Smartphone-Enabled, Telehealth-Based Family Conferences in Palliative Care During the COVID-19 Pandemic: Pilot Observational Study

Abstract

Background In the palliative care setting, infection control measures implemented due to COVID-19 have become barriers to end-of-life care discussions (eg, discharge planning and withdrawal of life-sustaining treatments) between patients, their families, and multidisciplinary medical teams. Strict restrictions in terms of visiting hours and the number of visitors have made it difficult to arrange in-person family conferences. Phone-based telehealth consultations may be a solution, but the lack of nonverbal cues may diminish the clinician-patient relationship. In this context, video-based, smartphone-enabled family conferences have become important. Objective We aimed to establish a smartphone-enabled telehealth model for palliative care family conferences. Our model integrates principles from the concept of shared decision making (SDM) and the value, acknowledge, listen, understand, and elicit (VALUE) approach. Methods Family conferences comprised three phases designed according to telehealth implementation guidelines—the previsit, during-visit, and postvisit phases. We incorporated the following SDM elements into the model: “team talk,” “option talk,” and “decision talk.” The model has been implemented at a national cancer treatment center in Taiwan since February 2020. Results From February to April 2020, 14 telehealth family conferences in the palliative care unit were analyzed. The patients’ mean age was 73 (SD 10.1) years; 6 out of 14 patients (43%) were female and 12 (86%) were married. The primary caregiver joining the conference virtually comprised mostly of spouses and children (n=10, 71%). The majority of participants were terminally ill patients with cancer (n=13, 93%), with the exception of 1 patient with stroke. Consensus on care goals related to discharge planning and withdrawal of life-sustaining treatments was reached in 93% (n=13) of cases during the family conferences. In total, 5 families rated the family conferences as good or very good (36%), whereas 9 were neutral (64%). Conclusions Smartphone-enabled telehealth for palliative care family conferences with SDM and VALUE integration demonstrated high satisfaction for families. In most cases, it was effective in reaching consensus on care decisions. The model may be applied to other countries to promote quality in end-of-life care in the midst of the COVID-19 pandemic.

Improved Serious Illness Communication May Help Mitigate Racial Disparities in Care Among Black Americans with COVID-19

“…[43][44][45][46] These discussions can also be conducted via telehealth technology, a platform patients and clinicians have rapidly adopted during the pandemic. 47,48 When patients, families, or surrogate decision-makers cannot be physically present to discuss treatment options with clinicians, telecommunication discussions help meet patient needs 24 while restoring a sense of human connection in difficult social distancing circumstances. 49 Although not a replacement for patient-provider conversations, online tools such as OurCareWishes.org, a free platform designed to guide patients and families through advance care planning, may also be used to help high-risk patients clarify goals and share preferences with providers 38,39 (Table 1).…”

Telehealth-Based Family Conferences with Implementation of Shared Decision Making Concepts and Humanistic Communication Approach: A Mixed-Methods Prospective Cohort Study

“…Those who declined to conduct virtual conferences or did not possess the technical skills to participate were excluded. We have conducted a pilot observational study using SDM concepts and VALUE approach in smartphone-enabled telehealth-based family conferences, and the result was highly satisfactory, especially in reaching a consensus on care decisions [29]. Physicians were trained to use the structured and templated SDM framework combining the VALUE and PLACE approach to share information and foster human connectedness in virtual family conferences (Figure 1).…”

“…As family conferences transition from in-person to virtual context, questions emerge about whether it will impede the meaningful physicianpatient/family relationship due to lack of direct human contact during difficult discussions [26][27][28]. Our team had conducted a pilot study using smartphone-enabled telehealth to provide family conferences and effectively reaching a consensus on end-of-life care goals [29]. Nevertheless, virtual physician-family interaction, especially with emotion recognition and response, remains unclear [30,31].…”

Papel da telemedicina em pacientes com câncer avançado durante a pandemia de covid-19: Uma revisão integrativa / Role of telemedicine in patients with advanced cancer during the covid-19 pandemic: An integrative review

“…Para mais, um estudo observacional, aplicado em Taiwan, constatou que o modelo de telessaúde atingiu o objetivo de permitir que mais membros da família participassem das conferências, que antes ocorriam sob restrições de visitantes devido à pandemia da COVID-19, além de ter observado alta taxa de satisfação do paciente e de seus familiares com esse tipo de atendimento (WU et al, 2020).…”