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
stroke rehabilitation in subacute settings is becoming
better recognized and vocalized, and there is greater ac-
knowledgement of the importance of family involvement
in patient outcomes.1 Hospital family conferences are
From Sacred Heart Rehabilitation Service, St. Vincents Hospital,
Sydney, New South Wales, Australia.
Received August 24, 2012; accepted December 8, 2012.
Address correspondence to Yasmine M. Loupis, BSW, BA, Sacred
Heart Rehabilitation Service, St. Vincents Hospital, 170 Darlinghurst
Rd, Darlinghurst, NSW 2010, Australia. E-mail: yloupis@stvincents.
com.au.
1052-3057/$ - see front matter
Crown Copyright 2013 Published by Elsevier Inc. on behalf of
National Stroke Association. All rights reserved.
http://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2012.12.003
important and beneficial for communicating progress
and therapeutic findings and to facilitate problem
solving for complex discharge planning, particularly in
the setting of stroke rehabilitation.2-14 They provide an
opportunity for family members to raise concerns
and gain valuable feedback from the treating
multidisciplinary team (MDT). They are also instrumental
in discharge planning and the communication of ongoing
care needs. Research suggests that family conferences
may differ in their purpose and application in a variety of
hospital settings, although they have rarely been analyzed
to investigate their value and application in specific
health areas, such as stroke and rehabilitation.15
A literature review was conducted at the Sacred Heart
Rehabilitation Service to investigate the purpose and ben-
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
stroke rehabilitation caseload, including evaluation of the
structure and cost effectiveness of the family conference.
The questions guiding this review were as follows: (1)
Are family conferences the most effective and adequate
method of communicating information and feedback
from MDTs to stroke patients and their families in an in-
patient rehabilitation setting? (2) How can the effective-
ness of family conferences be optimized?
This review aimed to integrate and analyze current
knowledge on family conferences in the inpatient stroke
rehabilitation setting.
Methods
In accordance with the Cochrane Handbook for Sys-
tematic Reviews of Interventions,25 the authors defined
the review questions, developed criteria for inclusion,
conducted a literature search using a 2-stage process,
and analyzed the findings; the results presented and in-
terpreted below address the initial research questions.
An electronic database search identified relevant jour-
nals and articles using the Clinical Information Access
Programs (CIAP) Medline, PubMed, Embase, Informit,
OvidSP, Proquest, and Psychlit databases. CIAP provides
access to clinical information and resources to support
evidence-based practice at the point of care, and is avail-
able to all staff working in the New South Wales public
health system. Keywords used for the search included
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-
multaneously. By reviewing citations from key articles re-
trieved in this first phase, additional articles of relevance
were identified. Initially, 21 articles were obtained; later,
an additional 16 articles of interest were found.
Articles included in this study made specific reference
to family conferences in clinical practice, identified stroke
rehabilitation as the primary research area, made refer-
ence to the inpatient rehabilitation experience rather
than outpatient or community approaches, and provided
guidelines for clinical practice. They also provided sug-
gestions for alternative support systems for stroke survi-
vors and caregivers, and referred to the multidisciplinary
approach to rehabilitation. Of the aforementioned 37
articles, 14 did not meet the study criteria and were
disregarded.
Results
Table 1 presents a summary of the 14 articles included
in this study that provide evidence levels between I and
III-3,24 listed alphabetically by surname of first author.
For each article, the author, year, country, title, aims,
methods, participants, findings, and levels of evidence
are summarized.
Y.M. LOUPIS AND S.G. FAUX
The articles have commonalities in themes and ideas.
Some authors suggest that patients and families have ad-
ditional education and support needs beyond what is al-
ready provided.1,3,8,11,13,16,18-22 Stein et al2 suggest that the
impact on caregivers of a series of weekly education ses-
sions and one-on-one teaching in addition to regular in-
tervention would be appropriate for additional study.
Pierce et al17 examined a web-based project that allowed
tailored information and support to caregivers from a va-
riety of MDT members throughout the rehabilitation pro-
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-
stroke, although Bhogal et al19 found that information
packages alone are not generally associated with im-
proved outcomes. In their experience, additional social
support interventions, such as active education and coun-
seling, were associated with improved patient and care-
giver outcomes, because caring for stroke survivors in
the community often has a dramatic effect on family func-
tioning and caregiver burden.
The 2010 Australian National Stroke Foundation (NSF)1
guidelines recommend that specific training should be
provided to the patient and caregiver by the MDT before
discharge in order to improve preparation for the chal-
lenges of daily activities at home. The guidelines make
reference to a randomized, controlled trial providing ba-
sic nursing and personal care training to caregivers that
a Cochrane review of effective information provision after
stroke. Their study examined randomized trials in which
the intervention group of stroke patients or caregivers
were provided with a course of lectures. Results indicated
reduced depression when provided with additional infor-
mation about severity of stroke, MDT interventions, and
expected outcomes, as well as feedback opportunities.
Perceived caregiver burden was also significantly re-
duced when reviewed at 3 and 12 months after discharge.
