Telemedicine (TM) has led to improvements in different areas of health care, including palliative care. Sensitive issues—such as prognosis and goals of treatments discussions—are being done via telemedicine, where patients and families can participate in the discussion.

This new resource poses some challenges.

Technical aspects. Audiovisual (AV) interruptions can be distracting for participants (patients, family, and clinicians). All should avoid: 1) using unstable connections or inadequate bandwidth; 2) participating while in a car, train, or elevator; and 3) using a cellular network. In case of AV equipment or connectivity failure, have a backup phone line so that important conversations can be continued. Not all conversations can be conducted via telemedicine; in those cases, it is necessary to arrange an in-person meeting.

Clinical aspects. Maintain visibility and appearance; wear professional clothing, work in a well-lit room with a neutral, virtual, or blurred background; focus the video on the face and upper torso. Avoid increasing AV noise by not wearing bright clothing or accessories. Avoid writing notes, texting, or eating. The question "Would I do this in an in-person meeting?" is applicable to gauge appropriate behavior. Show empathy by moving the head in agreement and using exploratory statements, such as, "Tell me more about that."

Patient aspects. Ensure that all relevant parties received a link to the meeting and that everyone who wants to participate is available before the meeting begins. If there is a language barrier, arrange for an interpreter in advance.

Ensure privacy. Work with an encrypted, password-protected connection so that privacy is maintained. Introduce meeting attendees and their roles in care so that the patient and family know who is involved and who knows the patient's medical information.

General considerations. After introducing everyone in person or online, ensure that everyone can see and hear the proceedings, and that they understand the reason for the meeting. To reduce the chance of confusion or incomplete communication, slow down the pace of the conversation. Frequently check with participants to ensure that they have heard the key information. At the end of the meeting, ask the patient or a key family member to summarize the key points that have been brought up and make sure they understand the next steps.

See reference for more information.

Adapted from Habib MH et al. Telemedicine best practices when leading serious illness discussions. Palliative Care Network of Wisconsin. Fast facts and concepts #448. Internet. Available at https://www.mypcnow.org/fast-fact/telemedicine-best-practices-when-leading-serious-illness-discussions/. Accessed on January 18, 2022.