Providers must be mindful of patient preferences for communication and receiving bad news via health technology.
As health IT revolutionizes patient-provider communication, it will be essential for providers to be judicious about the context in which they use that technology and aware of patient preferences for communication.
Empathy is a key principle of patient satisfaction, but oftentimes technology can get in the way. In most cases, that means an EHR detracts from meaningful conversations in the primary care office.
But a recent story originally reported by Fox affiliate KTVU revealed the consequences of relying on technology to enhance patient-provider relationships.
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At a Kaiser Permanente hospital, a 79-year-old-patient received the news that he “might not make it home,” from a physician performing rounds remotely using a telehealth tool, the outlet reported.
For their part, Kaiser expressed its condolences to the family and its best practices for telehealth use. These include speaking with a live physician on the other side of a telehealth line and having a nurse or other clinician in the room during the chat, the hospital said in a statement to KTVU.
This story has raised questions about the use of health technology when speaking with patients and delivering bad news. What are the ethics of using telehealth and other health IT to discuss serious health matters? Do they detract for the patient experience? And what do patients prefer?
Using telehealth to deliver bad news
The debate surrounding the use of telehealth to deliver bad news is complicated, experts agree. On the one hand, one might assume it better to deliver bad news in person where a provider can practice empathy and pick up on a patient’s emotional cues.
But waiting to deliver test results in person can take a few days, causing the patient to experience anxiety in the meantime, according to University of Michigan experts Naveen Krishnan, BS, Angela Fagerlin, PhD, and Ted A. Skolarus, MD, MPH.
“For patients, waiting for in-person communication of biopsy results may lead to apprehension of physicians,” the trio wrote in a JAMA opinion piece. “Compounding the issue, the ability to acutely process bad news in the office worsens under emotional duress and ensuing medical jargon. If practitioners remain cognizant of the limitations of communicating biopsy results at in-person consultations, their efforts may better support delivery of patient-centered care.”
Telehealth may offer one solution because it allows patients to video chat with a provider to find out the results of a certain test or examination. In these cases, providers must lean on patient decision aids, employ their empathy skills, and follow-up with an in-person visit.
Other clinicians disagree with this approach, remaining steadfast that serious conversations must occur in person. A 2016 survey conducted by Aptus Health and mHealthIntelligence.com revealed that 88 percent of clinicians prefer an in-person consultation when delivering biopsy or other test results.
“It is much harder to covey empathy to a person via electronics,” said one respondent. “The power of human touch should never be underestimated.”
“Cold, and inhuman,” added another. “Perhaps to report a flat tire, a leaking cooling system or bad timing belt on an auto, but not for human use.”
But what do patients prefer? According to one study, they aren’t quite sure. While some patients agree with Krishnan, Fagerlin, and Skolarus that telehealth could deliver news in a timely manner, others say bad news is best left for in-person visits.
“Others preferred to receive serious news in person, explaining, ‘If the doctor were telling me I have a fatal disease or a disease that could be fatal, and I have to go into immediate serious care, probably better in-person,’” researchers reported in a 2017 Annals of Family Medicine article.
The key may be to assess patient preferences for test results at the start of the care encounter. Clinicians may ask patients the method by which they would prefer to receive their results, document patients’ answers, and adhere to that preference once results come in.
Using the patient portal with serious illness
Of course, telehealth is not the only health technology over which providers can communicate test results or other health updates. The patient portal has become a boon for this, as patients can view their own medical records of lab results. The patient portal also hosts secure direct messaging by which providers may deliver abnormal test results.
Again, there are mixed reviews for using the patient portal to report bad news. While some patients and experts state that viewing lab results on their patient portal alleviates the worry that builds during the waiting period, others say the tool can be impersonal.
One 2017 report found that a whopping 98 percent of patients wanted to receive their lab results through a secure message in the patient portal. For most patients, receiving lab results via the patient portal saved them time. Eighty-two percent of patients still preferred receiving lab results online even when those results may be abnormal or concerning.
Even still, some clinicians are concerned about delivering bad news over the patient portal, stating that it may impede a patient’s ability to take the proper next steps for care.
“The lack of face-to-face interaction with laboratory staff, and of their personal encouragement, may result in the failure of patients with abnormal lab results to plan for their next treatment steps,” they pointed out.
Again, clinicians should note patient preferences, regardless of their own likings, said a group of researchers in a 2018 Journal of Medical Internet Research article.
“Perhaps, during an initial oncology consultation, oncologists should note that potentially threatening risk information can be available by using the portal and identify whether the portal is the patient’s preferred communication channel,” the research team recommended. “Oncologists should also recognize that their own preferred method of delivering bad news via in-person disclosures accompanied by emotional support, may need to be modified in the light of patient preferences for immediate delivery of results, even when they are abnormal.”
Date: March 15, 2019