Smartphone-Enabled, Telehealth-Based Family Conferences with Implementation of Shared Decision Making Concepts and Humanistic Communication: A Mixed Method Study (Preprint)
Authors: Chou Tzu-Jung , Wu Yu-Rui , Tsai Jaw-Shiun , Cheng Shao-Yi , Yao Chien-An , Peng Jen-Kuei , Chiu Tai-Yuan , Huang Hsien-Liang 
Published: November 2020

BACKGROUND

Smartphone-enabled, telehealth-based family conferences represents an attractive and safe alternative to deliver communication in the COVID-19 pandemic. However, some may fear that the therapeutic relationship might be filtered due to lack of direct human contact. Virtual physician –family interaction and participants’ experience warrant further investigation.

OBJECTIVE

The study aims to explore whether shared decision making (SDM) model combining VALUE (Value family statements, Acknowledge emotions, Listen, Understand the patient as a person, Elicit questions) and PLACE (Prepare with intention, Listen intently and completely, Agree on what matters most, Connect with the patient’s story, Explore emotional cues) framework can help physicians respond empathetically to emotion cues and foster human connectedness in virtual context.

METHODS

This is a mixed method study. Participants were recruited from inpatient and outpatient unit in a tertiary medical center in Taiwan from February to May 2020. Family conferences were held if patients or their family required an update of prognosis, a discussion about goal of care, or a potential discharge plan. Smartphone-enabled telehealth-based family conference was arranged if the patient and their family agreed to take part. Those who declined to conduct virtual conference or did not possess the technological skills to participate were excluded. The main outcome was patient and family reported communication satisfaction score with a 10-point Likert scale. Qualitative measures included data from physicians, patients, and family. Physicians’ empathetic statements were classified by VALUE approach. Participants’ emotional cues were categorized into verbal emotional distress, nonverbal emotional distress, and positive emotion.

RESULTS

Twenty-five telehealth family conferences were conducted. The patients’ mean age was 72.9 (SD 14.3) years; 19 (76%) were married, and the majority of them had Eastern Cooperative Oncology Group (ECOG) score of 3-4. Of the main participating family members, 11 (44%) were patients’ children, 7 (28%) were spouses, and 7 (28%) were other family members. The average length of the family conference was 31.9 ± 11.7 minutes. Expression of verbal emotional distress was noted in 20% of patients and 20% of family members, while nonverbal distress was observed in 24% and 28% respectively. The satisfaction score was 8.7 ± 1.5 toward overall communication and 9.0 ± 1.1 on meeting the family’s needs.

CONCLUSIONS

Adopting SDM concepts with VALUE and PLACE approaches helps physicians foster connectedness in smartphone-enabled telehealth-based family conferences. The model had high patient and family reported satisfaction scores. It could be adopted worldwide when using telehealth and had implications to governments for policy changing with reimbursement modification.