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.
1. Welcome and Prepare for the Conversation
- 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”.
3. Establish the Agenda
- 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.
4. Get Background (Especially for Initial Visits)
- 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).
5. Physical Examination, Targeted
- 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.
6. Medication Review
- 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.
7. Effective Time Management
- 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?”
8. Summarize and Document
- Review what was covered: “We discussed x, and concluded y.”
- Make sure all parties understood correctly.
- Document as required.
9. Outline Next Steps
- 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).
10. Schedule Next Encounter (If Warranted)
This guidance is based on recommendations from ProHEALTH/Optum, with additions from ResolutionCare.