Support for families

Palliative care includes the person and their family of choice

What it is

Care centred on the person and family as a unit is core to the philosophy of palliative care. Nurses will often spend much of their time providing care to and working with families.

Why it matters

The goals of supporting family have been described as: meeting their needs; minimising their distress; improving their well-being and ultimate outcomes; and empowering them to provide care. Achieving this requires health professionals to work with families.

In practice

Nurses working with people with palliative care needs will provide clinical care and spend time getting to know and building rapport with people in their care. The role can include:

• emotional and spiritual support,
• ongoing education about care and management,
• support during decision making on end-of-life issues,
• support after death
• working with colleagues to manage family differences of opinion and conflict.

Supporting families can often be complex and time-consuming. Family meetings and case conferences are one way of facilitating communication and decision-making.

• referral to palliative care
• confirmation of disease progression
• discontinuation of treatment or when maximal medical management has been reached
• discharge is planned from an inpatient setting, and
• the person’s condition changes and goals of care need re-assessing.

A case conference may also be required when a resident or patient meets the following criteria:

• By a positive response to the question: 'Would you be surprised if the resident died within the next six months?'
• If there has been a significant functional or medical decline

• If problems are perceived concerning goals of care around futile treatment (perhaps after an acute event), and

• If the resident is transferred or admitted to the RACF specifically for comfort care / palliative care.

When considering a case conference, it is important to decide who should be present, such as relevant members of the multidisciplinary team, a member(s) of the family, GP, a representative from community and or /care organisations. The person and their family should also be asked who they think should be present.

Sometimes discussions are held after hours where crisis management may be required. As soon as possible bring in the wider team to communicate and plan what is required next.

How to facilitate discussions and prioritise the needs of unpaid carers

One important aspect of a nurse’s role in palliative care is that of supporting carers. Carers are those who look after someone at home and are usually considered informal or lay carers as they are not being paid for what they do. They are part of the care team and it is important that support is provided for carers.

Marie Curie website provides practice guidance on Supporting family and friends in palliative care.