How to communicate with families living in complete isolation

Abstract

ImportanceDuring 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.ObjectiveThis 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 reviewPubMed, 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.FindingsTen 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 relevanceThe 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.

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“…To better deal with the pandemic, hospitals have undergone profound organizational changes [ 33 , 34 ]. Among the measures adopted by hospitals to reduce cross-infections, there was a ban on visits to patients by family members [ 35 ]. These restrictions generated conflicting emotions among HCWs, especially during end-of-life situations [ 36 , 37 ].…”

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“…The therapeutic choices that guide the care of each patient, to be effective, respectful and proportionate, call for sharing between the patient, family members and health professionals [ 13 ], even in times of pandemic [ 14 ]. First and foremost, this implies appropriate communication by telephone or video calls [ 15 ], which are also possible towards the end of life [ 16 ]. These communication modalities, even if feasible, are not sufficient [ 17 ] and pose some objective difficulties, including respect for privacy and confidentiality [ 18 ].…”

Cultivating Empathy and Soft Skills Among Intensive Care Residents: Effects of a Mandatory, Simulation-Based, Experiential Training

“…Clinician-family communication is an important component of the care of critically ill patients [ 7 ] and its role and function in the care process have become more evident since the SARS-CoV-2 pandemic outbreak [ 20 ]. The literature shows that the quality of the clinician-family communication has a direct impact on family members’ satisfaction, decision-making, and mental health [ 4 , 21 , 22 ].…”