Communication Currents

Hospice care is for terminally ill patients who have less than six months to live. This care is typically provided in the patient's home by a family caregiver or friend who communicates and works with the hospice team. These teams usually include a medical director, nurse, social worker, and chaplain. Thus, hospice care is a very personal, intimate service, and its effectiveness is based on how messages are exchanged among these parties.

However, in some locations, especially rural or remote areas, this type of personal care is difficult to deliver. As a solution, the Telehospice Project used videophone technology. According to a study funded by the National Cancer Institute, hospice patients and their family caregivers benefit from improved communication with hospice staff. Dr. Elaine Wittenberg-Lyles, a communication researcher at the University of North Texas and a co-investigator on the Telehospice Project, reports that family participation in hospice team meetings led to an improvement in services and patient care.

The videophone units installed in patient homes showed live images of hospice team meetings. The patients and caregivers were able to use the videophones to communicate directly with hospice staff, asking questions and getting immediate feedback regarding patient care issues.

For example, in one interaction, a caregiver reported that the patient was having a hard time holding her head up. Using the video technology, the medical director was able to see the patient and prescribe additional pain medication. Not only does the use of technology help the hospice team provide better care to the patient, adding the family caregiver to team meetings helps the team communication and decision-making processes, which are important parts of the hospice mission.

Family caregivers and hospice staff reported improvements in communication and decision-making as a direct result of using the technology. For example, one hospice team member said, “It gives [families] . . . a feeling of being involved [rather] than being treated. . . . We know what the patient and family want, and we also know what we are capable of doing, and when they mix it together, it makes a team effort.”

Another family caregiver explained the benefits: “There was no . . . asking one person and then them talking to the team and finding out if we could do what we wanted to do. . . . We could find out immediately, so there was no lag as far as the decision making process.”

Family caregivers are responsible for giving medication to the patient and they often have questions about patient care. The technology also allows them to communicate changes and concerns, or to get advice from the team about specific care needs. One caregiver shared with the team that she was concerned about patient addiction to a prescribed narcotic. The team was able to address this concern by explaining the disease process and educating the caregiver that addiction is not a concern for terminally-ill patients. The study found that caregivers' concerns about giving pain medication decreased when they were able to join team meetings.

Videophone images of caregivers and patients also had an impact on the staff's relationship with the caregiver. Rural caregivers reported that they felt more connected to the hospice team. One family caregiver claimed, “It's almost like they bring the hug. You're isolated in your own home and family members don't even come by. And it's like you have that hand on your shoulder with the phones and the faces . . . and it made a big difference.”

Being able to talk to and see how the patient was doing also led to important changes in care. For example, during one videophone interaction the medical director noticed that the patient was shaking and trembling. After talking further and watching the videophone images, the medical director was able to diagnose Parkinson's disease as a related illness.

Videophone technology provided direct communication between the hospice team, patients, and caregivers, allowing all parties to have a better understanding of changes in patient care. Caregivers and staff provided numerous example of this, explaining how involvement in team meetings resulted in a better understanding of the patient's plan of care, knowing who was doing what for the patient and when, and knowing what to expect in the future.