Quality of life in patients and caregivers significantly im-
proved at 3 and 12 months when caregivers received ad-
ditional training, and there was a reduction in total health
and social care costs over 12 months, which was largely
related to shorter admissions.20 After this study, the
most effective method of information provision was still
unclear, although active strategies and planned follow-
up for clarification and reinforcement of this intervention
had a greater effect on patient mood.
A common theme of the articles reviewed was that
much of family involvement that occurs in rehabilitation
is reactive rather than proactive. This indicates that clini-
cians spend much of their time responding to specific
issues or crises rather than addressing concerns pre-
emptively to prevent miscommunication or distress.
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)

Author, year, country Title
Duncan et al, 2005, US Management of adult
stroke rehabilitation
care: A clinical practice
guideline
Fronek, 2008, Australia The RAP in rehabilitation: Review of family
The family conference in conference literature and
practice application to specific
practice setting
Table 1. (Continued )
Aims Methods
Evidence-based practice for Analysis of reviews and Acute and postacute care
stroke rehabilitation, current practices
recommendations
Clinical practice review, Informal feedback from
participatory observation
study
Participants
Family/CG need to be
facilities; national health
guidelines
FCs facilitate
health care professionals
and patients of a spinal
cord injury service
886
Level of
Findings evidence
I
involved in decision-
making and treatment
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
I
communication/planning
between professionals,
Y.M. LOUPIS AND S.G. FAUX
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
necessary information about the patients condition and
progress, and the caregiver does not always understand
the purpose of stroke rehabilitation and its role specifi-
cally in relation to the person receiving care.11,21
Providing active problem-solving intervention and edu-
cational resources as preventative measures resulted in
fewer incidents of depression and anxiety among care-
givers and enhanced knowledge compared with control
groups.1,12,13,19,23
Most authors agree that family conferences are time-
consuming for the MDT and families involved, and
strategies to encourage better time management were
therefore suggested. In the Australian context, each hos-
pital family conference can cost a facility between AUD
$1000 and AUD $1500 (approximately $1038-1557 US)
when taking into account 1 hour of attendance for an ad-
mitting medical officer, medical registrar, resident medi-
cal officer, physiotherapist, occupational therapist,
psychologist, social worker, speech pathologist, and
nurse, in addition to other patients potentially missing
out on an hour of therapy. Donnelly et al9 describe family
conferences as successful when their purpose has been ef-
fectively communicated, good time management has
been used, and all participants are involved in the
decision-making process. Hansen et al5 agree that greater
clarification of the agenda of each family conference is
beneficial, and that additional smaller meetings to the
larger family conference (held either before or after, and
usually with the treating social worker) would provide
more regular problem-solving opportunities, again pro-
moting the preventative approach. This may be practical
to implement in family meetings, giving them structure
and assisting caregivers to feel more prepared and confi-
dent to fully participate.
There is some debate in the literature as to when infor-
mation and rehabilitation feedback should be provided
to caregivers. Eight articles made suggestions for the
most beneficial and appropriate timing of family con-
ferences throughout patient admission.1,3,4,6,8,10,11,21
Friedemann-Sanchez et al15 suggest that family confer-
ences are best organized just before discharge, coupled
with follow-up in the community to ensure information
retention. The Australian NSF guidelines suggest that in-
formation provided at all stages of a patients hospital
admission would be more effective, because their studies
found that patients and caregivers respond well to
regular feedback on progress and functional capacity.1
Duncan et al3 and Giacino et al7 suggest that family con-
ferences should be held shortly after admission and
again before discharge in order for a complete care
plan to be devised.
Caregivers assume their role suddenly, and most fami-
lies of patients undergoing physical rehabilitation are
subject to a great deal of stress, largely relating to lack
of information and carer burden.11 Rates of depression
and anxiety amongst caregivers are often high, and pro-
891
fessionals should be mindful of this. Health care profes-
sionals are ideally positioned to monitor caregiver
moods and needs and develop strategies to decrease
strain where possible.3,13,21,23 Caregivers with a better
understanding of a patients functional abilities may
have increased capacity to make accurate predictions,
and therefore may experience less stress than those
without this information.2 Studies revealed that family
support is associated with progressive improvement for
rehabilitation patients (both physically and psychologi-
cally), and greater communication as a MDT with care-
givers can reduce psychological stress and facilitate
better adjustment to an illness or disability, thereby im-
proving quality of life and long-term outcomes.4,6,11,12
The NSF and Amador et al1,10 recommend that patients
and caregivers be provided with the opportunity to be
involved in discharge planning where needs can be
identified, goals devised, and plans specified, serving to
increase satisfaction with the care provided and increase
feelings of preparedness. Decision-making must often
take into account competing values, expectations, differ-
ent definitions of the nature of the problem and accept-
able outcomes, and therefore cannot occur without
negotiation.5 In the case of family conferences in stroke re-
habilitation, Griffith et al6 and Donnelly et al9 suggest that
it is important to identify agenda items that can be agreed
upon to set a clear purpose for the meeting, clarify expec-
tations, and to hold the meeting at a time that is appropri-
ate for all involved to improve productivity. Particularly
in a rehabilitation setting, Fronek8 suggests that patient
self-determination is crucial; where the patient leads the
recovery process, and where capacity exists and options
have been discussed, they should be encouraged to
make decisions regarding treatment and ongoing
support.
