Background <p>Effective communication in the intensive care unit (ICU), such as conferences between clinicians and family members as surrogate decision–makers, is key since patients frequently lack decision-making capacity because of the severity of their illness. However, there is little evidence about family conferencing, processes and missed opportunities during family conferences from the perspective of family members. This study explored the process, structure and missed opportunities during family conferencing among the family members of patients in the intensive care unit (ICU) of one Regional Referral Hospital in western Uganda.</p> Methods <p>A qualitative study was conducted in the general ICU. Close family members who participated in patient care provided information about the family conferencing procedure. The data were collected via individual interviews, transcribed verbatim and analysed using content analysis as described by Krippendorff.</p> Findings <p>The participants were middle-aged and ranged from 25 to 60 years, with good level of education, and most of them were employed. The generated categories were dichotomized into two sections. The first section explored the factors related to the process linked to readiness and the structure of family conferences. The observations included accidental meetings, which were conducted in unfamiliar places, were attended by an unintegrated disciplinary team, and mostly discussed patients’ values, care and treatment management. Uncertain experiences revealed perceived satisfactory communication to some family members, whereas others reported sadness with missed opportunities in the process of family conferences.</p> Conclusion <p>Family conferences lack adequate preparedness, and family members’ emotions are missed in care. This study recommends that family conferencing protocols be followed to enhance effective communication skills that align with family members’ emotions.</p>