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Family Conferences in Stroke Rehabilitation:

A Literature Review

Yasmine M. Loupis, BSW, BA, and Steven G. Faux, MBBS, BA

Background: Family conferences in hospital settings are acknowledged as being im-


portant and beneficial for enhancing communication between patients, family mem-
bers, and the multidisciplinary team. They provide feedback on progress and
therapeutic findings, and facilitate problem solving in cases of complex discharge
planning. Methods: A literature review was conducted, with 23 articles highlighting
problem areas within current practice and discussing the merits of existing ap-
proaches. Results: The articles suggest that stroke survivors and their families
have additional education and support needs beyond what is already provided,
and that intervention may be enhanced by being more proactive rather than reactive,
preventing potentially avoidable crises or disputes. This review provides insight
into the ideal methods for communicating and planning and identifies better uses
of these opportunities. Conclusions: Much more can be done within the multidisci-
plinary team to ensure that the information needs of patients and families are ca-
tered for during their inpatient admission and on their return to the community.
Additional research and trials of interventions by established rehabilitation services
will allow for improved and more informed clinical practice (including cost effec-
tiveness), enhanced knowledge of caregiver needs, and essentially more positive
outcomes for rehabilitation patients and their families. Research may be able to de-
velop best practice guidelines to ensure reduced caregiver stress and anxiety during
admission and discharge. We require additional investigation of the effects of edu-
cational and emotional support provided in the hospital setting and as an outpatient
on quality of life for caregivers and prevention of readmission to hospital or entrance
into residential care for patients. Key Words: Carerconferenceeducation
familymeetingplanningrehabilitationstrokesupporttrigger.
Crown Copyright 2013 Published by Elsevier Inc. on behalf of National Stroke
Association. All rights reserved.

The importance of holistic care for patients undergoing important and beneficial for communicating progress
stroke rehabilitation in subacute settings is becoming and therapeutic findings and to facilitate problem
better recognized and vocalized, and there is greater ac- solving for complex discharge planning, particularly in
knowledgement of the importance of family involvement the setting of stroke rehabilitation.2-14 They provide an
in patient outcomes.1 Hospital family conferences are opportunity for family members to raise concerns
and gain valuable feedback from the treating
multidisciplinary team (MDT). They are also instrumental
From Sacred Heart Rehabilitation Service, St. Vincents Hospital, in discharge planning and the communication of ongoing
Sydney, New South Wales, Australia.
Received August 24, 2012; accepted December 8, 2012.
care needs. Research suggests that family conferences
Address correspondence to Yasmine M. Loupis, BSW, BA, Sacred may differ in their purpose and application in a variety of
Heart Rehabilitation Service, St. Vincents Hospital, 170 Darlinghurst hospital settings, although they have rarely been analyzed
Rd, Darlinghurst, NSW 2010, Australia. E-mail: yloupis@stvincents. to investigate their value and application in specific
com.au.
health areas, such as stroke and rehabilitation.15
1052-3057/$ - see front matter
Crown Copyright 2013 Published by Elsevier Inc. on behalf of
A literature review was conducted at the Sacred Heart
National Stroke Association. All rights reserved. Rehabilitation Service to investigate the purpose and ben-
http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2012.12.003 efits of family conferences specifically for an inpatient

Journal of Stroke and Cerebrovascular Diseases, Vol. 22, No. 6 (August), 2013: pp 883-893 883
884 Y.M. LOUPIS AND S.G. FAUX

