Chapter 2: Assessment

Support needs

The palliative care expert says
Dr. Mike Harlos explains how to approach conversations with families and "titrate" information.(3:22)Video transcript

To assess the patient's and family's needs for information and support, consider the following:  

Family's perception

It’s very important to determine how a family is interpreting a patient’s condition. It’s best not to make assumptions – they may or may not have a clear grasp of the medical situation. Is there a gap between their understanding of the patient’s medical status and the actuality?

Often there’s some discrepancy between the reality of the clinical situation and the family’s perception. Connecting with a member of the primary health care team can help to fill gaps and identify discrepancies. Remember that their 911 call, at least in part, is probably for your guidance, expert assessment and intervention.

Home environment

Pay attention to your surroundings. Your observations about the home environment will help you understand how the family is managing overall and identify their needs.

  • How fatigued does the family look?
  • How clean is the home?
  • Does anything look out of place?

 

 

 

 

Communication

You can gather a lot of information about a family's understanding and coping by observing communication patterns.

  • Who’s making the decisions in the room?
  •  Who’s talking the most?
  • Who’s keeping silent?
  • How is the family talking about the situation?
  • Do they refer to the patient as being sick or unwell, or are they talking about dying or passing away?

Some families won’t have discussed death and the likelihood the patient will die. They may need some tactful education to understand the patient’s condition, and what they may expect as the illness progresses and death approaches. Be patient and sensitive as you share information with them.

Social support

The prompts below may help you assess for both formal and informal sources of social support. If the situation warrants, you may also consider making recommendations for connecting to community services.

Who are your main sources of support? Who has been helping you?

Who can you call on for support? Can I call someone for you?

Do you have a family doctor? Palliative care team? A social worker? Do they know what’s going on? How can we reach them?

The greater the social isolation, the greater the risk for coping difficulties in the future. Encourage those who are isolated to speak to their family physician. Their healthcare provider can assess the situation and make referrals as necessary. 

Click on each item for more detail

Conversation Prompts

Use these prompts to assess how the family is coping, to better understand their needs and to formulate an effective care plan.

How are you coping with the stress of all this?

How is your health? 

Are you eating and sleeping?

What’s your main source of stress or worry?

Are you feeling depressed?


See also:All in the family: Coping with advanced illness and dying as a family article.