Improving "Webside Manner" for Virtual Visits About Serious Illness
Key findings
- In a recent report, geriatricians at Massachusetts General Hospital shared their insights into key elements of maintaining empathic connection with patients during virtual serious illness conversations
- To create a sense of looking directly at the participant, clinicians can slightly minimize their image and move it as close as possible to the camera
- It can be helpful to acknowledge the novelty of the format, express the wish that the participant could be in the same room and ask whether the sound and camera position are satisfactory
- Avoid prolonged silence, but to prevent overtalking, pause for one or two seconds after the participant finishes speaking
- Thanking participants for taking time to share personal information in a virtual format is often appreciated
Subscribe to the latest updates from Geriatrics & Palliative Care Advances in Motion
Nuanced verbal and nonverbal skills are essential to conducting effective virtual visits. In the Journal of Palliative Medicine, Vicki Jackson, MD, MPH, chief of the Division of Palliative Care at Massachusetts General Hospital, and Mihir Kamdar, MD, associate director of the Division of Palliative Care and director of the Mass General Cancer Pain Clinic at the Mass General Cancer Center, and a colleague outline key elements of a videoconference based on their experience in palliative care.
Setup and Beginning the Visit
The authors offer steps for setup and beginning the videoconference visit. First, choose a well-lit, private and quiet setting. Be sure your head and the upper third of your torso appear onscreen. And to create the sense of looking directly at the participant, slightly minimize the image and move it as close as possible to the camera.
When beginning the visit, wave hello as a way to establish rapport and put the participant at greater ease. It can be helpful to acknowledge the novelty of the format and express the wish that you and the participant could be in the same room. And to reduce participant anxiety about using the platform, ask after a minute or two whether you can do anything to improve the experience (e.g., speak louder or softer, adjust the positioning of the camera).
Fostering the Conversation
Avoid prolonged silence that may cause the participant to suspect a delay in connectivity. But to prevent talking over the participant, pause for one or two seconds after they finish speaking.
Avoid saying ''mm-hmm," which can disrupt the flow of a videoconference. Instead, verbally reflect on words or feelings (e.g., ''I hear how very sad all of this is'' or ''I hear how sad this is and I wonder if it is even harder now that your daughter is going to college?")
Responding to Emotion
''I wish'' statements can take the place of a gentle touch on the shoulder or passing a box of tissues. One example is, "I wish I could be there to comfort you. I'm sorry you're going through this.'' A similar response is, ''Take your time. I am here.''
Conversational connections can sometimes be deepened nonverbally, such as by leaning in slightly to convey intentional listening or placing your hand on your own chest.
Ending the Visit
Thoughtfully closing a virtual discussion is just as important as closing a face-to-face encounter. Summarize what was discussed, verify understanding, provide an opportunity to ask questions and outline the next steps in the care plan.
Thanking participants for taking the time to share personal information in a virtual format is often appreciated.
view original journal article Subscription may be required
Learn more about the Division of Palliative Care and Geriatric Medicine
Refer a patient to the Division of Palliative Care and Geriatric Medicine