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Introduction

To health care professionals everywhere: COVID-19 has challenged us on all fronts. We are facing conversations that we never expected, nor wanted to have. The relentless demand for care during this pandemic has pushed clinicians over the edge. You did not sign up for this. It is unfair. It is difficult to set aside.

VitalTalk and our community want to help. Our founders and over 80 clinicians across the globe have pitched in to create a COVID-19 Communication Playbook guide with practical advice on how to talk about very difficult topics. Together can help each other with empathy, compassion and sense of service.

Additional resources can also be found at CAPC COVID-19 Rapid Response Resources Hub.

Our world needs you—your expertise, your kindness, your aspirations, and your strength. We are grateful you are here.

 

How can I share this guide?

Please feel free to disseminate this this playbook freely. We ask that when you share or adapt this guide you agree its use

• Is informational, non-commercial or for educational use only
• Include our website vitaltalk.org and  VitalTalk logo
• Include copyright notice at the end of the material, specifically “Copyright © Vital Talk. All rights reserved”

 

Using these tips

This is a super-concentrated blast of tips focused on COVID. We’ve pared away all the usual educational stuff because we know you’re busy. If you want more, check out the talking maps and videos on fundamental communication skills, family conferences, and goals of care at vitaltalk.org.

As the pandemic evolves, the caseload in your region will determine whether your clinic or hospital or institution is ‘conventional’ mode (usual care), ‘contingency mode’ (resources stretched although care functionally close to usual), or ‘crisis’ mode (demand outstrips resources). Most of the tips here are for conventional or contingency mode. If your region moves to crisis standards, how medicine is practiced will change dramatically—triage decisions will be stark and choices will be limited. If needed, future versions of this doc will shift towards crisis. For now, please note that the crisis mode tips are marked [C] and should be reserved for a crisis designated by your institution.  Clinicians should check their state or regional crisis standards. And remember that even in a crisis, we can still provide compassion and respect for every person.

Some of the communication tips in this document depict ways to explain resource allocation to a patient or family or caregiver. However, note that decisions about how resources are allocated—what criteria are used or where lines are drawn—should happen at a different level—at the regional or state or country level. Rationing decisions should not be made at the bedside. In these tips, we steer away from complex discussions about rationing, and use language that is for lay people rather than ethicists.

 

About VitalTalk

VitalTalk is a 501c3 nonprofit social impact organization dedicated to making communication skills for serious illness part of every clinician’s toolbox. This content is availible in our free VitalTalk Tips app for iOS and Android.

 

Screening

Screening

When someone is worried they might be infected

Preferencing

Preferencing

When someone may want to opt out of hospitalization

Triaging

Triaging

When you’re deciding where a patient should go

Admitting

Admitting

When your patient needs the hospital, or the ICU

Counseling

Counseling

When coping needs a boost, or emotions are running high

Deciding

Deciding

When things aren’t going well, goals of care, code status

Resourcing

Resourcing

When limitations force you to choose, and even ration

Notifying

Notifying

When you are telling someone

Anticipating

Anticipating

When you’re worrying about what might happen

Grieving

Grieving

When you’ve lost someone

Talking map - CALMER

New talking maps for contingency and crisis

Proactive planning, resource limits

 

“CALMER”

For proactive planning in contingency. The COVID-as-a-starter preferences or goals talk for patients in a health care setting.

Check in

Take a deep breath (yourself!).
“How are you doing with all this?” (Take their emotional temperature.)

Ask about COVID

“What have you been thinking about COVID and your situation?”
(Just listen)

Lay out issues

“Here is something I want us to be prepared for.” / “You mentioned COVID. I agree.”
“Is there anything you want us to know if you got COVID / if your COVID gets really bad?

Motivate them to choose a proxy and talk about what matters

“If things took a turn for the worse, what you say now can help your family / loved ones”
“Who is your backup person–who helps us make decisions if you can’t speak? Who else? (having 2 backup people is best)
“We’re in an extraordinary situation. Given that, what matters to you? (About any part of your life? About your health care?)
Make a recommendation–if they would be able to hear it. “Based on what I’ve heard, I’d recommend [this]. What do you think?”

Expect emotion

Watch for this – acknowledge at any point
“This can be hard to think about.”

Record the discussion

Any documentation – even brief — will help your colleagues and your patient
“I’ll write what you said in the chart. It’s really helpful, thank you.”

 

Talking map - SHARE

“SHARE”

For crisis only [C]. Talking about resource allocation (i.e. rationing).

Show the guideline

“Here’s what our institution / system / region is doing for patients with this condition.”
(State the part directly relevant to that person.)

Headline what it means for the patient’s care

“So for you, what this means is that we care for you on the floor and do everything we can to help you feel better and fight this illness. What we won’t do is to transfer you to the ICU, or do CPR if your heart stops.
(Note that you talk about what you *will* do first, then what you won’t do)

Affirm the care you will provide

“We will be doing [the care plan], and we hope you will recover.”

Respond to emotion

“I can see that you are concerned.”

Emphasize that the same rules apply to everyone

“We are using the same rules with every other patient in this hospital / system /institution. We are not singling you out.”

***This talking map is only used when an institution has declared use of crisis standards of care, or a surge state. When the crisis standards or surge are discontinued, this map should no longer be used.

 

Talking map - LOVE

“LOVE”

When you need to talk a family member on phone or video through saying goodbye to a patient who is in their last hours or minutes.

Lead the way forward

         “I am [name], one of the [professionals] on the team.”

         “For most people, this is a tough situation.”

         “I’m here to walk you through it if you’d like.”

“Here’s what our institution / system / region is doing for patients with this condition.”
(State the part directly relevant to that person.)

Offer the four things that matter to most people

         “So we have the opportunity to make this time special.”

         “Here are five things you might want to say. Only use the ones that ring true for you.”

                     “Please forgive me”

                     “I forgive you”

                     “Thank you”

                     “I love you”

                     “Goodbye”

         “Do any of those sound good?”

Validate what they want to say

“I think that is a beautiful thing to say”

“If my [daughter] were saying that to me, I would feel so valued and so touched.”

“I think he/she can hear you even if they can’t say anything back”

“Go ahead, just say one thing at a time. Take your time.”

Expect emotion

         “I can see that he/she meant a lot to you.”

         “Can you stay on the line a minute? I just want to check on how you’re doing”

 

Thanks

Thank you

Alaa Albashayreh, MSN, RN
Patrick Archimbault MD
Bob Arnold MD
Darren Beachy MTS
Yvan Beaussant MD
Brynn Bowman MPA
Colleen Christmas MD
Randy Curtis MD MPH
James Fausto MD
Lyle Fettig MD
Jonathan Fischer MD
Michael Fratkin MD
Christina Gerlach MD
Marian Grant DNP
Caroline Hurd MD
Margaret Isaac MD
Josh Lakin MD MD
Elke LowenKopf MD
Joanne Lynn MD
Nick Mark MD
Diane Meier MD
Susan Merel MD
Tona McGuire PhD
Kathryn Pollak PhD
James Tulsky MD
Tali Sahar MD
Vicki Sakata MD
The John A. Hartford Foundation
Cambia Health Foundation