- Now that hospitals are allowing limited family visits, Massachusetts General Hospital clinicians have shared strategies for working around "low-touch" precautions when conducting serious illness conversations in person
- Reassure family members they will be safe: before the meeting, explain whether masking is required throughout the visit, tell them clinicians will stay six feet from them and arrange telemedicine for anyone feeling unwell
- Recall the old ways of connecting by naming them with "I wish" statements: "I wish I could shake your hand," or "I wish we could sit together on this couch"—and replace familiar gestures like handshakes with words: "I'm so glad to meet you"
- Affirm the patient's or family's experience, for example: "It is so helpful that you were able to travel to the hospital so we can talk in person—I can see it means a lot to your brother that you are here today"
- By sharing a bit of information about their own struggles during the pandemic, clinicians can build better connections with patients and families—and might even improve health care
Early in the COVID-19 pandemic, visitors were barred from the bedsides of seriously ill patients. Telemedicine became the core intervention for inpatient goals of care discussions with family members and still is advantageous.
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Now the norm is for hospitals to allow a limited family presence, but the ordinarily "high-touch" serious illness conversation must be adjusted to "low-touch" precautions.
In the Journal of General Internal Medicine, physicians Leah B. Rosenberg, MD, and Juliet C. Jacobsen, MD, of the Division of Palliative Care and Geriatrics at Massachusetts General Hospital, and Margaret A. Cramer, PhD, of the Department of Psychiatry, offer four suggestions for conducting effective and empathetic family meetings during the pandemic.
Reassure Family Members They Will Be Safe
Before the meeting, explain how many visitors may attend, for how long and whether masking is required throughout the visit. Assure family members that clinicians will stay six feet from them. Encourage anyone feeling unwell to participate via telephone or video conferencing.
Make Strategic Use of Telemedicine
- Arrange a telemeeting if any family members are geographically distant, have travel-limiting disabilities, have conflicting work or childcare responsibilities, are reluctant to expose themselves to virus risk or are barred because of excess numbers
- Ask continuity clinicians and subspecialists to attend family meetings remotely if possible
- Recall the old ways of connecting by naming them with "I wish" statements: "I wish I could shake your hand," or "I wish we could sit together on this couch"
- Replace familiar gestures like handshakes with a warm verbal greeting: "I'm so glad to meet you"
- Affirm the patient's or family' experience, for example: "It's so helpful you were able to travel to the hospital so we can talk in person—I can see it means a lot to your brother that you are here today"
- Lacking the benefit of full facial cues, guess emotions, then doublecheck: "I imagine this is very frustrating, am I understanding you correctly?"
- A genuine smile can be perceived even under a surgical mask if the zygomaticus major and orbicularis oculi muscles are engaged—"hold the gaze of the patient's family member over the mask or through the screen, and crinkle those muscles extra hard—wrinkles be damned"
Although the burdens are distributed unequally, the COVID-19 era is a shared human experience of personal vulnerability. As families gather in-person and online, clinicians may use the first few minutes of small talk to build rapport by disclosing a limited amount of personal information (e.g., "This situation is so difficult. My kids are really struggling."). By being open about their own lives, clinicians can build better connections with patients and families—and might even improve health care.
Learn more about the Division of Palliative Care and Geriatric Medicine
Refer a patient to Geriatric Medicine at Mass General