Effective facilitation ensures all participants feel comfortable to speak openly and are able to contribute to the discussion. Open respectful discussion ensures that a range of different perspectives can be gathered, solutions developed and consensus is more readily reached.
Strategies to encourage discussion include:
- Take time to establish rapport before discussing ‘difficult’ topics
- Initiate discussion using open ended questions
- Ask follow-up questions or summarise comments to encourage further input and discussion
- Provide gentle encouragement to those who may be reluctant to speak, especially families
- Keep the conversation on track by revisiting past contributions and incorporating them into current discussions
Agreeing on a plan of care
During the case conference it is the role of the facilitator to ensure the meeting is kept to the agenda and returns regularly to overall goals of care rather than specific treatments and details of daily care. Without facilitation, there is a danger opportunities will be missed because people are hesitant to have the ‘difficult conversations’ required. It is important to;
- Raise and discuss issues related to dying with dementia and the need for advance care planning. Opportunities for these discussions are presented whenever families ask questions about the future or indicate they may be thinking about quality versus quantity of life.
- Where families become emotionally distressed, ensure they have the opportunity to talk and be listened to in a sensitive way rather than changing the subject.
- Recognise that grief is normal, and often starts before the person with dementia has died. Where families are very distressed, it may be appropriate to tell them about avenues for counselling via referral from their GP or other local services
- Document key points from the discussion in the facilitated case conference action plan to ensure their is a record of what was discussed and what was the agreed plan of care.