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• W3033935143 abstract "telemedicine: telemedicineThe COVID-19 pandemic has challenged oncological and palliative care specialists to find ways to treat patients without jeopardizing their health and safety. While some patients must continue inpatient physical treatments, many are instead being asked to communicate with their providers via telemedicine. Despite the ability for remote health care to minimize the spread of infection, interacting with patients through a screen has presented medical professionals with new obstacles. According to Toby C. Campbell, MD, MSCI, FAAHPM, a thoracic medical oncologist at the University of Wisconsin Carbone Cancer Center, literature out of Italy, Iran, and China suggests that patients with advanced cancer are at substantially higher risk of serious or life-threatening outcomes if infected with COVID-19. Thus, telemedicine can be a cautious alternative to in-office appointments. Preparing for the Appointment Before beginning any telemedicine conversation, Campbell noted clinicians must assess their “web-side manner.” This is to ensure that best practice telemedicine strategies are being employed to prevent the use of technology from interrupting the optimal patient experience. When making the transition to telemedicine, Campbell said the first element of “web-side manner” to consider is the setting. He urges clinicians to review how they can minimize distractions and arrange their environments to avoid disturbances while maintaining complete HIPAA compliance during calls. Campbell added that having a thorough understanding of the software that will be used during each visit is essential, as is learning some basic patient troubleshooting tips. “You want to do the best that you can to keep this like a [normal] clinic visit,” Campbell said. “I can assure you that even if [my patient population and I] have had a successful telemedicine visit [in the past], it is routine that I need to give them a little bit of coaching before the visit every time. Have a phone backup ready so that if the video doesn't work for whatever reason you can always resort to the telephone call if you need to.” The next step in preparing for a telemedicine appointment, according to Campbell, is to position the camera about forehead height. This is to avoid angles that are too low and can be achieved by raising a camera on top of books or other objects. Campbell noted proper posture, in addition to the height of the camera, will help present a more professional appearance. “Most patient-doctor communications happen from about arms-length, so you want to try to be about arms-length from the camera,” Campbell said. “This is not a time to be too close—awkwardly close—or too far away. Neither of these facilitates that kind of optimal relationship with your patient [that] you would [have] if you were in [an in-person] conversation.” He added that another important consideration prior to a telemedicine interaction is how the screen display is organized. Through his work at the University of Wisconsin, Campbell has found that minimizing the patient's video box and moving it to the top of the screen, near the camera, gives the appearance that the clinician is making eye contact with the patient. Clinicians should also be sure to have an application open allowing them to actively take notes during the session. “Just like in a regular visit, when I'm typing or looking up something, I make sure to tell the patient what I'm doing,” Campbell said. “Patients will hear you typing and can see if you're looking off to the sides. They can't see your screen and so it's very helpful to let them know what you're up to.” Talking About Therapy Changes Assess the patient's understanding of COVID-19 and correct anything they have misunderstood (i.e., overestimated mortality risk). Ask what the patient is doing to protect themselves. Share COVID-19 information, facts, and resources. Discuss changes in treatment to reduce risk of COVID-19 infection. Make recommendations and explaining reasoning. Explore the patient's reactions. End the discussion by recognizing courage and bravery (i.e., “This has been hard to talk about, and I appreciate your willingness to talk to me so openly.”) Tips for the Visit Once preparation is complete, Campbell suggests opening each visit with a smile and a wave. While it might seem “corny and awkward,” Campbell says immediately addressing the unusual remote circumstances can help to remove some of the technological barriers that “get in between the human relationship.” Next, clinicians should give their patients verbal permission to let them know if any technical issues arise. “Patients may not let you know if you're breaking up, that they're unable to see you or that their Wi-Fi is freezing up and they're not hearing you very well,” Campbell said. “They need to let you know or [the telemedicine session] is not going to work. Giving them permission to [let you know if they're experiencing problems] turns out to be necessary for many people.” In closing the visit, Campbell suggests making patients aware when there is about 10 minutes left on the call. This gives them time to address any aspect of their care or condition that has not yet been covered. If they have no outstanding questions or comments, Campbell advises to end the visit with a summary noting primary takeaways from the session, concerns, treatment plans, future appointments, and when to expect any subsequent results. Lastly, the clinician should wave and say goodbye. Tailoring Telemedicine While this general outline of how to prepare for and execute a telemedicine session is considered to be best practice by Campbell and his institution, he added that clinicians should further organize their thoughts and treatment decisions by considering four types of patients. The first type is those whose care is not time-sensitive and who are strong candidates for remote medicine. The second includes those whose care cannot be delivered remotely, but who would have minimal effects resulting from a delay in care. The third group includes those patients whose delay of treatment would have a moderate, clinically important adverse influence on their quality of life or survival. The fourth type is those patients whose treatment is of curative intent and cannot be delayed. When communicating strategies and proposing changes to the care and treatment of patients in these four categories, Campbell stresses that clinicians must explain the risks, rationalize any changes to a patient's treatment, and identify how these changes align with advanced care planning. “When your goal is to provide the best care, it's possible for you to see all of the instruments you have at your disposal as tools,” Campbell said. “That helps you when you're explaining why you're going to alter chemotherapy, stop chemotherapy, or make changes to therapy [based on] organized principles and guided core values to provide the best care possible.” Lindsey Nolen is a contributing writer. Nuances During Telemedicine Visits Little verbal utterances get picked up by the camera and the microphone and interrupt the other person in a way that's unhelpful. Little verbal utterances like “uh-huh” and “yes” that you would normally do in conversation actually do not work in a telemedicine environment. You need to turn up your nod verbal [cues], [such as] nodding, even an exaggerated nod, or leaning in, or sometimes leaning in with your hand on your chin. These kinds of [movements] can be surrogates for encouraging someone to keep talking, answering the question, or whatever portion of the conversation you're in.” “You also have to be careful with silence. Unlike in a face-to-face encounter, silence can lead people to think that you froze, that you're not hearing them or that something technologically happened. Silence still works, but not too much. You have to be a little briefer on your silence, and a little more on the nonverbal [side].” “It's not uncommon that your video is kind of working but that your audio is cutting in and out. You can always keep the video going and go to your phone backup. Having a phone backup has allowed me to continue a number of telemedicine visits that I would have otherwise had to abort.”" @default.
• W3033935143 created "2020-06-12" @default.
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• W3033935143 date "2020-06-20" @default.
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• W3033935143 title "Telemedicine" @default.
• W3033935143 doi "https://doi.org/10.1097/01.cot.0000681572.78768.d3" @default.
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