Discussion
The literature indicates that successful family confer-
ences are those in which both the patient and caregiver
feel engaged with the process and decision-making. Fam-
ily conferences can be used to plan practical approaches
to professional care, including encouraging increased in-
volvement of caregivers in practical care tasks on the hos-
pital ward. Understanding predictors or triggers of family
conferences could provide MDTs with insight into the
types of events or illnesses that might be a catalyst for re-
quirement of a family conference.
Providing information regarding long-term prognosis
shortly after admission to rehabilitation may be difficult
and fraught with inaccuracy, particularly because partic-
ipation in rehabilitation, natural recovery, and the effi-
cacy of high-intensity therapy have yet to be tested. As
such, family conferences held on admission may be
less likely to assist in discharge planning or reduce anx-
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
weeks of a rehabilitation admission), appointment of
a contact person in the treating team to provide feedback
on rehabilitation progress, the provision of written and/
or electronic information on the roles of assessment,
timetabling, and expectations of stroke rehabilitation
may assist in reducing caregiver and patient anxiety
and improving levels of engagement early in the stroke
rehabilitation process.
Quality assurance data from the authors rehabilitation
service indicate that a proportion of health professionals
in MDTs working in stroke rehabilitation do not receive
formal training to conduct family conferences, and
many express anxieties about ensuring they run well, par-
ticularly because the decision-making process, discharge
planning outcomes, and levels of satisfaction can vary.
There is a clear need for best practice guidelines with
regard to family conferences that may alleviate stress on
caregivers and patients and provide information regard-
ing stroke rehabilitation at the time of the family confer-
ence to allay concerns about discharge. From this
review, a guideline for family conferences during stroke
rehabilitation is proposed that may minimize carer bur-
den and stress and optimize patient engagement with
the discharge planning process and successful commu-
nity reintegration (Table 2). According to the literature,
patients and caregivers may benefit from timely warning
of a family conference together with a proposed agenda
and at a mutually acceptable time. For optimal effective-
ness, family conferences may use good time management
principles and acknowledge that caregivers and patients
have been inconvenienced to attend. Health professionals
may prepare patients and caregivers for family confer-
ences by providing updated and regular information on
their progress in rehabilitation and their functional capac-
ity, which may assist families to engage in the discharge
planning process. The family conference may focus on ac-
tive problem solving, decision-making, and discharge
planning from all participants for the benefit of the stroke
survivor, potentially reducing feelings of despair and
carer burden after a prognosis.
Power disparities in family conference settings, such as
an unwelcoming environment or differences in knowl-
edge of stroke rehabilitation and projected outcomes,
can influence confidence and capacity for the patient
and caregivers to participate. The meeting environment
needs to be comfortable and conducive to communication
and contact with all participants. Venues such as dining
rooms, lecture theatres, and staff offices where there are
desks or too much distance between therapists and family
members, or the presence of background noise, would
further reinforce power inequalities and potentially be
confrontational. Pressures of time, limited options, and
duration of stay present barriers to ideal outcomes for in-
dividuals and families. On the whole, better education
and ongoing support for patients and their caregivers
provided in a proactive manner may reduce strain on
both patients and their families. The articles highlight
that more personalized and concise information, deliv-
ered in a timely fashion, and with a more preventative ap-
proach, could promote better short- and long-term
outcomes. Patients and their families may benefit from
closer involvement in discharge planning to reduce care-
giver burden and stress.
In conclusion, stroke is a complex condition with wide-
ranging effects, and it requires a more comprehensive ap-
proach to promote recovery than can be achieved by the
provision of information alone. Evidence from this litera-
ture review indicates that a family conference should be
considered the standard of care for inpatient stroke reha-
bilitation. It is clear from the literature that having a family
conference before discharge; providing clear agendas, in-
vitations, and information on the process, and ensuring
efficient time management; facilitating active problem
solving; and providing social work services for follow-
up of issues of psychological adjustment are vital for en-
suring better information provision and patient outcomes
in inpatient stroke rehabilitation.
Because the Medicare schedule provides specialists and
general practitioners in Australia with remuneration for at-
tendance and organization of discharge case conferences in
the private sector, and because the cost of allied health
FAMILY CONFERENCES IN STROKE REHABILITATION
attendance is substantial, it behooves the Australian stroke
rehabilitation community to examine the factors that opti-
mize the effectiveness of the intervention and to develop
guidelines for their use. Additional research into whether
family conferences could be included as standard best
practice in stroke rehabilitation or whether they are simply
required as deemed necessary would be beneficial. Future
research should include well designed, randomized, con-
trolled trials that examine specific outcome measures,
such as caregiver burden, readmission rates, psychological
measures, and staff and patient/caregiver satisfaction with
discharge.
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