title: Benefits and resource implications of family meetings for hospitalized palliative care patients: research protocol.
abstract: BACKGROUND
  Palliative care focuses on supporting patients diagnosed with advanced, incurable disease; it is 'family centered', with the patient and their family (the unit of care) being core to all its endeavours. However, approximately 30-50% of carers experience psychological distress which is typically under recognised and consequently not addressed. Family meetings (FM) are recommended as a means whereby health professionals, together with family carers and patients discuss psychosocial issues and plan care; however there is minimal empirical research to determine the net effect of these meetings and the resources required to implement them systematically. The aims of this study were to evaluate: (1) if family carers of hospitalised patients with advanced disease (referred to a specialist palliative care in-patient setting or palliative care consultancy service) who receive a FM report significantly lower psychological distress (primary outcome), fewer unmet needs, increased quality of life and feel more prepared for the caregiving role; (2) if patients who receive the FM experience appropriate quality of end-of-life care, as demonstrated by fewer hospital admissions, fewer emergency department presentations, fewer intensive care unit hours, less chemotherapy treatment (in last 30 days of life), and higher likelihood of death in the place of their choice and access to supportive care services; (3) the optimal time point to deliver FM and; (4) to determine the cost-benefit and resource implications of implementing FM meetings into routine practice.
  
  
  METHODS
  Cluster type trial design with two way randomization for aims 1-3 and health economic modeling and qualitative interviews with health for professionals for aim 4.
  
  
  CONCLUSIONS
  The research will determine whether FMs have positive practical and psychological impacts on the family, impacts on health service usage, and financial benefits to the health care sector. This study will also provide clear guidance on appropriate timing in the disease/care trajectory to provide a family meeting.
  
  
  BACKGROUND
  Australian New Zealand Clinical Trials Registry ACTRN12615000200583.
authors.affiliation: Centre for Palliative Care St Vincent's Hospital, University of Melbourne, Melbourne, Australia. phudson@unimelb.edu.au.|Queens University, Belfast, UK. phudson@unimelb.edu.au.
authors.forename: Peter L
authors.initials: PL
authors.lastname: Hudson
authors.affiliation: Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, UNSW Medicine, The University of New South Wales, Sydney, Australia. girgisafaf@gmail.com.
authors.forename: Afaf
authors.initials: A
authors.lastname: Girgis
authors.affiliation: School of Medicine, University of Queensland, Queensland, Australia. g.mitchell@uq.edu.au.
authors.forename: Geoffrey K
authors.initials: GK
authors.lastname: Mitchell
authors.affiliation: Centre for Palliative Care St Vincent's Hospital, University of Melbourne, Melbourne, Australia. Jennifer.Philip@svha.org.au.
authors.forename: Jenny
authors.initials: J
authors.lastname: Philip
authors.affiliation: Centre for Applied Nursing Research, Ingham Institute for Applied Medical Research, School of Nursing and Midwifery, Western Sydney University, Sydney, Australia. deborah.parker@uqdeb.edu.au.
authors.forename: Deborah
authors.initials: D
authors.lastname: Parker
authors.affiliation: Discipline, Palliative and Supportive Services, Flinders University, Adelaide, South Australia. david.currow@health.sa.gov.au.
authors.forename: David
authors.initials: D
authors.lastname: Currow
authors.affiliation: Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Australia. danny.liew@msh.org.au.
authors.forename: Danny
authors.initials: D
authors.lastname: Liew
authors.affiliation: Centre for Palliative Care St Vincent's Hospital, University of Melbourne, Melbourne, Australia. kristina.thomas@svha.org.au.
authors.forename: Kristina
authors.initials: K
authors.lastname: Thomas
authors.affiliation: Palliative & Supportive Care Melbourne Health & University of Melbourne, Melbourne, Australia. brian.le@mh.org.au.
authors.forename: Brian
authors.initials: B
authors.lastname: Le
authors.affiliation: Palliative Care Austin Health, Melbourne, Australia. juli.moran@austin.org.au.
authors.forename: Juli
authors.initials: J
authors.lastname: Moran
authors.affiliation: Melbourne EpiCentre, University of Melbourne and Melbourne Health, Melbourne, Australia. caroline.brand@monash.edu.|Department of Epidemiology and Preventive Medicine, Monash University Melbourne, Melbourne, Australia. caroline.brand@monash.edu.
authors.forename: Caroline
authors.initials: C
authors.lastname: Brand
mesh_terms: D001315:Australia; D002985:Clinical Protocols; D005190:Family / Q000523:psychology; D006295:Health Resources / Q000600:supply & distribution; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data; D010166:Palliative Care / Q000379:methods* / Q000523:psychology; D011788:Quality of Life / Q000523:psychology; D011795:Surveys and Questionnaires