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Jain N, Bernacki RE, Lee KA, Siegel JH, Yenulevich EG, Lally KM. Adaptations within Palliative Care Delivery Models Due to the COVID-19 Pandemic at a Tertiary Care Hospital. J Palliat Med 2023; 26:544-547. [PMID: 36719991 DOI: 10.1089/jpm.2022.0398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background: Since the onset of the COVID-19 pandemic, all facets of palliative care provision for patients with serious illness have faced unparalleled challenges. Methods: We describe our palliative care program's response to the increased clinical volume associated with the pandemic by adapting workflows for inpatient and outpatient palliative care teams caring for oncology and nononcology populations. Results: During the initial surge, the demand for palliative care consultation for patients affected by SARS-CoV-2 was high, accounting for 75% of all inpatient palliative care referral requests for oncology and nononcology patients. Furthermore, our ambulatory clinic experienced a 40% increase in visits for complex oncology patients between February and December of 2020. Discussion: This article highlights transformations in palliative care delivery implemented in response to the pandemic and reflects on how these transformations have shaped our current care delivery models. We further delineate our intentional reliance on key population health principles to drive ongoing innovation in palliative care provision across our clinical teams.
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Affiliation(s)
- Nelia Jain
- Department of Psychosocial Oncology and Palliative Care and Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Rachelle E Bernacki
- Department of Psychosocial Oncology and Palliative Care and Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Kathleen A Lee
- Harvard Medical School, Boston, Massachusetts, USA.,Section of Palliative Care, Division of General Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Jocelyn H Siegel
- Department of Psychosocial Oncology and Palliative Care and Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Eric G Yenulevich
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Kate M Lally
- Department of Psychosocial Oncology and Palliative Care and Dana-Farber Cancer Institute, Boston, Massachusetts, USA.,Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
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2
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Daniel D, Krotinger A, Wolbrink T. Changes in utilization of online pediatric educational resources during the coronavirus disease 2019 pandemic. Pediatr Investig 2023; 7:49-53. [PMID: 36967742 PMCID: PMC10030686 DOI: 10.1002/ped4.12360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 10/25/2022] [Indexed: 01/05/2023] Open
Abstract
The COVID-19 global pandemic disrupted healthcare, society, and medical education. Use of online video educational content increased at the onset of the COVID-19 pandemic, across two platforms. This demonstrates the potential of online videos to provide timely information in a scalable fashion, quickly meeting clinical information needs.
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Affiliation(s)
- Dennis Daniel
- Harvard Medical School Boston Massachusetts USA
- Department of Anesthesiology, Critical Care, and Pain Medicine Boston Children's Hospital Boston Massachusetts USA
| | | | - Traci Wolbrink
- Harvard Medical School Boston Massachusetts USA
- Department of Anesthesiology, Critical Care, and Pain Medicine Boston Children's Hospital Boston Massachusetts USA
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3
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Khamees D, Peterson W, Patricio M, Pawlikowska T, Commissaris C, Austin A, Davis M, Spadafore M, Griffith M, Hider A, Pawlik C, Stojan J, Grafton-Clarke C, Uraiby H, Thammasitboon S, Gordon M, Daniel M. Remote learning developments in postgraduate medical education in response to the COVID-19 pandemic - A BEME systematic review: BEME Guide No. 71. MEDICAL TEACHER 2022; 44:466-485. [PMID: 35289242 DOI: 10.1080/0142159x.2022.2040732] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Prior reviews investigated medical education developments in response to COVID-19, identifying the pivot to remote learning as a key area for future investigation. This review synthesized online learning developments aimed at replacing previously face-to-face 'classroom' activities for postgraduate learners. METHODS Four online databases (CINAHL, Embase, PsychINFO, and PubMed) and MedEdPublish were searched through 21 December 2020. Two authors independently screened titles, abstracts and full texts, performed data extraction, and assessed risk of bias. The PICRAT technology integration framework was applied to examine how teachers integrated and learners engaged with technology. A descriptive synthesis and outcomes were reported. A thematic analysis explored limitations and lessons learned. RESULTS Fifty-one publications were included. Fifteen collaborations were featured, including international partnerships and national networks of program directors. Thirty-nine developments described pivots of existing educational offerings online and twelve described new developments. Most interventions included synchronous activities (n Fif5). Virtual engagement was promoted through chat, virtual whiteboards, polling, and breakouts. Teacher's use of technology largely replaced traditional practice. Student engagement was largely interactive. Underpinning theories were uncommon. Quality assessments revealed moderate to high risk of bias in study reporting and methodology. Forty-five developments assessed reaction; twenty-five attitudes, knowledge or skills; and two behavior. Outcomes were markedly positive. Eighteen publications reported social media or other outcomes, including reach, engagement, and participation. Limitations included loss of social interactions, lack of hands-on experiences, challenges with technology and issues with study design. Lessons learned highlighted the flexibility of online learning, as well as practical advice to optimize the online environment. CONCLUSIONS This review offers guidance to educators attempting to optimize learning in a post-pandemic world. Future developments would benefit from leveraging collaborations, considering technology integration frameworks, underpinning developments with theory, exploring additional outcomes, and designing and reporting developments in a manner that supports replication.
