“I will never forget the times my husband was hospitalized for treatment and complications for stage III rectal cancer,” says Jennifer L. Kemp, MD, FACR, associate professor of radiology at the University of Colorado. During each 24-hour period as an inpatient, their lives revolved around the 10 minutes each day the attending physician would stop by to check in and update them on the care plan. “I would save all my questions and have my wording for each question and comment lined up for the physician when they entered the room. My husband would also have his list handy. Then, after the physician left the room, the vicious cycle would start again — When is the doctor going to come by next? What questions do we need to ask next? I couldn’t believe that here I was, a physician, and I was shell-shocked with anxiety and white coat syndrome every time one of my husband’s treating physicians entered the room!”
The scenario described above is a common one for many patients in healthcare settings who find themselves overwhelmed and leaning on loved ones to help them recount clinical history, remember details, ask important questions, and advocate for them. Once COVID-19 hit, reliance on loved ones as advocates became a non-option in most cases — as many patients were directed not to bring anyone to appointments. In addition to Kemp, the Bulletin spoke with Arun Krishnaraj, MD, MPH, chair of the ACR’s Commission on Patient- and Family-Centered Care; Linda Sample, CPXP, founder and president of Empowered Healthcare, LLC; and Linda Dowling, RN, BSN, program manager and nurse navigator at Rush Lung Center, Rush University Medical Center, about the impacts that COVID-19-related restrictions on visitors have had on patients — and what radiologists and their teams can do to help.
How is care impacted when patients are unable to bring loved ones to in-person healthcare appointments?
Dowling: The physical aspects of getting to appointments have presented a challenge for patients since the pandemic hit. We’re a big facility, and our cancer center is on the 10th floor. So patients have to first deal with getting transportation to the facility, then they have to get from the parking lot to the building, and then from the lobby up to the cancer center — for many patients, that’s a lot of ramps and walking. We had a strict no-visitor policy at the beginning of the pandemic, so for patients who rely on family for physical help with their appointments, this was hard. Some of these patients are dealing with a new diagnosis of lung cancer, for example, and then to be told they’ll have to navigate their appointments alone was scary.
Another challenge we’ve faced involves patients’ access to, and ability to navigate technology. Many of our elderly patients, for example, either aren’t tech savvy or don’t have access to smart phones — some don’t even have access to computers. And they now need to use an app to facilitate their care through our patient portal. In the beginning, we were trying to do video visits, but in some cases it just wasn’t possible. So that was really hard and frustrating for patients.
Sample: When patients can’t bring a care partner to an appointment, there’s often a higher sense of anxiety, fear, and even self-doubt. As a result, patients may postpone appointments or even forgo recommended screenings.
Kemp: In many cases, a loved one is the patient’s healthcare advocate or at least a key decision-maker. That loved one will have their own interpretation of the visit discussion and recommendations. That loved one will often have their own questions, which may be different from what the patient might think of. Often the patient can be overwhelmed and stressed at the visit. They may forget key components of their history. Patients’ stress also can limit the amount of information their brain can process at once. Having that second person there to help remember important information, ask the right questions, and absorb all relevant information from healthcare personnel is critical for some patients.
What can radiologists and their teams do to minimize these impacts for patients?
Kemp: I think the radiologist’s primary goal during this pandemic is to make sure everyone — the patient, their caretaker, radiology staff, etc. — is as safe as they can possibly be. Although I laud the benefits of including family members in patients’ care, I put safety first during a deadly pandemic. Thus, we need to look for alternate methods of communication — to include telehealth conferencing as well as being more available for phone, email, or patient portal questions.
Krishnaraj: The key for radiology and radiologists is to make themselves available. Imaging is a vital component of most patients’ care and yet radiologists are often absent from the conversation with patients when decisions are made. Making yourself available via email, phone, or video chat together with the entire care team can improve care decisions and outcomes as well.
In many cases, a loved one is the patient’s healthcare advocate or at least a key decision-maker. That loved one will have their own interpretation of the visit discussion and recommendations. That loved one will often have their own questions, which may be different from what the patient might think of.
Sample: I think there are opportunities for additional training for radiologists and their broader care teams around empathy and communication. The RTs, front office staff, and everyone who interacts with the patient in some capacity has the potential to impact a patient’s experience and sense of well-being. If a patient seems anxious, reaching out by saying, “It seems like you may be feeling anxious; what can I do to help?” can make a big difference. Sometimes we just need someone to communicate with us and ask us the right questions.
Dowling: We need to provide a lot of reassurance and communication to help patients feel they can get to their imaging — whether that is offering wheelchairs or making sure an extra staff person is available. We also decided to take the additional step of working directly with patients who needed assistance using technology to navigate our patient portal. Our IT team drafted instructions, and then we had our medical assistants work with the patient or the family member to try to get the portal set up. Then they even took it a step further, as they were seeing the patients were still struggling with it. They started asking patients if they’d like to do a “dry run” by phone once they got home, to make sure they would be able to connect when the time came for their actual appointments. It was extra work on our end but ultimately saved a lot of work and confusion downstream.
I would also recommend helping facilitate videoconferencing for patients and their families, using apps like Skype or FaceTime. Whether that’s assisting a patient with videoconferencing their family while they’re physically in the appointment or helping the patient set up videoconferencing so that they can include loved ones in telehealth appointments later — videoconferencing can be an incredibly useful tool to allow loved ones to participate in patients’ care safely.
How can radiologists help patients and their loved ones for whom English is not a first language?
Krishnaraj: At UVA, we have worked with the Holvan Group, which offers patient prep videos in both Spanish and English. Spanish-speaking patients are given a tablet with pre-recorded videos to help them understand the procedure they are scheduled to undergo. Additionally, radiologyinfo.org has ample Spanish language content that is very useful for patients and is 100% free.
Kemp: All hospitals have policies that patients need to be provided a medical translator and, at least in my experience, medical translators (even when remote) are available 24/7.1 Unfortunately, people often don’t take the time to use the translator, as this can slow down the process. So planning in advance for when a translator will be needed and making sure all staff are comfortable accessing a translator and communicating via a medical translator is paramount to success. The process needs to be as easy as possible without causing significant workflow disruption.