THE USE OF ALS IN FAMILY

MEETINGS:
THE CEA METHOD

Jenell Y. Oczon-Naldo, MD, MPH, FPAFP

Assistant Professor, FEU-NRMF DCFM
 FM PRACTICE
PATIENT CENTERED

FAMILY FOCUSED
 When to convene the family?
No strict criteria

Physician feels that it would be helpful for the

patient
1. situations when involving a family member
should be routine:
Hospitalization
Routine obstetrical and well-child care
Serious chronic illness
Terminal illness and death
2. consider convening the family in the following
circumstances:
Serious illness
Compliance problems
Poor control of a chronic illness
High utilization of medical service by an individual or
family
Somatization
Anxiety or depression
Substance abuse
Parent-child problems
Marital and sexual difficulties
 What are the guidelines in convening a
family meeting?
1. involve the family in the patient's care as early
as possible
2. routinely ask if any family members came with
them and invite them in for part of the visit
3. be positive and direct about your need to see
the family
Tell your patient that you expect them to come
and explain that it is a routine procedure
 What are the guidelines in convening a
family meeting?
4. emphasize the importance of family as a
resource in caring for the patient.
Family's help and opinion are needed
5. stress the benefit of a family meeting.
Acknowledge that the problem affects all family members
6. give specific instructions to the patient on who
to invite and how to invite them
 What is family counseling?
Intervention involving at least 2 members of the
family, the patient and another member.
Also means family psycho-education

Focuses on helping the family to cope more

effectively with an illness or disorder
It assumes that the family is healthy and is doing its
best to cope with the illness
If the family is dysfunctional a more sophisticated

model is needed
2 key elements:
1. education
2. psychological support
 key elements of family
counseling
1. education- provides specific guidelines for
illness management and assistance with problem-
solving skills
2. psychological support- provides empathy, an
opportunity to share feelings, and assistance to
the family's efforts to cope by expanding the
family's social network
 What are the steps in family counseling
Key principle: BE NEUTRAL
Give each member a chance to speak and be
heard
Direct important questions to each family
member present
Reflect their thoughts and feelings before
proceeding to the next question
 What are the steps in family counseling
The doctor should be a directive facilitator and
non-directive listener
It would allow the doctor to elicit psychosocial
and biomedical data
Gives the doctor the opportunity to explore the
emotional impact of illness on the members of
the family
 What are the STEPS IN FAMILY CEA?
A. discuss the clinical problem
1. reason for consult
2. medical history
3. assess health condition by PE
 What are the STEPS IN FAMILY CEA?
B. define the clinical problem (CATHARSIS)
1. explore the patient's and family's health
understanding
2. identify the ECM
Sample Questions:
What do you call your illness?

What do you understand about your illness?

What do you think has caused the illness?

 What are the STEPS IN FAMILY CEA?

3. Probe/reflect the feeling of the patient
Sample questions for patients:
What does your sickness do to you?

What can you no longer do that you want to do?

How do you feel about your illness?

How does your family react to you bec of your

illness?
How do you feel about their reaction?

 What are the STEPS IN FAMILY CEA?

3. Probe/reflect the feeling of the family member
Sample questions for Family members:
How does his sickness affect you?

How do you feel about his sickness?

Sample questions to both:

What do you think will happen to the illness in the future?

What do you fear most about the illness?

What is the worst thing that could happen?

 What are the STEPS IN FAMILY CEA?

C. Correct the Misperception (Educate)
1. share your findings with the
patient and the family
2. address immediately the ECM of
the family
 What are the STEPS IN FAMILY CEA?
D. address the patient's problems (Action)
1. address ECM regarding treatment
Sample questions for both:
How do you feel about the treatment

What important results do you expect?

Sample questions for the patient:

What might make the treatment difficult for you to

follow?
What do you like your doctor to do for you?

 What are the STEPS IN FAMILY CEA?

2. summarize the misperceptions and correct them
starting with the ones that upset them most emotionally.
3. involve the patient and family in the management
plan. Ask them to state what they need from each other.

Sample question for the patient:

What would you like your family to do for you?

Sample question for the family:

What would you like him to do for you?

Come to agreement about the things they will do for

each other in order to meet each other's needs.

Set the treatment plan to include tasks of patient and

family members in relation to the behavioral contract.
 What are the STEPS IN FAMILY CEA?
E. closing and follow up
1. do a feelings check
Ask after the discussion, how are each of you
feeling right now?
If upsetting or negative feelings still remain you
can decide to deal with it immediately or include it
on the agenda for the next meeting

2. set specific time and date for follow-

up.
TIP
Active listening skills are applied
throughout all phases of the model to
correct the misperceptions and to provide
emotional support to all family members
without sacrificing neutrality.