End-of-life care can be challenging even in the most ideal circumstances, given our frequent societal reluctance to discuss medical plans around dying and death.
But the coronavirus pandemic means it’s more important than ever to communicate with patients and families honestly about what to expect – particularly given that social-distancing protocols may mean these conversations are not happening in person.
At the American Telemedicine Association virtual conference earlier this month, experts urged attendees to use technology to help facilitate end-of-life discussions and care.
“The right time to have the conversation about what you want, and how you want to live your very last days, is not during your very last days,” said panel moderator Alexandra Drane, CEO and cofounder of the caregiver resource ARCHANGELS.
“One of the things that is most difficult at this time is taking care of patients that are alone in the hospital,” said Dr. Silvia Perez Protto, medical director of the Center for End of Life Care at the Cleveland Clinic.
Perez Protto told Healthcare IT News that she embraces technology as a way to connect patients with loved ones and with care providers.
At the center, she said, the team launched the Care Companion tool, an app powered by Epic that connects a patient’s electronic medical record with the patient portal.
“We created a navigator in the electronic medical record to document decision-makers … advance directives documents, goals of care discussions [and] code status discussions, in a single location of the chart for easy access,” Perez Protto explained.
The team also offered information about advance directives to all patients with none in the chart and created a “wishes/values/worries” questionnaire based on the conversation guide from the innovation center Ariadne Labs. The patients can complete the questionnaire in MyChart, and it populates in the EHR for clinician use.
Given the isolation necessitated by the pandemic, Perez Protto said, the Cleveland clinic has secured iPads for all nursing units for patients to connect with their loved ones using video calls.
Other panelists referred to technology’s ability to clarify patients’ wishes more objectively. Dr. Ferdinando Mirarchi, medical director of the Institute on Healthcare Directives, said living will documents are often misinterpreted as “do-not-resuscitate” orders – even if that’s not what the patient really wants.
Instead, Mirarchi said, he lives “in a world of process improvement.”
Mirarchi pointed to the institute’s MIDEO tool, or “My Informed Decision on VidEO,” which allows patients to record a “short, brief and to the point” video explaining their emergency medical care wishes.
The institute is “trying to build tools so decision-makers wouldn’t be taxed” about their loved ones’ medical treatment.
Unfortunately, he said, “oftentimes, that decision is a guess.”
The panelists also stressed the importance of maintaining empathy even when relying on digital technology that might make it more challenging to do so.
“Expressing empathy nonverbally is more difficult using technology,” said Perez Protto.
“The provider should look comfortable, and make eye contact that is achieved [by] looking at the camera,” she said. “This takes practice and having a sign towards the camera may help.”
“It is important to be aware of the body positioning, movement, facial gestures, voice quality and vocal tone,” she continued.
She advised exaggerating motions such as nods so the patient notices them and placing a hand on your heart that “may replace a hug or the appropriate touch we offer to our patients or loved ones often.”
“We can also validate their feelings or experiences, and name the emotions we are sensing, or we can ask how they are feeling,” she said. “Also, it is very important to use pauses [and] make sure everyone has time to express themselves.”
Kat Jercich is senior editor of Healthcare IT News.
Healthcare IT News is a HIMSS Media publication.
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