How to communicate with families living in complete isolation
Authors: Mistraletti Giovanni , Gristina Giuseppe , Mascarin Sara , Iacobone Emanuele , Giubbilo Ilaria , Bonfanti Silvia , Fiocca Federico , Fullin Giorgio , Fuselli Ennio , Bocci Maria Grazia , Mazzon Davide , Giusti Gian Domenico , Galazzi Alessandro , Negro Alessandra , De Iaco Fabio , Gandolfo Enrico , Lamiani Giulia , Del Negro Silvia , Monti Laura , Salvago Fabrizia , Di Leo Silvia , Gribaudi Maria Nefeli , Piccinni Mariassunta , Riccioni Luigi , Giannini Alberto , Livigni Sergio , Maglione Carla , Vergano Marco , Marinangeli Franco , Lovato Luisa , Mezzetti Andrea , Drigo Elio , Vegni Elena , Calva Sally , Aprile Anna , Losi Gianfranco , Fontanella Lucia , Calegari Giulio , Ansaloni Cristina , Pugliese Francesco Rocco , Manca Salvatore , Orsi Luciano , Moggia Fabrizio , Scelsi Silvia , Corcione Antonio , Petrini Flavia 
Published: October 2020

Importance

During the SARS-CoV-2 pandemic, a complete physical isolation has been worldwide introduced. The impossibility of visiting their loved ones during the hospital stay causes additional distress for families: in addition to the worries about clinical recovery, they may feel exclusion and powerlessness, anxiety, depression, mistrust in the care team and post-traumatic stress disorder. The impossibility of conducting the daily meetings with families poses a challenge for healthcare professionals.

Objective

This paper aims to delineate and share consensus statements in order to enable healthcare team to provide by telephone or video calls an optimal level of communication with patient’s relatives under circumstances of complete isolation.

Evidence review

PubMed, Cochrane Database of Systematic Reviews, Database of Abstracts and Reviews of Effectiveness and the AHCPR Clinical Guidelines and Evidence Reports were explored from 1999 to 2019. Exclusion criteria were: poor or absent relevance regarding the aim of the consensus statements, studies prior to 1999, non-English language. Since the present pandemic context is completely new, unexpected and unexplored, there are not randomised controlled trials regarding clinical communication in a setting of complete isolation. Thus, a multiprofessional taskforce of physicians, nurses, psychologists and legal experts, together with some family members and former intensive care unit patients was established by four Italian national scientific societies. Using an e-Delphi methodology, general and specific questions were posed, relevant topics were argumented, until arriving to delineate position statements and practical checklist, which were set and evaluated through an evidence-based consensus procedure.

Findings

Ten statements and two practical checklists for phone or video calls were drafted and evaluated; they are related to who, when, why and how family members must be given clinical information under circumstances of complete isolation.

Conclusions and relevance

The statements and the checklists offer a structured methodology in order to ensure a good-quality communication between healthcare team and family members even in isolation, confirming that time dedicated to communication has to be intended as a time of care.