Palliative Care During the COVID-19 Era
Caring for patients and loved ones with serious or even terminal illness can be one of the most difficult tasks. Caregivers and physicians are endlessly looking for new ways to make a difficult time, a bit easier, not only for the patient, but for their family and friends as well. Technology is allowing palliative care to not only alleviate some suffering, but is also bringing happiness during a hard time and easing a potential burden on the family.
Before we dive into what technology is doing in the palliative sector, let’s look at a few areas where technological advances could have the most impact:
Communication: Keeping an open line of communication with both caregivers and physicians is critical. Knowing what the patient’s wants and needs are makes for a better experience and a more comfortable time.
Keeping Independent: When you are dealing with an end of life illness it’s important that the patient still feels like they are in control of decisions.
Loneliness: Dealing with ‘end of life’ can feel lonely for some. Not every patient is lucky enough to have family surrounding them if they live far apart.
Its human nature to be reluctant to discuss end of life plans, simply because it’s not something we really want to think about, especially if you are young. But as the coronavirus pandemic drags on, it has become more and more apparent and important that healthcare organizations need to be communicating the importance of this ‘plan’ with their patients.
Earlier this month, the American Telemedicine Association urged attendees at their virtual conference to utilize technology as a way to help facilitate end of life care and discussions.
So how can and has technology aided in palliative care?
Experts in hospice care express, “The right time to have the conversation about what you want, and how you want to live your very last days, is not during your very last days,” according to Alexandra Drane, CEO and cofounder of the caregiver resource ARCHANGELS, who was a panel moderator at the conference.
Drane later went onto explain what they are doing at their organization. Their team has deployed the Epic-powered Care Companion tool which connects a patient’s medical record with the patient portal.
“We created a navigator in the electronic medical record to document decision-makers … advance directives documents, goals of care discussions [and] code status discussions, in a single location of the chart for easy access,” Perez Protto explained. The portal also has a questionnaire about end of life “wishes/values/worries.” The questionnaire can be easily completed in MyChart and will automatically populate within the EHR for the physician or nurse.
This portal has proved very effective given the social distancing protocols may mean conversations with families are not happening in person, but rather virtually. To help with patients being distant with their families during a difficult time, Cleveland Clinic has used iPads. All nursing units have them on hand for their patients to connect with their loved ones via video chats.
Another panelist at the conference, Dr. Ferdinando Mirarchi, Medical Director of the Institute on Healthcare Directives, spoke about written vs verbal statements. He explained that living will documents are often times misinterpreted as “do-not-resuscitate” orders – even if that’s not what the patient wants. He later spoke on what his organization is using to help curb that ailment, using what is called the MIDEO tool, or “My Informed Decision on Video,” it allows patients to record a, “short, brief and to the point” video file that explains their emergency medical care wishes.
The panel as a whole expressed the difficulty of palliative care, let alone during a worldwide pandemic. They stressed that even though a lot is being done via phone, video chat, etc, that maintaining empathy (both verbal and nonverbal) is of utmost importance. Protto explained that, “The provider should look comfortable, and make eye contact that is achieved [by] looking at the camera. It is important to be aware of the body positioning, movement, facial gestures, voice quality and vocal tone.”
Caregivers are often able to make terrible situations a little better. That cord hasn’t changed with the pandemic and even as the back side of COVID feels closer than it did a few weeks ago, healthcare as a whole, including those in palliative care, has had to step outside their comfort zones and shift standard tools and technologies used for decision making for the new reality we are living in.
Sources:
https://www.healthcareitnews.com/news/technology-can-make-end-life-care-more-compassionate
https://ndocsoftware.com/2019/03/technology-transforming-approach-palliative-care/
