Conclusions
During the COVID-19 pandemic when social distancing required a no-visitor policy, we demonstrated the efficient deployment of telemedicine for e-family meetings that was both feasible and effective for decision-making for patients who were near end of life and their families. Family meetings likely happened sooner and with far more participants than would have been possible without the use of the technology. While providers expressed limitations in the use of technology including difficulty hearing over devices in the ICUs, they reported key benefits including observation of prayer rituals and promoting understanding to the family of the patient's condition. Other limitations included inability to support families longitudinally after the video session. In addition, it is unknown what continued support these families either required or obtained after the meeting ended; this was almost impossible to achieve during COVID due to volume, logistics, and complexity.
The ability to implement and iterate on this telemedicine use case under these conditions during a pandemic will have lasting effects for the palliative care shared decision-making care model. Before pandemic, we have often faced the challenge of delays and or inability to involve family members that are convalescent, distant, or simply unable to come to the hospital in a timely fashion to participate in family meetings. We intend to further study telemedicine for e-family visits, while studying both provider- and patient/family-reported outcomes using video technology for palliative care in the acute care setting.