Families of COVID-19 Patients Say Goodbye on Video: A Structured Approach to Virtual End-of-Life Conversations

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Journal of Palliative MedicineVol. 23, No. 12 Letters to the EditorFree AccessFamilies of COVID-19 Patients Say Goodbye on Video: A Structured Approach to Virtual End-of-Life ConversationsJulia L. Frydman, Eugene W. Choi, and Elizabeth C. LindenbergerJulia L. FrydmanAddress correspondence to: Julia L. Frydman MD, Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, New York, NY 10029, USA E-mail Address: [email protected]Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.Search for more papers by this author, Eugene W. ChoiBrookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.Search for more papers by this author, and Elizabeth C. LindenbergerBrookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.Geriatric Research, Education and Clinical Center, James J. Peters Veterans Affairs Medical Center, Bronx, New York, USA.Search for more papers by this authorPublished Online:11 Nov 2020https://doi.org/10.1089/jpm.2020.0415AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookXLinked InRedditEmail To the Editor:COVID-19 has challenged our ability to support patients and families at the end of life. Hospital policies, established to protect patients, health care workers, and family members, often dictate that no or few visitors be allowed at the bedside. Without the ability to see their loved ones in person, the emotion and disbelief of the patient's sudden serious illness are magnified leading to high levels of emotional distress. Families worry about the patient being abandoned, not having an advocate, and dying alone. Many family members have serious medical problems themselves and are precluded from leaving the house even if a visit becomes available per hospital policy; furthermore, transportation is limited. For those who do have brief visits, they are not permitted to come together and provide support to each other.In this setting of strict hospital visitation policies and the need for physical distancing, family members are often unable to say goodbye to their loved ones in person. Health care providers are being asked to play an increasing role in facilitating communication between patients with COVID-19 and their families; this work is emotionally challenging and has potential consequences for providers' mental health. Furthermore, we know that family members who have the opportunity to say goodbye at the end of life have lower rates of depression and complicated grief.1Through iterative clinical experience at the height of the pandemic, and drawing on guidelines from multiple national organizations focused on improving communication in the setting of COVID-19,2,3 we developed a novel “Video Goodbye Tool” (Fig. 1). Although many of the communication strategies used in the tool are not new, we have coupled them with the technical details of planning these meetings that we found most challenging at the start of the pandemic. How could we assess a family's readiness for a video goodbye? How could we prepare them for what they would see and what to say? What were strategies to ensure technological issues did not become a barrier to making the encounter meaningful? The “Video Goodbye Tool” is meant to be used by providers in real time to prepare for end-of-life encounters, easing the transition from in-person to virtual goodbyes.FIG. 1. Video Goodbye Tool.Given the ongoing nature of the COVID-19 pandemic and the likelihood of multiple waves over the next one to two years,4 the “Video Goodbye Tool” is a resource to support patients, families, and providers who are navigating COVID-19's impact on end-of-life care. Our hope is that coupling video technology wi