Imagine you are sitting at the dinner table with your grandmother and the rest of your family, enjoying fried chicken and talking for hours. Everything feels normal, safe and warm. Then, three days later, you’re sitting with your grandmother again, except this time, hearing that she has cancer that has metastasized throughout her entire body.

When this happened to me, it was incredibly difficult for our family to absorb this information and have a conversation on whether to move forward with treatment or hospice. If we were to have had this conversation over Zoom, it would have been even more difficult.

Discussing a terminal illness and asking the family to decide whether to pursue treatment or hospice is a very difficult conversation for families to have virtually, so before the pandemic, only a few hospice organizations were truly forward-facing with telehealth technology. However, the pandemic has required telehealth to be more embraced.

When the Centers for Medicare and Medicaid Services (CMS) waived several hospice regulations and expanded the allowable use of telehealth — including temporarily removing the requirement that a nurse conduct a home visit at least every two weeks — it made sense that 84% of respondents in a recent survey stated they began using telehealth during the pandemic. But what was not anticipated were the aftereffects. 

The strong relationships that were often forged between the hospice clinical team and the patient and their family were more difficult to establish and maintain when using telehealth. In a recent study1, patients felt that telehealth provided several benefits such as increased care access and reduced time spent waiting and commuting, but also identified several challenges with telehealth visits. These challenges include patients believing that providers paid less attention to them, feeling less involved and feeling rushed, and that establishing a relationship was difficult.

So how do you make that empathetic connection? How do you have that bedside conversation?

Training can help 

To best circumvent these challenges, specially train staff on how to deliver care through telehealth by developing a unique program tailored to your organization’s clinical and technical staff. As you develop your training, place a focus on how to make an empathetic connection and how to have bedside conversations virtually.

Spoken words account for only 7% of the messages conveyed2. The remaining 93% is nonverbal. Therefore, break your training up into verbal versus non-verbal communication. Over video, staff may not emote and may speak in a flat tone, which creates a disconnect. This is commonly caused by video fatigue.

Video fatigue is a type of burnout associated with the prolonged use of videoconferencing platforms. Our attention on a video meeting is drastically different than our attention in a boardroom. On a video meeting, our attention is solely focused on the face in front of us. Having these faces stare back at us for an extended period of time can be intimidating, uninviting and exhausting, and without several forms of non-verbal communication, many believe they must try harder to appear engaged. Therefore, staff should not only be cognizant of the words they use, but also of their tone and facial expressions.

Facial expression is a key form of non-verbal communication. A smile sends a positive message and adds warmth, while mouth movements, such as twisting them to one side, communicate you are thinking about what is being said. Furthermore, keeping your head straight will make you appear self-assured and authoritative. Tilt your head to one side if you want to come across as friendly and open.

Super users can help with training

Additionally, work to establish “super users” within your organization to assist in implementing the training you develop. Super users can help train staff and new end-users through practice training sessions. For these sessions, equip your super users with your own custom training materials. These may include step-by-step instructions, screen shots, or recordings, which will enable the staff members to follow along.

Moving forward

Though telehealth has presented challenges, its benefits are undoubtedly still worthwhile, as it has become an essential element in maintaining continuity of care. As vaccination against COVID-19 becomes more widespread, hospices have begun to perform visits in person again, but are still using telehealth to augment services. 

Organizations can use telehealth to triage patient needs and determine whether a home visit is necessary, helping build efficiency in terms of employees traveling to patient location. This strategy allows the provider to intervene more quickly to determine how they can meet the patient’s needs without higher acuity care and ensure that they are responding to the patients who have the greatest immediate need.

While we all know that people prefer to receive healthcare in their home, delivering care from a distance through telehealth can be challenging. However, by setting up staff for success through competencies, confidence will be built, and caregivers will be well prepared to both forge and maintain relationships with your patients.

Christina Andrews is director of professional services at Axxess, a fast-growing home healthcare technology company. In her role, she delivers practical operational solutions to help clients scale operations using technology for home health, home care, hospice and palliative sectors.

References

  1. Gordon, Howard S., et al. ““I’m not feeling like I’m part of the conversation” Patients’ perspectives on communicating in clinical video telehealth visits.” Journal of general internal medicine 35.6 (2020): 1751-1758.
  2. Mehrabian, Albert. Nonverbal communication. Routledge, 2017.