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Affiliation(s)
- Deena Khamees
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - William Peterson
- Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Teresa Pawlikowska
- Royal College of Surgeons, University of Medicine and Health Sciences, Dublin, Ireland
| | - Carolyn Commissaris
- Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Andrea Austin
- San Diego School of Medicine, University of California, San Diego, CA, USA
| | - Mallory Davis
- Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Maxwell Spadafore
- Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Max Griffith
- Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Ahmad Hider
- Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Cameron Pawlik
- Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Jennifer Stojan
- Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA
| | | | - Hussein Uraiby
- School of Medicine, University of Leicester, Leicester, UK
| | | | - Morris Gordon
- Blackpool Victoria Hospital, Blackpool, UK
- School of Medicine, University of Central Lancashire, Preston, UK
| | - Michelle Daniel
- San Diego School of Medicine, University of California, San Diego, CA, USA
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4
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Aaronson EL, Wright RJ, Ritchie CS, Grudzen CR, Ankuda CK, Bowman JK, Kuntz JG, Ouchi K, George N, Jubanyik K, Bright LE, Bickel K, Isaacs E, Petrillo LA, Carpenter C, Goett R, LaPointe L, Owens D, Manfredi R, Quest T. Mapping the future for research in emergency medicine palliative care: A research roadmap. Acad Emerg Med 2022; 29:963-973. [PMID: 35368129 DOI: 10.1111/acem.14496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/10/2022] [Accepted: 03/23/2022] [Indexed: 01/24/2023]
Abstract
BACKGROUND The intersection of emergency medicine (EM) and palliative care (PC) has been recognized as an essential area of focus, with evidence suggesting that increased integration improves outcomes. This has resulted in increased research in EM PC. No current framework exists to help guide investigation and innovation. OBJECTIVE The objective was to convene a working group to develop a roadmap that would help provide focus and prioritization for future research. METHODS Participants were identified based on clinical, operation, policy, and research expertise in both EM and PC and spanned physician, nursing, social work, and patient perspectives. The research roadmap setting process consisted of three distinct phases that were time staggered over 12 months and facilitated through three live video convenings, asynchronous input via an online document, and a series of smaller video convenings of work groups focused on specific topics. RESULTS Gaps in the literature were identified and informed the four key areas for future research. Consensus was reached on these domains and the associated research questions in each domain to help guide future study. The key domains included work focused on the value imperative for PC in the emergency setting, models of care delivery, disparities, and measurement of impact and efficacy. Additionally, the group identified key methodological considerations for doing work at the intersection of EM and PC. CONCLUSIONS There are several key domains and associated questions that can help guide future research in ED PC. Focus on these areas, and answering these questions, offers the potential to improve the emergency care of patients with PC needs.
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Affiliation(s)
- Emily L. Aaronson
- Department of Emergency Medicine Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Division of Palliative Care and Geriatric Medicine Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
| | | | - Christine S. Ritchie
- Division of Palliative Care and Geriatric Medicine Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
- Mongan Institute Center for Aging and Serious Illness Boston Massachusetts USA
| | - Corita R. Grudzen
- Ronald O. Perelman Department of Emergency Medicine NYU Grossman School of Medicine, NYU Langone Health/Bellevue Hospital Center New York New York USA
| | - Claire K. Ankuda
- Brookdale Department of Geriatrics and Palliative Medicine Icahn School of Medicine at Mount Sinai New York New York USA
| | - Jason K. Bowman
- Department of Emergency Medicine Brigham and Women's Hospital, Harvard Medical School Boston Massachusetts USA
- Department of Psychosocial Oncology and Palliative Care Dana‐Farber Cancer Institute Boston Massachusetts USA
| | - Joanne G. Kuntz
- Department of Palliative and Supportive Care Emory University Hospital Midtown, Emory University School of Medicine Atlanta Georgia USA
| | - Kei Ouchi
- Department of Emergency Medicine Brigham and Women's Hospital, Harvard Medical School Boston Massachusetts USA
- Department of Psychosocial Oncology and Palliative Care Dana‐Farber Cancer Institute Boston Massachusetts USA
| | - Naomi George
- Department of Emergency Medicine and Division of Adult Critical Care University of New Mexico School of Medicine Albuquerque New Mexico USA
| | - Karen Jubanyik
- Emergency Department Yale University School of Medicine New Haven Connecticut USA
| | - Leah E. Bright
- Department of Emergency Medicine Johns Hopkins Hospital Baltimore Maryland USA
| | - Kathleen Bickel
- Hospice and Palliative Medicine in the Division of General Internal Medicine University of Colorado Anschutz Medical Campus Aurora Colorado USA
| | - Eric Isaacs