stroke rehabilitation caseload, including evaluation of the The articles have commonalities in themes and ideas.
structure and cost effectiveness of the family conference. Some authors suggest that patients and families have ad-
The questions guiding this review were as follows: (1) ditional education and support needs beyond what is al-
Are family conferences the most effective and adequate ready provided.1,3,8,11,13,16,18-22 Stein et al2 suggest that the
method of communicating information and feedback impact on caregivers of a series of weekly education ses-
from MDTs to stroke patients and their families in an in- sions and one-on-one teaching in addition to regular in-
patient rehabilitation setting? (2) How can the effective- tervention would be appropriate for additional study.
ness of family conferences be optimized? Pierce et al17 examined a web-based project that allowed
This review aimed to integrate and analyze current tailored information and support to caregivers from a va-
knowledge on family conferences in the inpatient stroke riety of MDT members throughout the rehabilitation pro-
rehabilitation setting. cess. Clark et al18 found that providing a discharge
information package in addition to follow-up home visits
resulted in better maintenance of family function post-
Methods
stroke, although Bhogal et al19 found that information
In accordance with the Cochrane Handbook for Sys- packages alone are not generally associated with im-
tematic Reviews of Interventions,25 the authors defined proved outcomes. In their experience, additional social
the review questions, developed criteria for inclusion, support interventions, such as active education and coun-
conducted a literature search using a 2-stage process, seling, were associated with improved patient and care-
and analyzed the findings; the results presented and in- giver outcomes, because caring for stroke survivors in
terpreted below address the initial research questions. the community often has a dramatic effect on family func-
An electronic database search identified relevant jour- tioning and caregiver burden.
nals and articles using the Clinical Information Access The 2010 Australian National Stroke Foundation (NSF)1
Programs (CIAP) Medline, PubMed, Embase, Informit, guidelines recommend that specific training should be
OvidSP, Proquest, and Psychlit databases. CIAP provides provided to the patient and caregiver by the MDT before
access to clinical information and resources to support discharge in order to improve preparation for the chal-
evidence-based practice at the point of care, and is avail- lenges of daily activities at home. The guidelines make
able to all staff working in the New South Wales public reference to a randomized, controlled trial providing ba-
health system. Keywords used for the search included sic nursing and personal care training to caregivers that
family, conference, meeting, carer, rehabilita- found reduced care costs and caregiver burden and an in-
tion, trigger, planning, support, stroke, and ed- creased quality of life for caregivers and patients in the in-
ucation. The words of, and, and for were used to tervention group.14 Smith et al20 make reference to
combine keywords and to search for multiple topics si- a Cochrane review of effective information provision after
multaneously. By reviewing citations from key articles re- stroke. Their study examined randomized trials in which
trieved in this first phase, additional articles of relevance the intervention group of stroke patients or caregivers
were identified. Initially, 21 articles were obtained; later, were provided with a course of lectures. Results indicated
an additional 16 articles of interest were found. reduced depression when provided with additional infor-
Articles included in this study made specific reference mation about severity of stroke, MDT interventions, and
to family conferences in clinical practice, identified stroke expected outcomes, as well as feedback opportunities.
rehabilitation as the primary research area, made refer- Perceived caregiver burden was also significantly re-
ence to the inpatient rehabilitation experience rather duced when reviewed at 3 and 12 months after discharge.
than outpatient or community approaches, and provided Quality of life in patients and caregivers significantly im-
guidelines for clinical practice. They also provided sug- proved at 3 and 12 months when caregivers received ad-
gestions for alternative support systems for stroke survi- ditional training, and there was a reduction in total health
vors and caregivers, and referred to the multidisciplinary and social care costs over 12 months, which was largely
approach to rehabilitation. Of the aforementioned 37 related to shorter admissions.20 After this study, the
articles, 14 did not meet the study criteria and were most effective method of information provision was still
disregarded. unclear, although active strategies and planned follow-
up for clarification and reinforcement of this intervention
had a greater effect on patient mood.
Results
A common theme of the articles reviewed was that
Table 1 presents a summary of the 14 articles included much of family involvement that occurs in rehabilitation
in this study that provide evidence levels between I and is reactive rather than proactive. This indicates that clini-
III-3,24 listed alphabetically by surname of first author. cians spend much of their time responding to specific
For each article, the author, year, country, title, aims, issues or crises rather than addressing concerns pre-
methods, participants, findings, and levels of evidence emptively to prevent miscommunication or distress.
are summarized. Patients and caregivers are often not provided with
FAMILY CONFERENCES IN STROKE REHABILITATION
Table 1. Summary of articles and findings with evidence levels I to III-3*

Level of
Author, year, country Title Aims Methods Participants Findings evidence

Amador et al, 2007, US The acute care for elders Review effectiveness of Review of literature NA Recommend FC and early I
unit: Taking the geriatric care discharge planning; CGs
rehabilitation model into involved in discharge
the hospital setting planning had improved
satisfaction, feelings of
preparedness, and
perception of care
continuity
Bhogal et al, 2003, Community reintegration Evaluate effectiveness of Literature review 2500 study abstracts Social support/education I
Canada after stroke community integration (1970-1994), all RCTs counseling improved
and issues facing patient outcomes,
survivors/CGs on whereas printed
discharge from inpatient information packages did
rehabilitation not; CGs and patients
often have conflicting
views of functional
status
Brereton et al, 2006, Interventions for adult Review effectiveness of Systematic review of RCTs NA CG training improved well- I
England family carers of people interventions for carers of interventions aimed being and quality of life
who have had a stroke: A of people with stroke primarily at adult family by reducing levels of
systematic review carers of stroke survivors depression, anxiety, and
burden; a combination of
education and
counseling interventions
improved CG knowledge
and family functioning;
support groups and home
visits by nurse educators
improved CG coping
skills; training in nursing
techniques and provision
of support improved CG
quality of life

