Webside Manner during the COVID-19 Pandemic: Maintaining Human Connection during Virtual Visits

Abstract

Background: As the death rate numbers in the United States related to COVID-19 are in the tens of thousands, clinicians are increasingly tasked with having serious illness conversations. However, in the setting of infection control policies, visitor restrictions, social distancing, and a lack of personal protective equipment, many of these important conversations are occurring by virtual visits. Objective: From our experience with a multisite study exploring the effectiveness of virtual palliative care, we have identified key elements of webside manner that are helpful when conducting serious illness conversations by virtual visit. Results: The key elements and components of webside manner skills are proper set up, acquainting the participant, maintaining conversation rhythm, responding to emotion, and closing the visit. Other considerations that may require conversion to phone visits include persistent technical difficulties, lack of prerequisite technology to conduct virtual visits, patients who are too ill to participate, or who find virtual visits too technically challenging. Conclusions: Similar to bedside manner, possessing nuanced verbal and nonverbal webside manner skills is essential to conducting serious illness conversations during virtual visits.

COVID-19: guidance on palliative care from a European Respiratory Society international task force

“…However, a report from the implementation of palliative care e-family meetings with trained clinicians showed the benefits of these meetings, including satisfied family members [ 30 ]. The key elements of remote communication skills have been published [ 31 ].…”

“…To overcome communication barriers in COVID-19, including the need to wear PPE and the physical absence of families and loved ones, healthcare professionals need new skills and experience. Fortunately, training and tools are being rapidly developed to facilitate communication with patients with COVID-19 and their loved ones [ 26 , 30 , 31 , 42 ]. More experience as well as studies exploring the effects of tools and training are needed to optimally support communication skills in palliative care for patients with COVID-19 and their loved ones.…”

“…[28] Key elements of remote communication skills have been published. [29] Results: Most experts provided a strong (58.8%) or conditional ( Rationale: Psychological symptoms such as anxiety and agitation are highly prevalent in dying patients with COVID-19. [6,17] Psychosocial interventions in palliative care can relieve emotional and existential distress and improve quality of life.…”

Family Presence for Patients with Severe Acute Brain Injury and the Influence of the COVID-19 Pandemic

“…Building and maintaining empathic connection and providing emotional support virtually require new skills, both verbal and nonverbal. 5,6 All of these changes require additional resources from hospitals including IT support and provision of devices so that all patients and families have an equal opportunity to participate, and health care providers are not additionally burdened by managing communication devices.…”

We Will All Be Changed: Palliative Care Transformation in the Time of COVID-19

“…Yet together, we share emerging best practices in ''webside manner,'' as coined by members of the Massachusetts General Hospital palliative care team. 6 Virtual visits have allowed us to console and support families shut out by visitation policy, and to bring them to the bedside through video visits with patients. These new skills remind us that before COVID-19, many families were unable to visit due to lack of transportation or ill health-and we will continue virtual visits even when COVID-19 runs its course.…”