From: Family meetings in palliative care: Multidisciplinary clinical practice guidelines
Below are key points to be recorded at the completion of the family meeting by the Family Meeting's Facilitator. | ||||
A copy should be provided to the patient and family carer and one copy kept in the medical record. | ||||
Date of meeting: __________________________ | ||||
Name of family meeting facilitator: _________________________________ | ||||
Proposed purpose of the meeting: __________________________________ | ||||
FAMILY MEMBERS PRESENT | ||||
Name: | Relationship: | |||
Name: | Relationship: | |||
Name: | Relationship: | |||
STAFF MEMBERS PRESENT | ||||
Name: | Role/Discipline: | |||
Name: | Role/Discipline: | |||
Name: | Role/Discipline: | |||
KEY ISSUES RAISED AT THE MEETING | ||||
_________________________________________________________________________________ | ||||
_________________________________________________________________________________ | ||||
KEY ACTIONS FROM THE MEETING | ||||
Current Situation | Goal | Action | Key Person to follow up | Review Date |
Adapted (with permission) from Single Session Therapy Resource Guide (The Bouverie Centre 2006) |