1. Members of Eastern Health: Angliss Hospital, Box Hill Hospital, Healesville & District Hospital, Maroondah Hospital, Peter James Centre, Turning Point Alcohol & Drug Centre, Wantirna Health, Yarra Ranges Health and Yarra Valley Community Health Members of Eastern Health: Angliss Hospital, Box Hill Hospital, Healesville & District Hospital, Maroondah Hospital, Peter James Centre, Turning Point Alcohol & Drug Centre, Wantirna Health, Yarra Ranges Health and Yarra Valley Community Health Do Family Meetings Improve Measurable Outcomes for Patients, Carers, or Health Systems? A Systematic Review Melissa Reed, Social Worker Eastern Health melissa.reed@easternhealth.org.au Katherine Harding, Mentor Allied Health Research Office

2. Background Family meetings are common practice in the acute and sub-acute hospital system Anecdotally they appear to be a useful intervention to facilitate discharge planning and to provide family or carers with information & support

3. Background However, family meetings are also time intensive interventions for busy clinicians I wanted to know then what the evidence says about the effectiveness of family meetings for the purpose of discharge or care planning

4. Research Question “Do family meetings for the purpose of care planning in inpatient settings result in measurable improvements to carer, patient, or health service outcomes?”

5. Methods – Search Strategy In July 2012 a search was conducted from the earliest available date to the present in Medline, CINAHL, Embase, Psychinfo, PubMed databases, using relevant search terms

6. Methods – Selection Criteria Selection criteria was firstly applied to title and abstract and then to eligible full-text articles by two independent reviewers Any differences in opinion between the reviewers were discussed until agreement was reached

7. Methods – Selection Criteria InclusionsExclusions Inpatient settings Family meetings for the purpose of care / discharge planning Quantitative studies – patient & carer outcomes Community / residential settings Family meetings without a care planning purpose (e.g. not for end- of-life decision making) Qualitative studies / discussion or editorial papers

8. Results  Database searching identified 344 articles  After application of selection criteria to title and abstract 20 full-text articles were included  Selection criteria was then applied to full-text articles resulting in a final yield of 8 studies  Downs & Black quality assessment tool was applied to the selected studies and results indicated that the studies were of low to moderate quality

9. Results Data extracted from the final yield articles included method, participant details, study setting, intervention description, outcome measures & data outcomes Result outcomes were grouped into two categories  Carer outcomes: 5 studies  Health service outcomes: 3 studies

10. Research Overview Settings: 3 palliative care units, 2 psychiatric units, 2 intensive care units, 1 detoxification unit Sample sizes ranged from 15 to 263 Research aims: 6 of the studies specifically investigated family meeting interventions, whilst 2 considered family meetings as one of multiple variables. In these studies only data relating to family meeting intervention was considered.

11. Carer outcome results Three studies using the same outcome measures reported significant decreases in carer psychological distress & greater fulfillment of carer needs post-meeting One study reported a significant decrease in carer anxiety post- meeting compared to pre-meeting Another study reported carers were less likely to report dissatisfaction with patient care if a family meeting had been conducted

12. Health service outcome results One study found that readmission rates were significantly reduced for patients who had family meetings, whilst another reported a positive trend on this variable. One study found a significant increase in entry to continuing care programs for patients in the family meeting intervention group The study also considered attendance rates for continuing care programs and frequency of substance abuse post-discharge. Results were in a positive direction but no significant differences were found

13. Implications The current systematic review identified some low to moderate quality evidence in the area of interest The results provided some evidence that family meetings are beneficial for carers through the reduction of anxiety and psychological distress and in meeting carer needs

14. Implications Evidence for health service outcomes was weaker, although the researchers did report positive trends in the results There was limited evidence that family meetings may have a small positive effect on reducing readmission rates and increasing positive health behaviours

15. Conclusion  Additional research would be useful in providing further support for family meeting interventions  Consideration of patient outcomes would be useful as this seems to be largely absent from the identified research evidence  However on the basis of existing research evidence family meeting interventions can be seen to have positive effects for carers

16. Finally… Health professionals, and particularly social workers, who dedicate a significant allocation of time to family meeting interventions can be supported in the view that family meetings can contribute to the psychological well- being of carers

17. Reference Do Family Meetings Improve Measurable Outcomes for Patients, Carers, or Health Systems? A Systematic Review Melissa Reed, Katherine E. Harding Australian Social Work pp. 1-15 | DOI: 10.1080/0312407X.2014.913070 Australian Social Work http://www.tandfonline.com/eprint/xKG7FnUBPM3EAHPA8 vXP/full