- Emergency Department Zuckerberg San Francisco General Hospital, University of California at San Francisco San Francisco California USA
| | - Laura A. Petrillo
- Division of Palliative Care and Geriatric Medicine Massachusetts General Hospital, Harvard Medical School Boston Massachusetts USA
| | - Christopher Carpenter
- Washington University School of Medicine in St. Louis St. Louis Missouri USA
- Department of Emergency Medicine Rutgers New Jersey Medical School Newark New Jersey USA
| | - Rebecca Goett
- Department of Emergency Medicine Rutgers New Jersey Medical School Newark New Jersey USA
| | - Lauren LaPointe
- Department of Social Work Massachusetts General Hospital Boston Massachusetts USA
| | - Darrell Owens
- University of Washington Medical Center, UW School of Medicine Seattle Washington USA
| | - Rita Manfredi
- Department of Emergency Medicine The George Washington University School of Medicine Washington DC USA
| | - Tammie Quest
- Department of Palliative and Supportive Care Emory University Hospital Midtown, Emory University School of Medicine Atlanta Georgia USA
- Department of Family and Preventive Medicine, Department of Emergency Medicine Emory University School of Medicine Atlanta Georgia USA
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5
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Gebbia V, Piazza D, Valerio MR, Firenze A. WhatsApp Messenger use in oncology: a narrative review on pros and contras of a flexible and practical, non-specific communication tool. Ecancermedicalscience 2022; 15:1334. [PMID: 35211203 PMCID: PMC8816506 DOI: 10.3332/ecancer.2021.1334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Indexed: 01/06/2023] Open
Abstract
The spread of instant messenger systems provides an excellent opportunity and a helpful tool to healthcare professionals. WhatsApp instant messenger use is widely prevalent among health professionals, cancer patients, caregivers and the general population. It is a quick and easy communication tool that may also be used on personal computers and business purposes. WhatsApp instant messenger and other similar tools may be a very useful complement for e-medicine. Instant messaging systems may be helpful, especially in rural areas, in medium- or low-income countries, or to avoid unnecessary travels, improve knowledge and awareness of cancer, monitor home care and support the delivery of home care. The unregulated use of WhatsApp instant messenger requires sound and shared guidelines to assure impeccable professional service. Although a significant number of papers have investigated the roles of social networks in connecting patients to health professionals, there is still a lack of information and scientific data about their uses, benefits and limitations in connecting health providers only for professional communication. The role of instant messenger systems in cancer practice and research needs to be clarified. In this paper, we report a focus on available data, pros and contras of the unregulated use of WhatsApp instant messaging, in the context of e-medicine, as an interprofessional and doctor/patient communication tool in oncology.
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Affiliation(s)
- Vittorio Gebbia
- Medical Oncology Unit, La Maddalena Clinic for Cancer, Palermo, Italy.,Department of Internal Medicine 'Promise', University of Palermo, Palermo, Italy
| | - Dario Piazza
- GSTU Foundation for Cancer Research, Palermo, Italy
| | - Maria Rosaria Valerio
- Medical Oncology Unit, Policlinic 'P. Giaccone', University of Palermo, Palermo, Italy
| | - Alberto Firenze
- Department of Internal Medicine 'Promise', University of Palermo, Palermo, Italy.,Risk Management Unit, Policlinic 'P. Giaccone', University of Palermo, Palermo, Italy
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6
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Mohammad H, Elham M, Mehraeen E, Aghamohammadi V, Seyedalinaghi S, Kalantari S, Nahid M, Nasiri K. Identifying data elements and key features of a mobile-based self-care application for patients with COVID-19 in Iran. Health Informatics J 2021; 27:14604582211065703. [PMID: 34936526 DOI: 10.1177/14604582211065703] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Mobile Health applications have shown different usages in the COVID-19 pandemic, which consisted of empowering patient's awareness, promoting patient's self-care, and self-monitor behaviors. The purpose of this study is to identify key features and capabilities of a mobile-based application for self-care and self-management of people with COVID-19 disease. This study was a descriptive-analytical study that was conducted in two main phases in 2020. In the first phase, a literature review study was performed. In the second phase, using the information obtained from the review of similar articles, a questionnaire was designed to validate identified requirements. Based on the results of the first phase, 53 data elements and technical key features for mobile-based self-care application for people with COVID-19 were identified. According to the statistical population, 11 data elements for demographic requirements, 11 data elements for clinical requirements, 15 data elements for self-care specifications, and 16 features for the technical capability of this app were determined. Most of the items were selected by infectious and internal medicine specialists (94%). This study supports that the use of mobile-based applications can play an important role in the management of this disease. Software design and development could help manage and improve patients' health status.
