April 4-6, 2024 • Hyatt Regency • Lexington, KY
Innovations in Health Communication
Innovations in Health Communication
Abstract: “It’s strange on many levels”: Primary Care Clinicians’ Experiences Communicating Through Telemedicine During COVID-19
COVID-19 forced the U.S. healthcare system to change how patient care is delivered. Physicians at large U.S. health systems and small private practices turned to telemedicine (i.e., virtual/phone visits) to minimize the spread of infection. Researchers have explored telemedicine as a solution to rural health disparities and minimizing barriers to primary care. However, less is known about the specific communication challenges patients and practitioners face using telemedicine.
The current study uses the ecological model of communication in medical encounters to examine primary care clinicians’ experiences of rapidly transitioning to telemedicine at COVID-19’s onset. It identifies the communication challenges, opportunities, and strategies clinicians experienced while practicing patient-centered communication virtually. Our research questions are: (RQ1) How does verbal/nonverbal communication differ in telemedicine and face-to-face visits? (RQ2) What communication challenges do clinicians face using telemedicine? (RQ3) What do clinicians perceive to be the major challenges patients face using telemedicine? (RQ4) What do clinicians perceive to be the major strengths of telemedicine for providing primary care?
Data were collected using semi-structured interviews with 24 family medicine/primary care clinicians (i.e., physicians, physician assistants, nurse practitioners). Two authors conducted semi-structured interviews with participants over the phone or videoconferencing software (i.e., Zoom). We analyzed our data using a phronetic iterative approach. During this process, we noticed a clear connection between emerging findings and the ecological model of communication in medical encounters. We continued to refine our codes and categories while paying close attention to how the data illustrated, contradicted, or expanded the ecological model.
Our analysis revealed that verbal and nonverbal aspects of socioemotional communication and information exchange communication differed between telemedicine and face-to-face visits during COVID-19 shutdowns (RQ1). Clinicians reported challenges related to care quality, communication quality, diagnosis, privacy/security, technology, and organizational oversight (e.g., reimbursement; RQ2). Many reported a “fear of missing something” over telemedicine, while others reported no substantial difference in their ability to provide care. Participants found that some patients prefer virtual visits over in-person visits due to safety, comfort, and convenience, while others prefer in-person visits for socioemotional communication and perceived quality of care (RQ3). Clinicians acknowledged that several individual factors such as age, technology literacy, chronic/acute illness, and rural/urban location affected patients’ preferences. Overall, the reported strengths (RQ4) of telemedicine include improving care access/delivery, humanizing physicians and patients, increasing patient safety and comfort, reducing missed visits, and improving chronic disease management. However, a common theme was that some conditions are more suitable for telemedicine than others.
These themes extend key components of the ecological model to a global pandemic and telemedicine context. They explain how clinician and patient predisposing influences, cognitive-affective influences, and verbal and nonverbal communication behaviors can affect patient-centered care if rapid shifts to virtual meetings are needed. Results also illustrate the significance of media, cultural, political-legal, and organizational contexts, while also revealing new contexts such as disease severity and trajectory.
The current study uses the ecological model of communication in medical encounters to examine primary care clinicians’ experiences of rapidly transitioning to telemedicine at COVID-19’s onset. It identifies the communication challenges, opportunities, and strategies clinicians experienced while practicing patient-centered communication virtually. Our research questions are: (RQ1) How does verbal/nonverbal communication differ in telemedicine and face-to-face visits? (RQ2) What communication challenges do clinicians face using telemedicine? (RQ3) What do clinicians perceive to be the major challenges patients face using telemedicine? (RQ4) What do clinicians perceive to be the major strengths of telemedicine for providing primary care?
Data were collected using semi-structured interviews with 24 family medicine/primary care clinicians (i.e., physicians, physician assistants, nurse practitioners). Two authors conducted semi-structured interviews with participants over the phone or videoconferencing software (i.e., Zoom). We analyzed our data using a phronetic iterative approach. During this process, we noticed a clear connection between emerging findings and the ecological model of communication in medical encounters. We continued to refine our codes and categories while paying close attention to how the data illustrated, contradicted, or expanded the ecological model.
Our analysis revealed that verbal and nonverbal aspects of socioemotional communication and information exchange communication differed between telemedicine and face-to-face visits during COVID-19 shutdowns (RQ1). Clinicians reported challenges related to care quality, communication quality, diagnosis, privacy/security, technology, and organizational oversight (e.g., reimbursement; RQ2). Many reported a “fear of missing something” over telemedicine, while others reported no substantial difference in their ability to provide care. Participants found that some patients prefer virtual visits over in-person visits due to safety, comfort, and convenience, while others prefer in-person visits for socioemotional communication and perceived quality of care (RQ3). Clinicians acknowledged that several individual factors such as age, technology literacy, chronic/acute illness, and rural/urban location affected patients’ preferences. Overall, the reported strengths (RQ4) of telemedicine include improving care access/delivery, humanizing physicians and patients, increasing patient safety and comfort, reducing missed visits, and improving chronic disease management. However, a common theme was that some conditions are more suitable for telemedicine than others.
These themes extend key components of the ecological model to a global pandemic and telemedicine context. They explain how clinician and patient predisposing influences, cognitive-affective influences, and verbal and nonverbal communication behaviors can affect patient-centered care if rapid shifts to virtual meetings are needed. Results also illustrate the significance of media, cultural, political-legal, and organizational contexts, while also revealing new contexts such as disease severity and trajectory.