Table 5.

Discordant perspectives between clinicians and families about telehealth

Clinician Perspectives	Family Perspectives
Communicating empathy over telehealth
Clinicians worry about conveying empathy.	Empathy comes across regardless of medium.
Physician: “When the patient’s daughter broke down and cried and when it was harder. . .in real life I probably would’ve given a box of tissues. I would have given a pat on the shoulder. I would have demonstrated with probably my body language that I'm concerned. I could not do any of that.”	Patient’s daughter: “I feel like people who have more of a bedside manner, that still comes across well on the phone.”
Using video to convey an understanding of patient’s clinical status
Clinicians felt video communication might help families to understand severity of illness.	Family preferences about using video to understand the patient’s status are mixed.
Nurse: “When she got to see him [over video], I think it helped her comprehension. . .she started to understand why he was having so much trouble breathing and getting out of the ICU. . . .Without the video she wouldn't have been able to do that.”	Patient’s daughter: “I think in person would be. . .I mean, it would be tragic and horrible in itself, but just seeing her through a screen like that would just be....You don’t Google horrid pictures of people. I definitely wouldn’t want to see that through a phone or computer screen.”
Nurse: “She thought we were neglecting him. . .or not telling her the full truth. So, when she got to see him [over video]. . .she started to understand why he was having so much trouble breathing and getting out of the ICU.”	Patient’s husband: “Her reactions to us [over FaceTime] were a definite sign that she has some abilities. Whereas the way they were describing that over the phone. . .the nurses said there was no response to their command....I surmised from their conversation it was worse than what it is.”
Trust and rapport between clinician and family
Trust can be difficult to establish.	Clinicians can establish trust and rapport.
Physician: “[Over the phone], a lot of this came down to trust. There was a lot of questioning, concern....[The family] said some pretty rude things that implied that we didn’t care about the patient....Those things kind of seemed to go away once we met them in person.”	Patient’s husband: “Honestly I think it was better over the phone for some reason....It seemed like they felt bad they couldn't talk to us in person, so they really listened and they really, they never rushed us off the phone....The doctor was really, really good.”
Some clinicians feel awkward when there is no in-person relationship.	Families are generally less concerned about the impact of remote interactions with physicians.
Nurse: “I still interact with families on the phone every day, but it still feels weird and I think it’s because I have no personal interaction with them.”	Patient’s mother: “I don't think [meeting in-person] would've changed the physician interaction. . .because I was still able to receive the information that they had [over the phone], and ask questions and have those questions, and they've been answered.”
Physician: “I'm glad that we had the conversation. . .but I overall didn't like it. I don't like that I couldn't see her, so I couldn't see what her body language was or what her voice was like or if she was fearful. I couldn't read her to see if she really understood what I was saying.”	Some families may trust clinicians less without meeting them in-person.
	Patient’s husband: “If you’re talking to a strange doctor that you’ve never met in person, what kind of confidence [do] you have in their abilities? I know they’re all doctors, but all doctors aren’t born equal. Yes. If you can meet face to face, it is a lot better.”
Aligning clinician and family perspectives
Telehealth-only (especially phone-only) interactions can result in families being less aligned with clinicians about their loved one’s condition.	Families felt forced to rely on clinician judgment.
Physician: “I think it's easier to talk with families when they have either seen no change, or a change, whether it's for better or for worse, to frame the discussion. And to check in with family and be like, ‘Hey, what we’re seeing is they're getting worse.’ And the family's often like, ‘Yeah, we’re seeing that too.’. . .So it's easier to align ourselves with the family [in person].”	Patient’s husband: “With the coronavirus thing, there’s no visitation. We have to rely on their interpretation of what’s going on. They’re experts.”
Physician: “Aligning our points of view was more difficult over the phone. Despite every time they said, ‘We're just trying to advocate for our mom.’ We’re like, ‘Absolutely.’ It just—there seemed to be a little bit of a disconnect. And I can't help but imagine that telecoms, teleconferencing as opposed to in-person, contributed....”	Patient’s daughter: “I had no other choice but to trust them. We can't come into the hospital now to visit with patients because of the coronavirus so we have to trust the administrators and doctors that are taking care of our families.”
Perceptions of amount and type of information shared over telehealth
Some clinicians worry about high-stakes conversations.	Most families feel they would have received the same information in person that they did remotely.
Physician: “I think I’m more reluctant to address goals of care, and I’ve been doing more like information sharing. Because it’s just harder to read, like, families and where they are and how they’re receiving bad news.”	Patient’s wife: “I don’t think that we could have gotten different information if we were there. Because pretty much, we can ask anything we want to them on the Zoom.”

Definition of abbreviation: ICU = intensive care unit.