Communication Tools to Support Advance Care Planning and Hospital Care During the COVID-19 Pandemic: A Design Process

摘要

The COVID-19 pandemic has exposed the medical and social vulnerability of an unprecedented number of people.Consequently, there has never been a more important time for clinicians to engage patients in advance care planning(ACP) discussions about their goals, values, and preferences in the event of critical illness. An evidence-based communicationtool-the Serious Illness Conversation Guide-was adapted to address COVID-related ACP challenges using auser-centered design process: convening relevant experts to propose initial guide adaptations; soliciting feedback from keyclinical stakeholders from multiple disciplines and geographic regions; and iteratively testing language with patient actors.With feedback focused on sharing risk about COVID-19-related critical illness, recommendations for treatment decisions,and use of person-centered language, the team also developed conversation guides for inpatient and outpatient use. Thesetools consist of open-ended questions to elicit perception of risk, goals, and care preferences in the event of critical illness,and language to convey prognostic uncertainty. To support use of these tools, publicly available implementation materialswere also developed for clinicians to effectively engage high-risk patients and overcome challenges related to the changedcommunication context, including video demonstrations, telehealth communication tips, and step-by-step approachesto identifying high-risk patients and documenting conversation findings in the electronic health record. Well-designedcommunication tools and implementation strategies can equip clinicians to foster connection with patients and promoteshared decision making. Although not an antidote to this crisis, such high-quality ACP may be one of the most powerfultools we have to prevent or ameliorate suffering due to COVID-19.