Sorting Through Family Issues

Mrs. K had lung cancer with t-spine metastases, cord compression treated with radiation therapy, and profound hyponatremia due to SIADH. She was delirious, with suspected meningeal carcinomatosis. The series of attending hospitalists had convened multiple family meetings, trying to address the family's innumerable questions on details of her medical care, complications, explanations of her symptoms, medications, test results, etc. The three adult sons and husband all had different approaches to information and different emphases on issues.


Using four packs of cards, the palliative care physician asked the husband and each son to pick out from his deck the cards that he thought would be the patient's top ten if she were doing the sorting herself. The physician then went though each of the four groups of ten cards with the family as a group, laying out the cards and stacking the ones that got more than one ‘vote'. This exercise allowed the group both to acknowledge the range of their interpretations of her concerns and to direct the focus toward those goals and values that a majority of the family members agreed on as being most important to the patient.