Background: When a family member is dying, many questions arise for the relatives: “Why? How? When? What do we say? Plan? Do to help? – a predictable sequence of questions. We aim to present a clinical assessment plan that can be readily applied in a family meeting to address these issues clinically.

Methods: The routine family meeting is facilitated to seek to understand the story of illness, the family’s experience of loss and their patterns of relating and mutual support over time. A 3-generation genogram that explores loss events and coping proves invaluable. Use of circular questions, interspersed with integrative summaries, form the mainstay of the therapist’s strategies. Discussion of prognosis, death and advanced care planning will prove challenging for many families. The model has been recently tested in NCI-funded randomized controlled trial of Family Focused Grief Therapy involving 170 families in the palliative care setting.

Results: A facilitated family meeting can successfully open up communication about topics otherwise avoided by many patients and their families in the palliative care setting. Maintaining a safe environment for the family necessitates respect for their pace, need for protectiveness and openness to talk about talking. Examples of therapeutic challenges from our family therapy trial will inform this approach.

Conclusion: From those routinely appraised, families ‘at risk’ can be selected to continue in a program of preventive family therapy that promotes mutual support and shared grieving. Outcome findings show that this model can prevent the development of complicated grief and depressive disorders in bereaved relatives. Optimizing family functioning does much to help the family adapt to the threat of any loss.