• Allow time and privacy
• Consider whether the child should be part of the discussion
• If the parents need to leave the child, ensure they are comfortable that the child is being cared for appropriately
• Ask the family who they would like to include as a support for them
• Optimise communication for families from culturally/linguistically diverse backgrounds (for example by organising an interpreter or Aboriginal liaison officer)

Discussing the potential for deterioration or death with families can be difficult even in the best circumstances. Some simple environmental measures can help you have a productive discussion.

There must be an appropriate space for the meeting available for the time required.
It should be completely private with a closed door, and have low ambient noise. Ideally, it should be in a place familiar to the family, such as in a familiar ward or consulting room.

If the family need to leave the room during the meeting, there should be a safe place nearby for them, such as a tea-room or family space. If the child is not going to attend the meeting, ensure a trusted person is caring for them in the parent’s absence.

There should be enough seats for all participants in the meeting. A ‘round table’ or circle of chairs is ideal, as it avoids creating a physical division between the family and the medical staff. It can be good for a trusted healthcare worker to sit beside the family to create a sense that everyone is on the same team.

It should also be possible for any participant to easily leave the room without being disruptive. If a family member has in the past been upset during distressing discussions, make sure they have easy and direct access to the door. Tissues should always be available but they don’t need to be ‘on display’.

It is rare for meetings in a hospital to start exactly on time, so have some leeway to enable ongoing use of the room for a reasonable period of time.

Try to ensure that participants will not be interrupted during the meeting (for example, phones set to silent or switched off, pagers silent or covered) and that no time-sensitive, unrelated meetings are planned to immediately follow on from the family meeting.

Family meetings usually need at least 30 minutes, however they may go substantially longer.

If the family are non-English speaking, ensure that an appropriate interpreter is booked for the required period of time. Using an interpreter can increase the duration of the discussion, so take this into account.

Interpreters can provide useful insights about how a cultural group makes decisions and views death. For children who are of Aboriginal or Torres Strait Island descent, Aboriginal liaison officers can provide important support for the family and assist with understanding the cultural issues.

Ensure the interpreter is aware of the nature of the discussion before commencing the meeting. Interpreters may be distressed or traumatised by being required unexpectedly to interpret about the possible death of a child.