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Affiliation(s)
- Heydari Mohammad
- Department of Health Information Technology, Khalkhal University of Medical Sciences, Khalkhal, Iran
| | - Monaghesh Elham
- Department of Health Information Technology, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Khalkhal, Iran
| | - Esmaeil Mehraeen
- Department of Health Information Technology, 48439Tehran University of Medical Sciences, Khalkhal, Iran
| | - Vahideh Aghamohammadi
- Department of Nutrition, 6339Khalkhal University of Medical Sciences, Khalkhal, Iran
| | - Seyedahmad Seyedalinaghi
- Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk Behaviors, 48439Tehran University of Medical Sciences, Tehran, Iran
| | - Saieed Kalantari
- Antimicrobial Resistance Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mehrabi Nahid
- Assistant Professor of Health information management, Aja University of Medical Sciences (AUMS), Aja, Iran
| | - Khadije Nasiri
- Department of Medical- Surgical Nursing, Khalkhal University of Medical Sciences, Khalkhal, Iran
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7
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Abd-Alrazaq A, Hassan A, Abuelezz I, Ahmed A, Alzubaidi MS, Shah U, Alhuwail D, Giannicchi A, Househ M. Overview of Technologies Implemented During the First Wave of the COVID-19 Pandemic: Scoping Review. J Med Internet Res 2021; 23:e29136. [PMID: 34406962 PMCID: PMC8767979 DOI: 10.2196/29136] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 04/28/2021] [Accepted: 06/20/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Technologies have been extensively implemented to provide health care services for all types of clinical conditions during the COVID-19 pandemic. While several reviews have been conducted regarding technologies used during the COVID-19 pandemic, they were limited by focusing either on a specific technology (or features) or proposed rather than implemented technologies. OBJECTIVE This review aims to provide an overview of technologies, as reported in the literature, implemented during the first wave of the COVID-19 pandemic. METHODS We conducted a scoping review using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) Extension for Scoping Reviews. Studies were retrieved by searching 8 electronic databases, checking the reference lists of included studies and relevant reviews (backward reference list checking), and checking studies that cited included studies (forward reference list checking). The search terms were chosen based on the target intervention (ie, technologies) and the target disease (ie, COVID-19). We included English publications that focused on technologies or digital tools implemented during the COVID-19 pandemic to provide health-related services regardless of target health condition, user, or setting. Two reviewers independently assessed the eligibility of studies and extracted data from eligible papers. We used a narrative approach to synthesize extracted data. RESULTS Of 7374 retrieved papers, 126 were deemed eligible. Telemedicine was the most common type of technology (107/126, 84.9%) implemented in the first wave of the COVID-19 pandemic, and the most common mode of telemedicine was synchronous (100/108, 92.6%). The most common purpose of the technologies was providing consultation (75/126, 59.5%), followed by following up with patients (45/126, 35.7%), and monitoring their health status (22/126, 17.4%). Zoom (22/126, 17.5%) and WhatsApp (12/126, 9.5%) were the most commonly used videoconferencing and social media platforms, respectively. Both health care professionals and health consumers were the most common target users (103/126, 81.7%). The health condition most frequently targeted was COVID-19 (38/126, 30.2%), followed by any physical health conditions (21/126, 16.7%), and mental health conditions (13/126, 10.3%). Technologies were web-based in 84.1% of the studies (106/126). Technologies could be used through 11 modes, and the most common were mobile apps (86/126, 68.3%), desktop apps (73/126, 57.9%), telephone calls (49/126, 38.9%), and websites (45/126, 35.7%). CONCLUSIONS Technologies played a crucial role in mitigating the challenges faced during the COVID-19 pandemic. We did not find papers describing the implementation of other technologies (eg, contact-tracing apps, drones, blockchain) during the first wave. Furthermore, technologies in this review were used for other purposes (eg, drugs and vaccines discovery, social distancing, and immunity passport). Future research on studies on these technologies and purposes is recommended, and further reviews are required to investigate technologies implemented in subsequent waves of the pandemic.