885
(Continued)
Table 1. (Continued )

886
Level of
Author, year, country Title Aims Methods Participants Findings evidence
Duncan et al, 2005, US Management of adult Evidence-based practice for Analysis of reviews and Acute and postacute care Family/CG need to be I
stroke rehabilitation stroke rehabilitation, current practices facilities; national health involved in decision-
care: A clinical practice recommendations guidelines making and treatment
guideline planning early and
throughout the
rehabilitation process,
recognizing this as
a useful means of
information
dissemination; patient/
CG to be provided
information and
opportunities to learn
about causes and
consequences of stroke,
potential complications,
and the goals, process,
and prognosis of
rehabilitation; MDTs
need to recognize stress
associated with
impairments (e.g.,
cognitive loss, urinary
incontinence, and
personality changes),
and provide support as
appropriate
Fronek, 2008, Australia The RAP in rehabilitation: Review of family Clinical practice review, Informal feedback from FCs facilitate I
The family conference in conference literature and participatory observation health care professionals communication/planning
practice application to specific study and patients of a spinal between professionals,

Y.M. LOUPIS AND S.G. FAUX


practice setting cord injury service patients, and CGs;
structural barriers and
organizational demands,
such as duration of stay,
limited options, and time
pressures can exacerbate
power imbalances,
affecting patient/CG
involvement; focus on
client self-determination
as drivers of rehabilitation
and decision-making
processes
Hill, 2005, Australia Rehabilitation after stroke To identify evidence-based Literature review NA Need for instituted I
literature review: Current best practice in the processes of MDT

FAMILY CONFERENCES IN STROKE REHABILITATION


evidence and future delivery of stroke care in approach to support
directions subacute settings coordination,
communication, and
training for effective
stroke rehabilitation;
stroke survivor/CG strain
needs monitoring and
strategies introduced on
both an individual and
service level to minimize
this; strategies to engage
stroke survivors/CGs in
care planning and
decision-making
throughout the care
continuum, particularly
early discharge options
and transitions in care,
need to be investigated
Hudson et al, 2008, Family meetings in To develop Literature review of MDT specialists from 3 Expressing empathy and I
Australia palliative care: multidisciplinary clinical evidence and conceptual palliative care units and 3 listening actively
Multidisciplinary practice guidelines for framework; guidelines major hospitals in improves psychological
clinical practice conducting family based on feedback from Melbourne adjustment; provision of
guidelines meetings expert panel and focus comprehensive
groups information about
prognosis promotes
psychological well-
being; opportunity to
discuss feelings with
a health professional
reduces psychological
distress; effective
communication between
health professionals and
families is crucial to
constructive FC
outcomes; FCs should
not be saved for crisis
situations, and
a preventative approach
is needed where issues
are anticipated

887
(Continued)
Table 1. (Continued )

Level of

888
Author, year, country Title Aims Methods Participants Findings evidence
Kautz et al, 2009, US Promoting family integrity Demonstration promoting Literature review and NA Encouraging family I
to inspire hope in family integrity also discussion members to express their
rehabilitation patients: promotes hope when feelings is crucial for
Strategies to provide families are confronted adjustment to new
evidence-based care with a new disability disability and promoting
family contributions to
rehabilitation;
interventions promoting
communication and
resolution of feelings of
guilt improve patient
outcomes; MDTs need to
assist families and
patients anticipate or
cope with negative
feelings or reactions after
discharge from hospital
National Stroke Clinical guidelines for To provide a series of Clinical guidelines, based NA Stroke survivors and CGs I
Foundation, 2010, stroke management evidence-based on 2 Cochrane reviews of require opportunities to
Australia recommendations related 17 and 10 RCTs identify and discuss
to recovery from stroke postdischarge needs with
to assist decision-making relevant members of the
MDT; a documented care
plan collaboratively
developed is necessary,
and MDT members must
provide tailored training
for CGs at appropriate
stages of recovery and
before discharge, in
addition to routine follow-

