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Published July 8, 2020

4 Tips for Effective Advance Care Planning Through Telemedicine

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As healthcare providers and patients contend with the spread of COVID-19, telemedicine is proving to be a key means for supporting safe access to care.

The CDC points out several benefits of offering telehealth services during the public health crisis:

  • Mitigates the spread of COVID-19 through increased social distancing
  • Reduces the strain on healthcare systems during surges of infection
  • Decreases the use of PPE (personal protective equipment) by healthcare workers
  • Maintains continuity of care for patients in need of preventive, chronic or routine care
  • Increases health participation among vulnerable populations with limited access to providers
  • Preserves the patient-provider relationship when in-person visits are not practical

Prior to the pandemic, adoption of telehealth technologies had been sluggish. As infections surged in the U.S., the federal government stepped in to promote the use of telemedicine and medical associations released practice guidelines. Within weeks, there was as much as a ten-fold increase in telemedicine consultations.

Advance care planning (ACP) and goals-of-care conversations have emerged as crucial health services that should be prioritized and can be provided virtually. With telemedicine services becoming more prevalent, healthcare professionals may consider the following four tips for conducting positive, effective ACP discussions:

Tip #1: Set a Professional Tone

Setting a professional tone for the encounter is essential to helping patients feel confident about the quality of care they are receiving. The first step is to make sure your personal appearance is professional. You also should pay attention to how your practice environment looks – research finds that patients consider the appearance of the virtual space to be just as important as a regular exam room.

Steps for setting a professional tone include:

  • Dressing professionally, just as you would during an in-person visit
  • Avoiding clothing with distracting patterns and colors
  • Ensuring adequate lighting
  • Removing clutter and any other potential distractions from the space
  • Making sure the clinical space is private and secure for HIPAA compliance

Tip #2: Be Comfortable with the Technology

The virtual environment should incorporate all the tools necessary to facilitate efficient communication. Knowing how to use telehealth technology will allow for more seamless and effective ACP discussions. Some things to keep in mind:

  • Understand how to use and test the technology and equipment
  • Ensure suitable placement of the camera, microphone, and speakers
  • Test for ambient noise and functioning microphones
  • Set up adequate broadband internet for quality connections
  • Know who to contact for troubleshooting
  • Get training on how to use the technology, if necessary

Tip #3: Prepare Your Patient for a Virtual Visit

For optimal patient experience, it is important to talk to your patient prior to an ACP discussion to determine if it is in their best interest to receive the service remotely.

  • Let your patient know they have the right to stop or refuse an ACP conversation at any time
  • Have your staff review technology needs with patients
  • Obtain the patient’s verbal or written informed consent to consult by telemedicine
  • Discuss a plan of what you will do if there is a technology malfunction
  • Find out what their insurer is doing about billing for ACP telemedicine visits

Tip #4: Ramp up your Communication Skills for ACP Telehealth

While many providers already find broaching the topic of end-of-life care with patients uncomfortable, holding this important conversation in a two-dimensional environment adds to the challenge. It can be tough to establish rapport and communicate empathy through a computer screen.

Whether an ACP discussion occurs in-person or through a video connection, patients expect to be heard and understood by their healthcare provider. To create the best virtual patient encounter possible, you should continue to practice good communication strategies while adjusting to the telehealth environment:

  • Introduce yourself, any others present, and your organization
  • Ask patient to introduce self and anyone else present
  • Maintain eye contact by looking at the actual camera, or webcam, rather than at the patient’s eyes on the computer screen
  • Remember to use attentive, positive body language and keep in mind not all your actions are visible (like consulting / taking notes)
  • Be prepared to address any language or health literacy barriers
  • Communicate clearly using plain language
  • Record yourself and review the video before any telehealth consults to get the patient’s perspective
  • Consider incorporating a high-quality, video-based decision aid to enhance shared decision making

 Additional Telehealth Resources

Telemental Health Toolkit from the Northwest Regional Telehealth Resource Center

Telehealth information for healthcare providers from Health and Human Services

Telehealth Implementation Playbook by the American Medical Association

Using Telehealth to Care for Patients During the COVID-19 Pandemic by the American Academy of Family Physicians

Guidance on state licensure requirements for telehealth services from the Federation of State Medical Boards

ACP Decisions creates evidence-based video decision aids that empower patients and healthcare providers to engage in shared decision making. Our advance care planning videos are patient-centered and designed to help patients optimally navigate their healthcare. To learn more about incorporating these videos into your ACP discussions, contact us today!

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