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Affiliation(s)
- Alaa Abd-Alrazaq
- Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | - Asmaa Hassan
- Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | - Israa Abuelezz
- Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | - Arfan Ahmed
- Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | - Mahmood Saleh Alzubaidi
- Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | - Uzair Shah
- Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
| | - Dari Alhuwail
- Information Science Department, Kuwait University, Kuwait, Kuwait
- Health Informatics Unit, Dasman Diabetes Institute, Kuwait, Kuwait
| | - Anna Giannicchi
- School of Professional Studies, Berkeley College, New York, NY, United States
| | - Mowafa Househ
- Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, Doha, Qatar
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8
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Palliative care in the emergency department: A qualitative study exploring barriers, facilitators, desired clinician qualities, and future directions. Palliat Support Care 2021; 20:363-368. [PMID: 34233782 DOI: 10.1017/s1478951521001012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To describe the perceived qualities of successful palliative care (PC) providers in the emergency department (ED), barriers and facilitators to ED-PC, and clinicians' perspectives on the future of ED-PC. METHOD This qualitative study using semi-structured interviews was conducted in June-August 2020. Interviews were analyzed via a two-phase Rapid Analysis. The study's primary outcomes (innovations in ED-PC during COVID) are published elsewhere. In this secondary analysis, we examine interviewee responses to broader questions about ED-PC currently and in the future. RESULTS PC providers perceived as successful in their work in the ED were described as autonomous, competent, flexible, fast, and fluent in ED language and culture. Barriers to ED-PC integration included the ED environment, lack of access to PC providers at all times, the ED perception of PC, and the lack of a supporting financial model. Facilitators to ED-PC integration included proactive identification of patients who would benefit from PC, ED-focused PC education and tools, PC presence in the ED, and data supporting ED-PC. Increased primary PC education for ED staff, increased automation, and innovative ED-PC models were seen as areas for future growth. SIGNIFICANCE OF RESULTS Our findings provide useful information for PC programs considering expanding their ED presence, particularly as this is the first study to our knowledge that examines traits of successful PC providers in the ED environment. Our findings also suggest that, despite growth in the arena of ED-PC, barriers and facilitators remain similar to those identified previously. Future research is needed to evaluate the impact that ED-PC initiatives may have on patient and system outcomes, to identify a financial model to maintain ED-PC integration, and to examine whether perceptions of successful providers align with objective measures of the same.
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9
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Aaronson EL, Daubman BR, Petrillo L, Bowman J, Ouchi K, Gips A, Traeger L, Jackson V, Grudzen C, Ritchie CS. Emerging Palliative Care Innovations in the ED: A Qualitative Analysis of Programmatic Elements During the COVID-19 Pandemic. J Pain Symptom Manage 2021; 62:117-124. [PMID: 33161031 PMCID: PMC7645272 DOI: 10.1016/j.jpainsymman.2020.10.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/29/2020] [Accepted: 10/30/2020] [Indexed: 11/18/2022]
Abstract
CONTEXT Health systems have aspired to integrate palliative care (PC) into the emergency department (ED) to improve care quality for over a decade, yet there are very few examples of implemented models in the literature. The coronavirus disease 2019 (COVID-19) pandemic led to an increase in the volume of seriously ill patients in EDs and a consequent rapid increase in PC integration in many EDs. OBJECTIVES To describe the new PC-ED delivery innovations that emerged during the COVID-19 pandemic. METHODS For this qualitative study of PC programs in EDs, semistructured interviews were conducted with ED and PC clinicians between June 30, 2020 and August 18, 2020. Participants were asked about PC-ED integration before, during, and after COVID. We conducted a two-phased rapid analysis using a rapid analysis template and consolidated matrix to identify innovations. RESULTS Using purposive and snowball sampling, we interviewed 31 participants, representing 52 hospitals. Several new innovations in care delivery were identified. These included elements of fully embedded PC, the use of PC extenders, technology both within the electronic medical record and outside it, and innovations in training emergency clinicians in primary PC skills to support care delivery. Most PC efforts focused on increasing goals-of-care conversations. Institutions that implemented these programs reported that they increased PC utilization in the ED, were well received by clinicians, and changed patient's care trajectories. CONCLUSION Several new innovations in PC-ED care delivery emerged during COVID. Many innovations leveraged different types of clinicians to deliver care, an increased physical presence of PC in the ED, and used technology to enhance care delivery. These innovations may serve as a framework for institutions as they plan for evolving needs in the ED during and after COVID. Additional research is needed to evaluate the impact of these programs and understand their applicability beyond the pandemic.
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Affiliation(s)
- Emily Loving Aaronson
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Lawrence Center for Quality and Safety, Massachusetts General Hospital and Massachusetts General Physicians' Organization, Boston, Massachusetts, USA.
| | - Bethany-Rose Daubman
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Laura Petrillo
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jason Bowman
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kei Ouchi
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Alexa Gips
- Department of Emergency Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA; Palliative Care Service, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Lara Traeger
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Vicki Jackson
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Corita Grudzen
- Department of Emergency Medicine, NYU Langone Health/Bellevue Hospital Center, NYU Grossman School of Medicine, New York, USA
| | - Christine Seel Ritchie
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA; Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA
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10
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Dunn M, Landman A, Cartright J, Bane A, Brogan A, Coy C, Zhang H. A Voice Activated Video Communication System for Nurses to Communicate with COVID19 Inpatients: Notes from the Field (Preprint). JMIR Form Res 2021; 6:e31342. [PMID: 35156929 PMCID: PMC8963263 DOI: 10.2196/31342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 12/17/2021] [Accepted: 02/08/2022] [Indexed: 11/17/2022] Open
Abstract
With the relaxing of telehealth regulations through the Health Insurance Portability and Accountability Act (HIPAA) waiver notification for Telehealth Remote Communications during the COVID-19 Nationwide Public Health Emergency, our organization had the opportunity to pilot an innovative virtual care solution using a modified consumer-grade voice-activated video communication system (Amazon Echo Show 8) within one inpatient COVID-19 unit. In this brief report, we describe our experiences with implementing the system and general feedback from clinicians, and discuss areas for future development required to enable future scaling of this solution. Our pilot demonstrates the feasibility of deploying a consumer-grade voice assistant device in COVID-19 patient rooms. We found the devices engaging due to the voice technologies and Alexa functionalities for both clinician and patient entertainment. To enable future deployment at scale, enhancements to the Echo Show and data analytics will need to be further explored.
