“If the Family Felt Heard”: Social Work Perspectives on Barriers and Facilitators In Family Meetings

Background and purpose: Family meetings (or family conferences) are structured clinical interventions in palliative care that provide a venue for patients, families, and interdisciplinary team members to openly exchange information and concerns, discuss the patient’s condition and prognosis, clarify goals of care, and make decisions. Clinical social workers often play a central role in coordinating and facilitating these meetings, given their expertise in communication, family dynamics, and psychosocial support. However, little is known about effective strategies for implementing family meetings in routine palliative cancer care practice. This qualitative study aimed to identify barriers and facilitators to implementing family meetings in palliative care from social worker perspectives, using the Consolidated Framework for Implementation Research (CFIR).

Methods: Using convenience sampling, we recruited clinical social workers (n=19) involved in palliative cancer care who played an active role in family meetings in the United States through the Social Work Hospice and Palliative Care Network. Semi-structured interviews were conducted via Zoom between December 2024 and March 2025. All interviews were recorded and transcribed. Four authors independently reviewed the transcripts for accuracy and then conducted the analysis. An initial coding framework derived from the CFIR and thematic analysis was used to identify key themes.

Results: Barriers emerged primarily within the inner setting domain, including: (1) inconsistent policies regarding when to hold meetings, and (2) time constraints, busy environments, and the lack of private spaces. Additional barriers were identified in the domain of individual characteristics, such as clinicians’ lack of formal training in family meetings and related communication skills, as well as patients and families with limited health literacy or strong religious beliefs being less likely to actively participate. Facilitators were observed in the process domain, including: (1) ensuring the presence of patients (whenever possible), key family members, decision-makers, and relevant multidisciplinary team members; (2) tailoring discussions to the patient’s culture, language, and needs; and (3) incorporating both formal and informal team debriefs to promote continuous learning. Hybrid technology was viewed both as a facilitator for expanding access and a barrier that could reduce the depth of interpersonal connection. The most frequently recommended implementation strategies were introducing family meetings earlier in the cancer care trajectory and ensuring that oncologists had dedicated time to participate.

Conclusions and implications: This study identified facilitators and barriers influencing the implementation of family meetings in palliative cancer care. These findings indicated that targeted strategies can be developed to improve family meetings in palliative care settings. Findings highlight the need for implementation strategies that address inner setting constraints, including inconsistent policies, limited resources, and insufficient coordination to support oncologist participation through protected and dedicated time. Introducing family meetings earlier in the cancer care trajectory supports their integration into routine clinical workflows. Provider training represents a critical capacity‑building strategy to strengthen clinicians’ communication skills and confidence, addressing key individual-level determinants. Finally, culturally responsive and tailored implementation approaches are needed to address outer setting and equity-related determinants, reinforcing engagement and effective participation among families from diverse backgrounds.