Accommodating People with Disabilities in Meetings: Tips for Hospital Social Workers

Team meetings with patients with disabilities and their supporters are excellent ways to enhance communication. Meetings can provide focused time to clarify information, discuss goals of care, and/or address team concerns. Social Workers play key roles in supporting the participation of patients to make these meetings as successful and positive as possible. Many medical decisions and care plans for people with disabilities impact the services, and supports they receive such as funding, housing, transportation, and other accommodations. If this is not addressed, patients are at higher risk of readmission.

Before the meeting:

• Identify who needs to be present from the patient’s circle of support. Include them in scheduling.
• A plan may be more complex for people who require personal assistance or accommodations. Include all relevant disciplines such as palliative care, chaplains, case management, hospice, home care nurses, occupational therapy, physical therapy, speech therapy, or any other expert requested by the family and the team.
• Identify access needs for the patient, and other attendees. Be flexible and creative in resolving any access-related challenges. Patients and supporters can often suggest solutions. Americans with Disabilities Act (ADA) officers for a medical center may also be able to assist.
• Sometimes the only place to accommodate the patient may be their hospital room. If this is the case, ensure that there are enough chairs so that people are not standing over the patient. Also, consider arranging remote participation through speakerphones or video conferencing if team members feel overwhelmed in groups or cannot attend in person.
• Even if patients are unable to speak or lack the mental capacity to make a medical decision at the time, it is important to provide an opportunity for them to attend meetings where issues that impact them will be discussed.
• Offer a pre-meeting to the patient to ascertain their priorities and give them time to think and to prepare. Offer assistance in bringing up difficult topics. Encourage patients to identify a note taker.
• Inquire if there are any pre-existing conflicts between team members so that you can manage them.  
• Encourage the patient and supporters to write down questions or priorities they have going into the meeting.
• A pre-meeting with the treating team may be appropriate depending on the complexity of the case, and/or if there are differing opinions among clinicians on the team.
• If appropriate, encourage the patient to bring photographs of what they love and/or being with loved ones. This can remind the entire team who the patient is outside of the hospital setting and what the patient’s goals are.
• Schedule an interpreter for any participant in the meeting if there are language or communication barriers. Ensure that the patient has access to communication support and equipment if needed. If the patient needs information in an alternative format such as pictures, audio, video, plain language, large print, or Braille, then make arrangements to have those available.
• Before the meeting, bring tissues, water and cups into the meeting room and remove protected health information (PHI) (e.g. notes on a blackboard from a previous meeting, etc.).

During the meeting:

• Start with introductions. Ask each person to state what role they play.
• If necessary, prompt team members to acknowledge patients and direct their comments directly to them.
• State the purpose of the meeting and address any access needs.
• Offer the patient an opportunity to be the first to speak or present.
• Watch for cues from participants of misunderstanding, confusion, or distress.
• If the family seems unclear or there are different perceptions during the meeting, ask clarifying questions. You can frame these questions as your own, e.g. “Excuse me Dr. X, could you go back to what you just said about prognosis and explain it again?” or “Ms. Y, does Dr. X’s recommendation match your priorities?
• If the meeting is moving rapidly and the patient has not participated, ask meeting members to pause and ask the patient if they have questions or anything to add. Because patient participation is vitally important, unless otherwise arranged in pre-meetings, their input should be encouraged throughout the meeting.
• Remind the patient that they do not have to make final decisions at the meeting. They can take time to process information, and respond after the meeting ends.

After the meeting:

• Debrief with the patient and family. One helpful way to start is to ask the family, “What are the main messages you got out of the meeting?” Their response will give you the opportunity to clarify or fill in any information they may have missed. Additionally, this may help you identify any issues you need to bring back to the team for follow-up.
• Depending on the meeting’s content, patients and families may feel heightened, emotional distress afterwards. You can acknowledge and normalize this as well as support their coping capacities. For example:
• Ask how participants typically cope. Assist them in accessing the internal or external resources they identify.
• Help patients and families process their experiences. A hospital stay can be traumatic and may trigger prior traumatic medical experiences. Providing an opportunity to address these concerns can destigmatize the intensity of the emotional experience and mitigate distress or trauma symptoms.
• Support patients and families in their attempts to understand hospital procedures and resources. Identify who can assist families with questions and be sure to let them know how they can reach you.
• Suggest using a resource such as www.caringbridge.org for families to share information. It can help families organize help from their support systems for tasks such as note taking in meetings, food preparation, child/pet care, and transportation.
• Connect families to hospital and local resources – familiarize yourself with the tools on the Office of Developmental PC website: https://odpc.ucsf.edu/advocacy/navigating-systems.