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Affiliation(s)
- Mimi Dunn
- Brigham Digital Innovation Hub, Brigham and Women's Hospital, Mass General Brigham, Boston, MA, United States
| | - Adam Landman
- Brigham Digital Innovation Hub, Brigham and Women's Hospital, Mass General Brigham, Boston, MA, United States
| | - Jennifer Cartright
- Brigham and Women's Hospital, Mass General Brigham, Boston, MA, United States
| | - Anne Bane
- Informatics and Medication Safety, Brigham and Women's Hospital, Mass General Brigham, Boston, MA, United States
| | - Anne Brogan
- Nursing Informatics Team, Brigham and Women's Hospital, Boston, MA, United States
| | - Caroline Coy
- Analytics, Planning, Strategy and Improvement, Brigham and Women's Hospital, Mass General Brigham, Boston, MA, United States
| | - Haipeng Zhang
- Brigham Digital Innovation Hub, Brigham and Women's Hospital, Mass General Brigham, Boston, MA, United States
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Ogunsanya ME, Goetzinger EA, Owopetu OF, Chandler PD, O'Connor LE. Predictors of Palliative Care Knowledge: Findings from the Health Information National Trends Survey. Cancer Epidemiol Biomarkers Prev 2021; 30:1433-1439. [PMID: 34088752 DOI: 10.1158/1055-9965.epi-20-1790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/10/2021] [Accepted: 04/09/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Palliative care plays an important role in improving the quality of life for patients with cancer and their caregivers and has been associated with increased patient satisfaction. However, palliative care knowledge in the general population is limited, and often physician referral occurs late in prognosis. The objective of this analysis was to examine factors associated with palliative care knowledge. METHOD Using data from the 2018 NCI's Health Information National Trends Survey (HINTS) 5 Cycle 2, descriptive statistics, bivariate analyses, and multivariable logistic regressions were used to assess factors associated with respondents' palliative care knowledge using ORs and 95% confidence intervals as measures of association. The outcome of interest was measured with the item "How would you describe your level of knowledge about palliative care?" Possible response selections were "I've never heard of it," "I know a little bit about palliative care," and "I know what palliative care is and could explain it to someone else." To reduce the risk of type 1 error, jackknife variance estimations with repeated replications were used. All analyses were conducted with the SURVEYLOGISTIC command using SAS 9.4 (SAS Institute Inc.), and the statistical significance level was set at P < 0.05. RESULTS A total of 3,450 respondents (weighted sample size: 249,489,772) met the inclusion criteria. About 89% (n = 3,000) of all respondents had inadequate knowledge of palliative care. Multivariable analyses indicated that frequent health care utilization as defined as ≥ 2 times per year [OR, 3.01; 95% confidence interval (CI), 2.65-3.58], female gender (OR, 2.15; 95% CI, 1.31-3.59), being married (OR, 2.02; 95% CI, 1.14-3.59), having a college degree or higher (OR, 13.83; 95% CI, 1.71-12.04), and having a regular source of care (OR, 2.67; 95% CI, 1.37-1.90) had greater odds of adequate palliative care knowledge. Those without a cancer diagnosis were less likely to have adequate knowledge of palliative care (OR, 0.49; 95% CI, 0.41-0.89). CONCLUSIONS Knowledge of palliative care in the United States is low, particularly for those not already actively using their available healthcare system. Public health education efforts are needed to target subgroups of the U.S. population identified by this analysis to increase palliative care knowledge. IMPACT Healthcare providers have a major role to play in improving palliative care knowledge.
