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Selected considerations for approaching serious discussions remotely during the COVID-19 pandemic, with example phrases

Selected considerations for approaching serious discussions remotely during the COVID-19 pandemic, with example phrases
SPIKES protocol Telehealth considerations Examples
Before meeting
  • At the time of ordering a diagnostic test, request permission to discuss the results with a patient, regardless of the test result.
  • "We expect to have the results of your biopsy in 2 weeks. Is it okay if we call you by telephone/videoconference to discuss the results at that time?"
At the meeting
  • Similar to silencing pagers and cell phones, mute/defer notifications on your computer and arrange so that you are not intruded upon during the appointment.
  • During the introduction, describe your setting and members present. If on video, describe what you see and inquire about whom may be present or listening to the discussion.
  • "Hello, I am Dr X. I am calling from my office to discuss the results of your biopsy. I see that you are in your living room and sitting down. Can you see/hear me clearly? Do you have time to discuss your test results now? Who is there with you? Is there anybody else present and able to hear our discussion?"
  • Privacy is important to patients. Explicitly state that information shared is confidential. Inquire regarding whether the discussion is being recorded.
  • "I am sitting down, my office door is closed, and I have the volume set so that our conversation will not be overheard. We are using a secure connection that is not being recorded on our end. Please let me know if you are recording anything."
Perception, invitation, knowledge
  • Disciplined use of communication skills, such as signposting or teach-back, can help to overcome the shortcomings of remote conversations.
  • Anticipate delayed audio transmission by using short sentences and allowing longer-than-usual pauses after statements to give time for patients to ask questions.
  • If videoconferencing, have the camera at eye level or slightly above. Have a simple backdrop behind you to minimize distractions.
  • "I am going to tell you the results of your biopsy/the treatment options for your cancer. I will be asking you questions often to ensure that you can hear me clearly and understand what I am saying. Please let me know if you have any questions at any time."
  • With telemedicine, displaying empathy can be difficult, but not impossible. Sometimes a prolonged silence can take the place of offering a tissue or an understanding touch that would be used in real life.
  • "I understand that this is difficult news to hear, especially over the phone/by video."
  • "I can hear that you are upset. Please share your thoughts with me."
  • Plan for follow-up by addressing the setting where the next meeting would be. Deliver handouts through mail or electronic transfer.
  • "Do you have any further questions? I will schedule a follow-up telephone/videoconference/in-person meeting in 2 weeks. I would like to share some handouts with you. Do you have any objections with us sending this to your e-mail address?"
SPIKES: Setting, Perception, Invitation, Knowledge, Empathy/Emotion, and Strategy/Summarize.
From: Holstead RG, Robinson AG. Discussing Serious News Remotely: Navigating Difficult Conversations During a Pandemic. JCO Oncol Pract 2020; 16:363. DOI: 10.1200/OP.20.00269. Copyright © 2020 American Society of Clinical Oncology. Reproduced with permission from Wolters Kluwer Health. Unauthorized reproduction of this material is prohibited.
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