Y.M. LOUPIS AND S.G. FAUX


up for clarification/
reinforcement of
information; MDT needs
to meet regularly with
patient/CG to involve
them in management,
goal setting, and
discharge planning; both
active and passive
interventions
significantly improve
knowledge gained, while
active interventions have
greater benefits for mood
FAMILY CONFERENCES IN STROKE REHABILITATION
Smith et al, 2008, UK Information provision for To assess effectiveness of Review of RCT registers 17 RCTs involving stroke Information provision I
stroke patients and their information provision and contact with survivors and/or their improved patient and
caregivers strategies respective researchers CGs carer knowledge,
satisfaction, and
depression scores; active
information had
a significantly greater
effect than passive
information on patient
mood
Clark et al, 2003, A randomized controlled Determine effect of Intervention group received RCT with 62 stroke Education and counseling II
Australia trial of an education and education and discharge information survivors and CGs, intervention improved
counseling intervention counseling after stroke package and 3 social completing rehabilitation family and physical
for families after stroke on physical and worker visits to reinforce at 2 subacute hospitals functioning for stroke
psychosocial outcomes education information survivors and CGs, as
and family functioning well as social recovery
(such as contributing to
domestic tasks and
participating in social
activities); there were no
significant effects on
depression, anxiety,
mastery, or health status
Kalra et al, 2004, Training carers of stroke To evaluate effectiveness of Single, blind, RCT; CGs 300 stroke patients and Training CGs in basic skills II
England patients: Randomized training CGs in reducing were trained in basic their CGs in a stroke of moving and handling,
control trial burden of stroke in both nursing and personal rehabilitation unit facilitation of activities
patients and their CGs care techniques of daily living, and
simple nursing tasks
reduces burden of care
and improves quality of
life in patients and CGs
at 3 and 12 months; this
training assists to bridge
the gap between patient
and CG expectations of
recovery and residual
disability to promote
overall well-being

889
(Continued)
Table 1. (Continued )

Level of

890
Author, year, country Title Aims Methods Participants Findings evidence
Donnelly et al, 2009, Family meeting: An To explore the experiences Convenience sample of 10 Inpatients of a department MDT described good FCs III-3
Ireland exploratory study of the of family meeting family meetings; mixed of geriatric medicine as having a clear purpose,
views and experiences of participants method study design, involving premeeting
older patients, family including participant preparation goal setting,
members and the observations, demonstrating good time
multidisciplinary team in questionnaires, and focus management, and an
a hospital setting groups with the MDT emphasis on decision-
making; patient and CG
expectations need
clarification and an
agenda agreed upon
before FC for a more
positive and productive
meeting; an education
program for health care
professionals, focusing
on strategies to increase
patient participation
levels, particularly those
with a cognitive
impairment, would be
beneficial
King et al, 2007, US Problem-solving early To examine efficacy of 10-session course for CGs 25 CGs of stroke survivors CGs of stroke survivors III-3
intervention: A pilot a CG problem-solving of problem-solving skills participating in acute assume their role
study of stroke intervention on CG and and cognitive behavioral rehabilitation, with 14 suddenly and with little
caregivers stroke survivor therapy, with provision completing final preparation, and are at
outcomes, matched with of a manual containing assessment risk of developing
a historical survivor/CG content for each session anxiety and depression;
group CGs receiving
a problem-solving
therapeutic intervention

Y.M. LOUPIS AND S.G. FAUX


experienced fewer
depressive symptoms;
quality of life,
depression, changes in
the dyadic relationship,
and family functioning
could be examined in
future studies that target
stroke survivor benefits
from a CG intervention