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Affiliation(s)
- Motolani E Ogunsanya
- Department of Pharmacy, Clinical & Administrative Sciences, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
| | - Elizabeth A Goetzinger
- Department of Pharmacy, Clinical & Administrative Sciences, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Oluwatomi F Owopetu
- Department of Community Medicine, University College Hospital, Ibadan, Nigeria
| | - Paulette D Chandler
- Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Lauren E O'Connor
- Risk Factor Assessment Branch, Epidemiology and Genomics Research Program, Division of Cancer Control and Population Sciences, NCI, NIH, Rockville, Maryland
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Abd-alrazaq A, Hassan A, Abuelezz I, Ahmed A, Alzubaidi MS, Shah U, Alhuwail D, Giannicchi A, Househ M. Overview of Technologies Implemented During the First Wave of the COVID-19 Pandemic: Scoping Review (Preprint).. [DOI: 10.2196/preprints.29136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
BACKGROUND
Technologies have been extensively implemented to provide health care services for all types of clinical conditions during the COVID-19 pandemic. While several reviews have been conducted regarding technologies used during the COVID-19 pandemic, they were limited by focusing either on a specific technology (or features) or proposed rather than implemented technologies.
OBJECTIVE
This review aims to provide an overview of technologies, as reported in the literature, implemented during the first wave of the COVID-19 pandemic.
METHODS
We conducted a scoping review using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) Extension for Scoping Reviews. Studies were retrieved by searching 8 electronic databases, checking the reference lists of included studies and relevant reviews (backward reference list checking), and checking studies that cited included studies (forward reference list checking). The search terms were chosen based on the target intervention (ie, technologies) and the target disease (ie, COVID-19). We included English publications that focused on technologies or digital tools implemented during the COVID-19 pandemic to provide health-related services regardless of target health condition, user, or setting. Two reviewers independently assessed the eligibility of studies and extracted data from eligible papers. We used a narrative approach to synthesize extracted data.
RESULTS
Of 7374 retrieved papers, 126 were deemed eligible. Telemedicine was the most common type of technology (107/126, 84.9%) implemented in the first wave of the COVID-19 pandemic, and the most common mode of telemedicine was synchronous (100/108, 92.6%). The most common purpose of the technologies was providing consultation (75/126, 59.5%), followed by following up with patients (45/126, 35.7%), and monitoring their health status (22/126, 17.4%). Zoom (22/126, 17.5%) and WhatsApp (12/126, 9.5%) were the most commonly used videoconferencing and social media platforms, respectively. Both health care professionals and health consumers were the most common target users (103/126, 81.7%). The health condition most frequently targeted was COVID-19 (38/126, 30.2%), followed by any physical health conditions (21/126, 16.7%), and mental health conditions (13/126, 10.3%). Technologies were web-based in 84.1% of the studies (106/126). Technologies could be used through 11 modes, and the most common were mobile apps (86/126, 68.3%), desktop apps (73/126, 57.9%), telephone calls (49/126, 38.9%), and websites (45/126, 35.7%).
CONCLUSIONS
Technologies played a crucial role in mitigating the challenges faced during the COVID-19 pandemic. We did not find papers describing the implementation of other technologies (eg, contact-tracing apps, drones, blockchain) during the first wave. Furthermore, technologies in this review were used for other purposes (eg, drugs and vaccines discovery, social distancing, and immunity passport). Future research on studies on these technologies and purposes is recommended, and further reviews are required to investigate technologies implemented in subsequent waves of the pandemic.
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Schwartz HEM, Stark NR, Sowa CS, Singh MK, Peabody CR. Building Back Better: Applying Lessons from the COVID-19 Pandemic to Expand Critical Information Access. J Emerg Med 2021; 61:607-614. [PMID: 34108121 PMCID: PMC7997598 DOI: 10.1016/j.jemermed.2021.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/09/2021] [Accepted: 03/17/2021] [Indexed: 11/29/2022]
Abstract
Background The Coronavirus disease 2019 (COVID-19) pandemic generated an unprecedented volume of evolving clinical guidelines that strained existing clinical information systems and necessitated rapid innovation in emergency departments (EDs). Objectives Our team aimed to harness new COVID-19-related reliance on digital clinical support tools to re-envision how all clinical guidelines are stored and accessed in our ED. Methods We used a design-thinking approach including empathizing, defining the problem, ideating, prototyping, and testing to develop a low-cost, homegrown clinical information hub: E*Drive. To measure impact, we compared web traffic on E*Drive to our legacy cloud-based folder system and conducted a survey of end-users using a validated health technology utilization instrument. Results Our final product, E*Drive, is a centralized clinical information hub storing everything from clinical guidelines to discharge resources. Clinical guidelines are standardized and housed within the high-traffic E*Drive platform to increase accessibility. Since launch, E*Drive has averaged 84 unique weekly users, compared with less than one weekly user on the legacy system. We surveyed 52 clinicians for a total response rate of 47%. Prior to the E*Drive rollout, 12.5% of ED clinicians felt confident accessing clinical information on the legacy system, whereas 76.6% of ED clinicians felt they could more easily access clinical information using E*Drive. Conclusion The COVID pandemic revealed vulnerabilities within our information dissemination system and presented an opportunity to improve clinical information delivery. Centralized web-based clinical information hubs designed around the clinician end-user experience can increase clinical guideline access in the ED.
