Palliative Care Telehealth Sample Guidelines

This is a sample outline for a palliative care visit conducted remotely with audio-visual devices. It includes suggested wording and a stepped approach for the visit.

• Set up the call as if you were a film director. Put yourself in a warm, neutral background, and make sure your own technology is working well. Check that the patient’s technology is working (and trouble-shoot any issues). Ask them to place the device in a way that works for the encounter. Ask them to gather anything they might need (e.g., their medication bottles and supplements).
• If using a translation service, ask them to confirm their capabilities. Then ask them to turn off their video.
• Once the stage is set, explicitly acknowledge that you’ve all “arrived”.
• Give permission to leave the technology alone now so you can focus on the session.

• Introduce everyone on the call, including all people who may be listening in but are not on-screen, and any learners you have invited.
• Explain the role of all members of the care team.
• Include something personal about yourself to add warmth to the encounter: “I am a palliative care physician as well as a wife and mother living in San Francisco”.

• Explicitly ask the patients what they want to discuss: “What is most important to cover during our visit today?”
• If you have specific items you want to cover, ask permission to include them as well.

• Ask what other clinicians have been involved in the care. Find out if they have been in the hospital or emergency department.
• Find out what they know about their circumstances: “What have the other doctors told you so far?”
• Ask permission to scan the environment (e.g., ask to see the room where they sleep, the inside of the refrigerator).

• Help them move the device as needed, and touch/press according to your instructions.
• Review vitals as available (i.e., if the patient has a thermometer, pulse oximeter, etc.).
• See resources in CAPC's Telehealth and Palliative Care toolkit under “Physical Examination”.
• If you review the medical record and/or document during the visit, ask permission to divert your attention: “This is important information, and I’d like to make sure I am capturing it for future use.” OR “Let me just check your past information to compare." If you are comfortable, you might want to share the record on the screen.

• Ask them to show you all the medications they take, including OTC and supplements. This works especially well if the patient is using a cell phone.
• Ask them to show you the rooms where the medications are located, where they are stored, and how they access them.

• General guidelines are 45 minutes for an initial visit, and 20 minutes for follow-up.
  • Do not substitute time for skill. Adhere to the agenda.
  • Remember that people have short attention spans.
  • Medication management is improved with more frequent, brief encounters.
• If there are more issues than can be covered in this encounter, make a follow-up appointment.
• Five minutes prior to the end of the encounter, give a warning: “We only have five minutes left. Did we cover what you wanted to? Is there anything else you’d like to discuss?”

• Review what was covered: “We discussed x, and concluded y.”
• Make sure all parties understood correctly.
• Document as required.

• Articulate the follow-up actions you will take (e.g., I will call the home health agency to arrange care; I will call in prescriptions; I will speak to the oncologist).

This guidance is based on recommendations from ProHEALTH/Optum, with additions from ResolutionCare.