Abbreviations: CG, caregiver; FC, family conference; MDT, multidisciplinary team; RCT, randomized, controlled trial.
*Designations of levels of evidence sourced from Australian National Health and Medical Research Council recommendations.24
FAMILY CONFERENCES IN STROKE REHABILITATION 891

necessary information about the patients condition and fessionals should be mindful of this. Health care profes-
progress, and the caregiver does not always understand sionals are ideally positioned to monitor caregiver
the purpose of stroke rehabilitation and its role specifi- moods and needs and develop strategies to decrease
cally in relation to the person receiving care.11,21 strain where possible.3,13,21,23 Caregivers with a better
Providing active problem-solving intervention and edu- understanding of a patients functional abilities may
cational resources as preventative measures resulted in have increased capacity to make accurate predictions,
fewer incidents of depression and anxiety among care- and therefore may experience less stress than those
givers and enhanced knowledge compared with control without this information.2 Studies revealed that family
groups.1,12,13,19,23 support is associated with progressive improvement for
Most authors agree that family conferences are time- rehabilitation patients (both physically and psychologi-
consuming for the MDT and families involved, and cally), and greater communication as a MDT with care-
strategies to encourage better time management were givers can reduce psychological stress and facilitate
therefore suggested. In the Australian context, each hos- better adjustment to an illness or disability, thereby im-
pital family conference can cost a facility between AUD proving quality of life and long-term outcomes.4,6,11,12
$1000 and AUD $1500 (approximately $1038-1557 US) The NSF and Amador et al1,10 recommend that patients
when taking into account 1 hour of attendance for an ad- and caregivers be provided with the opportunity to be
mitting medical officer, medical registrar, resident medi- involved in discharge planning where needs can be
cal officer, physiotherapist, occupational therapist, identified, goals devised, and plans specified, serving to
psychologist, social worker, speech pathologist, and increase satisfaction with the care provided and increase
nurse, in addition to other patients potentially missing feelings of preparedness. Decision-making must often
out on an hour of therapy. Donnelly et al9 describe family take into account competing values, expectations, differ-
conferences as successful when their purpose has been ef- ent definitions of the nature of the problem and accept-
fectively communicated, good time management has able outcomes, and therefore cannot occur without
been used, and all participants are involved in the negotiation.5 In the case of family conferences in stroke re-
decision-making process. Hansen et al5 agree that greater habilitation, Griffith et al6 and Donnelly et al9 suggest that
clarification of the agenda of each family conference is it is important to identify agenda items that can be agreed
beneficial, and that additional smaller meetings to the upon to set a clear purpose for the meeting, clarify expec-
larger family conference (held either before or after, and tations, and to hold the meeting at a time that is appropri-
usually with the treating social worker) would provide ate for all involved to improve productivity. Particularly
more regular problem-solving opportunities, again pro- in a rehabilitation setting, Fronek8 suggests that patient
moting the preventative approach. This may be practical self-determination is crucial; where the patient leads the
to implement in family meetings, giving them structure recovery process, and where capacity exists and options
and assisting caregivers to feel more prepared and confi- have been discussed, they should be encouraged to
dent to fully participate. make decisions regarding treatment and ongoing
There is some debate in the literature as to when infor- support.
mation and rehabilitation feedback should be provided
to caregivers. Eight articles made suggestions for the
Discussion
most beneficial and appropriate timing of family con-
ferences throughout patient admission.1,3,4,6,8,10,11,21 The literature indicates that successful family confer-
Friedemann-Sanchez et al15 suggest that family confer- ences are those in which both the patient and caregiver
ences are best organized just before discharge, coupled feel engaged with the process and decision-making. Fam-
with follow-up in the community to ensure information ily conferences can be used to plan practical approaches
retention. The Australian NSF guidelines suggest that in- to professional care, including encouraging increased in-
formation provided at all stages of a patients hospital volvement of caregivers in practical care tasks on the hos-
admission would be more effective, because their studies pital ward. Understanding predictors or triggers of family
found that patients and caregivers respond well to conferences could provide MDTs with insight into the
regular feedback on progress and functional capacity.1 types of events or illnesses that might be a catalyst for re-
Duncan et al3 and Giacino et al7 suggest that family con- quirement of a family conference.
ferences should be held shortly after admission and Providing information regarding long-term prognosis
again before discharge in order for a complete care shortly after admission to rehabilitation may be difficult
plan to be devised. and fraught with inaccuracy, particularly because partic-
Caregivers assume their role suddenly, and most fami- ipation in rehabilitation, natural recovery, and the effi-
lies of patients undergoing physical rehabilitation are cacy of high-intensity therapy have yet to be tested. As
subject to a great deal of stress, largely relating to lack such, family conferences held on admission may be
of information and carer burden.11 Rates of depression less likely to assist in discharge planning or reduce anx-
and anxiety amongst caregivers are often high, and pro- iety regarding outcomes. Other interventions, such as
892 Y.M. LOUPIS AND S.G. FAUX

