Framework for discussion
Within the first few hours of stroke, the priority for communication will generally include discussion about diagnosis, likely prognosis and management. If there is a possibility that the patient may die imminently, then this would need to be communicated promptly but effectively. The first conversation with the family is important to help establish trust.
Here are some tips about the first meeting with a family.
Initial conversation within first few hours of admission.
- Be honest with your perception of the severity of the situation. Do not hesitate to use the word dying is this is imminent or a possibility
- If death is not imminent but likely in the next hours to days, the person is still ‘dying’ and we can talk about how we care for people who are dying. (see NHS Scotland: Palliative Care Guidelines)
- Try and gauge if the person or their family may have preferences for spiritual/religious involvement
- Try to give clear information on what may be likely to happen in the next few hours
- In some settings it is possible to show scan results to explain the seriousness of the stroke
- Probe as to what the family think the patient would want if able to express themselves
- Emphasise the need for family to plan next 24 hours/rest/contacting other family members
- Answer any questions the family may have, and emphasise uncertainty of outcome if appropriate
- Take relevant contact details that suit family arrangements e.g. first contact person/day and night
- Document conversation in medical records and communicate same with clinical team caring for the patient at that time. Be clear about what agreed care and what treatments should and should not be given. If some decisions are still to be made, ensure this is highlighted and will be discussed again at the next meeting with families
- Some families may ask about organ or tissue donation, especially if the person had previously expressed this and is on the organ donation register
- Ensure you have information on how this may be further dealt with at an appropriate time.
Page last reviewed: 16 Jan 2023
