Using Mind Mapping in Family Meetings to Support Shared Decision Making with Pediatric and Geriatric Patients

Abstract

Introduction

Divergent objectives and narratives among members of a healthcare team may lead to suffering, underscoring the need to align patient care with the patient’s self-identified priorities and goals. Shared decision making (SDM) with patients who may not be able to make healthcare decisions for themselves presents a unique challenge to healthcare providers, caregivers, and patients. Children and the elderly are two such groups where substituted decision making is often required. Family meetings, wherein stakeholders in a patient’s care are gathered, present opportunities to align expectations and clinical goals. There is a clear need for a technique exploring all facets of the patient’s story within the context of the biopsychosocial-spiritual model. We sought to promote narrative equity among stakeholders and maintain patient focus during family meetings. We describe the use of Mind Mapping in the family meeting to meet these objectives.

Methods

Using two clinical scenarios, one involving a geriatric patient and another involving a pediatric patient, we describe the stepwise development of Mind Maps and how their use informed discussions among stakeholders in the family meeting.

Results

Stakeholders found the Mind Maps easy to draw and helpful in eliciting their own priorities and preferences. Group exploration and refinement of the Mind Maps helped stakeholders to appreciate others’ sometimes divergent perspectives, to ensure that the patient’s voice was heard, and to ensure that care decisions were patient focused.

Discussion

Mind Mapping was easily performed in two clinical scenarios, allowing the patient, family, and medical team to explore the biopsychosocial-spiritual model extensively, to appreciate each stakeholder’s priorities, and to identify areas for further development. We have found that Mind Mapping helps define the ‘topography’ of relationships, prioritizes team discussions, finds shared interests in seemingly divergent objectives, and identifies which team member may best lead a discussion on a particular topic.

Conclusion

Mind Mapping may be a useful tool for family meetings, particularly for geriatric and pediatric patients with multiple stakeholders involved.

Plain Language Summary

Patient-focused healthcare, which prioritizes the needs and desires of the patient when creating a plan of care, relies on the patient’s voice being clearly and accurately heard. This is especially important when the patient cannot make medical decisions alone, as may be the case for elderly patients or children. Unfortunately, there are times when the patient’s voice may be ‘drowned out’ by family members, friends, or members of the healthcare team. Family meetings offer an opportunity for all parties involved in the patient’s care to gather together to ensure agreement on treatment goals and next steps. In this manuscript, we explore the technique of Mind Mapping as a tool to encourage all family meeting participants to speak and be heard. Using two clinical scenarios, one involving an elderly patient and the other a pediatric patient, we describe in a stepwise fashion how to perform Mind Mapping, what was done in these two cases, and how the Mind Maps changed how health care was delivered. We have found Mind Mapping effective in planning for family meetings, encouraging all persons involved in the patient’s care to share their perspectives, ensuring that the patient’s story is heard, and confirming that care plans reflect the patient’s desires and needs.