Table 2. Essential ingredients for effective family conferences

Communicate meeting purpose to patients and caregivers


Provide written and verbal invitations to family conferences and ensure agenda is agreed upon before meeting between patients,
caregivers, and staff
Held in a comfortable environment that allows for effective communication and contact, reducing power disparities
Negotiate a time suitable for most people involved, not just the treating team
Use of good time management to enhance overall satisfaction with the process and ensure cost effectiveness
Acknowledge that patients and caregivers have taken time out of their own schedules to attend
Previous discussion between caregivers and the multidisciplinary team (premeetings) of rehabilitation progress and patients
functional capacity to ensure adequate opportunities for education provision and proactive use of the meeting time
Active problem solving, decision-making, and discharge planning from all participants for the benefit of the stroke survivor, and
to reduce feelings of despair and carer burden after a prognosis
Held before discharge when rehabilitation outcomes and available support systems/services can be thoroughly discussed

a social work consultation (particularly in the first 2 Power disparities in family conference settings, such as
weeks of a rehabilitation admission), appointment of an unwelcoming environment or differences in knowl-
a contact person in the treating team to provide feedback edge of stroke rehabilitation and projected outcomes,
on rehabilitation progress, the provision of written and/ can influence confidence and capacity for the patient
or electronic information on the roles of assessment, and caregivers to participate. The meeting environment
timetabling, and expectations of stroke rehabilitation needs to be comfortable and conducive to communication
may assist in reducing caregiver and patient anxiety and contact with all participants. Venues such as dining
and improving levels of engagement early in the stroke rooms, lecture theatres, and staff offices where there are
rehabilitation process. desks or too much distance between therapists and family
Quality assurance data from the authors rehabilitation members, or the presence of background noise, would
service indicate that a proportion of health professionals further reinforce power inequalities and potentially be
in MDTs working in stroke rehabilitation do not receive confrontational. Pressures of time, limited options, and
formal training to conduct family conferences, and duration of stay present barriers to ideal outcomes for in-
many express anxieties about ensuring they run well, par- dividuals and families. On the whole, better education
ticularly because the decision-making process, discharge and ongoing support for patients and their caregivers
planning outcomes, and levels of satisfaction can vary. provided in a proactive manner may reduce strain on
There is a clear need for best practice guidelines with both patients and their families. The articles highlight
regard to family conferences that may alleviate stress on that more personalized and concise information, deliv-
caregivers and patients and provide information regard- ered in a timely fashion, and with a more preventative ap-
ing stroke rehabilitation at the time of the family confer- proach, could promote better short- and long-term
ence to allay concerns about discharge. From this outcomes. Patients and their families may benefit from
review, a guideline for family conferences during stroke closer involvement in discharge planning to reduce care-
rehabilitation is proposed that may minimize carer bur- giver burden and stress.
den and stress and optimize patient engagement with In conclusion, stroke is a complex condition with wide-
the discharge planning process and successful commu- ranging effects, and it requires a more comprehensive ap-
nity reintegration (Table 2). According to the literature, proach to promote recovery than can be achieved by the
patients and caregivers may benefit from timely warning provision of information alone. Evidence from this litera-
of a family conference together with a proposed agenda ture review indicates that a family conference should be
and at a mutually acceptable time. For optimal effective- considered the standard of care for inpatient stroke reha-
ness, family conferences may use good time management bilitation. It is clear from the literature that having a family
principles and acknowledge that caregivers and patients conference before discharge; providing clear agendas, in-
have been inconvenienced to attend. Health professionals vitations, and information on the process, and ensuring
may prepare patients and caregivers for family confer- efficient time management; facilitating active problem
ences by providing updated and regular information on solving; and providing social work services for follow-
their progress in rehabilitation and their functional capac- up of issues of psychological adjustment are vital for en-
ity, which may assist families to engage in the discharge suring better information provision and patient outcomes
planning process. The family conference may focus on ac- in inpatient stroke rehabilitation.
tive problem solving, decision-making, and discharge Because the Medicare schedule provides specialists and
planning from all participants for the benefit of the stroke general practitioners in Australia with remuneration for at-
survivor, potentially reducing feelings of despair and tendance and organization of discharge case conferences in
carer burden after a prognosis. the private sector, and because the cost of allied health
FAMILY CONFERENCES IN STROKE REHABILITATION 893

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