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Affiliation(s)
- Hope E M Schwartz
- School of Medicine, University of California San Francisco, San Francisco, California
| | - Nicholas R Stark
- Department of Emergency Medicine, University of California San Francisco, San Francisco, California
| | - Cathleen S Sowa
- Department of Emergency Medicine, University of California San Francisco, San Francisco, California
| | - Malini K Singh
- Department of Emergency Medicine, University of California San Francisco, San Francisco, California
| | - Christopher R Peabody
- Department of Emergency Medicine, University of California San Francisco, San Francisco, California
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14
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Rao A, Zaaqoq AM, Kang IG, Vaughan EM, Flores J, Avila-Quintero VJ, Alnababteh MH, Kelemen AM, Groninger H. Palliative Care for Patients on Extracorporeal Membrane Oxygenation for COVID-19 Infection. Am J Hosp Palliat Care 2021; 38:854-860. [PMID: 33685240 PMCID: PMC7944020 DOI: 10.1177/10499091211001009] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Critically ill patients with COVID-19 infection on extracorporeal membrane oxygenation (ECMO) face high morbidity and mortality. Palliative care consultation may benefit these patients and their families. Prior to the pandemic, our institution implemented a policy of automatic palliative care consultation for all patients on ECMO due to the high mortality, medical complexity, and psychosocial distress associated with these cases. OBJECTIVES The main objective was to describe the role of the palliative care team for patients on ECMO for COVID-19 infection. The secondary objective was to describe the clinical outcomes for this cohort. DESIGN Case series. SETTINGS/SUBJECTS All patients age 18 or older infected by the novel coronavirus who required cannulation on ECMO from March through July of 2020, at an urban, academic medical center in the United States. Inter-disciplinary palliative care consultation occurred for all patients. RESULTS Twenty-three patients (median age 43 years [range 28-64], mean body mass index 34.9 kg/m2 [SD 9.2], 65% Hispanic ethnicity) were cannulated on ECMO. Eleven patients died during the hospitalization (48%). Patients older than 50 years of age demonstrated a trend toward increased odds of death compared to those younger than 50 years of age (OR 9.1, P = 0.07). Patients received an average of 6.8 (SD 3.7) palliative clinical encounters across all disciplines. The actions provided by the palliative care team included psychosocial support and counseling, determination of surrogate decision maker (for 100% of patients), pain management (83%), and non-pain symptom management (83%). CONCLUSIONS Here, we present one of the first studies describing the patient characteristics, outcomes, and palliative care actions for critically ill patients with COVID-19 on ECMO. Almost half of the patients in this cohort died during their hospitalization. Given the high morbidity and mortality of this condition, we recommend involvement of palliative care for patients/families with COVID-19 infection who are on ECMO. The impact of palliative care on patient and family outcomes, such as symptom control, satisfaction with communication, rates of anxiety, and grief experience merits further investigation.
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Affiliation(s)
- Anirudh Rao
- Department of Medicine, 12230Georgetown University School of Medicine, Washington, DC, USA.,Department of Medicine, Section of Palliative Care, 8405MedStar Washington Hospital Center, Washington, DC, USA
| | - Akram M Zaaqoq
- Department of Medicine, 12230Georgetown University School of Medicine, Washington, DC, USA.,Department of Critical Care Medicine, 8405MedStar Washington Hospital Center, Washington, DC, USA
| | - In Guk Kang
- Department of Medicine, 12230Georgetown University School of Medicine, Washington, DC, USA
| | - Erin M Vaughan
- Department of Medicine, 12230Georgetown University School of Medicine, Washington, DC, USA
| | - Jose Flores
- 12228Yale University School of Medicine, New Haven, CT, USA
| | | | - Muhtadi H Alnababteh
- Department of Critical Care Medicine, 8405MedStar Washington Hospital Center, Washington, DC, USA
| | - Anne M Kelemen
- Department of Medicine, 12230Georgetown University School of Medicine, Washington, DC, USA.,Department of Medicine, Section of Palliative Care, 8405MedStar Washington Hospital Center, Washington, DC, USA
| | - Hunter Groninger
- Department of Medicine, 12230Georgetown University School of Medicine, Washington, DC, USA.,Department of Medicine, Section of Palliative Care, 8405MedStar Washington Hospital Center, Washington, DC, USA
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15
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Feder S, Schulman-Green D, Akgün KM. Palliative Care During a Pandemic. Respir Med 2021. [DOI: 10.1007/978-3-030-81788-6_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gonçalves Júnior J, do Nascimento TGL, Pereira MMDM, Moreira EB. Changes in Communicating Bad News in the Context of COVID-19: Adaptations to the SPIKES Protocol in the Context of Telemedicine. Front Psychiatry 2020; 11:599722. [PMID: 33329151 PMCID: PMC7732520 DOI: 10.3389/fpsyt.2020.599722] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 09/30/2020] [Indexed: 02/03/2023] Open
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