

    'What kind of person is he? What mattered most to him?' - substituted judgement, not 'what do you want'.

  5. 5

    Recommend

    Make a clear medical recommendation; share the decision; do not ask families to decide alone on withdrawal.

  6. 6

    Close and document

    Summarise, set a review time, document attendees, information, decisions and the patient's goals.

  7. 7

    Disagreement

    Time-limited trial, second opinion, ethics committee or palliative care input; for persistent requests for treatment the team considers inappropriate, use a fair process (ATS multisociety policy).

Red flag · call your senior now
Family conflict escalating to threats or violence - involve senior administration and security early; never negotiate alone at the bedside.
Pitfall
Presenting a menu of interventions without a recommendation.
Pitfall
Multiple doctors giving inconsistent messages - one consultant voice.
Pearl
Time-limited trials ('we will try full treatment for 3-5 days and then review together against agreed goals') reduce conflict when prognosis is uncertain.

References

  1. 1

    Lautrette A, Darmon M, Megarbane B, et al. A communication strategy and brochure for relatives of patients dying in the ICU. N Engl J Med 2007;356:469-78.

  2. 2

    Davidson JE, Aslakson RA, Long AC, et al. Guidelines for family-centered care in the neonatal, pediatric, and adult ICU. Crit Care Med 2017;45:103-28.

  3. 3

    Bosslet GT, Pope TM, Rubenfeld GD, et al. An official ATS/AACN/ACCP/ESICM/SCCM policy statement: responding to requests for potentially inappropriate treatments in intensive care units. Am J Respir Crit Care Med 2015;191:1318-30.

  4. 4

    Chawla R, Kapadia F, Rajagopalan S, Amin P, et al. Guidelines for end-of-life and palliative care in Indian intensive care units: ISCCM consensus ethical position statement. Indian J Crit Care Med 2012;16:166-81.

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