Table 2.

Exemplar quotations for themes

Quotation Number and Participant Group	Subtheme	Exemplar Quotation
Patient and family needs
Quotation 1 Family member	Psychosocial needs, information sharing	“But I didn’t feel like I had enough information from the medical team . . . I needed more information. I tend to be that kind of person. I’m not afraid of science. I want to know. [chuckles] Let me know what’s going on. Odds are I probably won’t understand the terminology that you’ve thrown at me. I just need to know where things are, and I think it’s that it was more the facts are the facts, which helped a little bit with the guilt. But still, it probably would’ve helped a bit more at the time.”
Quotation 2 Family member	Information sharing	“Well, I mean, I live alone. So it was hard not being able to go there and get more information. So it certainly, you know . . . I was here rolling around the house just being probably more worried and panicked because of the lack of knowing than having to be able to go in and see him. I mean, I still would’ve been worried and panicked, but do you know what I mean, in a different way?”
Quotation 3 Physician	Information sharing	“It was quite difficult when families were distressed, especially for a COVID-19 patient where . . . you had a patient whose wife is at home, quarantined, isolated, old, hearing news from someone that she doesn’t know about her husband who’s in critical condition in the ICU.”
Quotation 4 Family member	Importance of communication	“To already feel so distanced, and then not being able to get through to someone that I just want to know if he’s okay, or had a good night, whatever you can tell me. Because we weren’t allowed ourselves in there, we have no assurance that that was actually done for every person that needed it or should have had some sort of somebody there so that they knew that they didn’t die alone, that people cared for them and that even if they didn’t understand that it wasn’t possible for us to be there, at least they weren’t alone. We have no assurance that that was actually done. Obviously, there’s no video of it.”
Quotation 5 Family member	Importance of communication	“But I really needed some feedback on what was going on with him medically. Which I really didn’t get anything, other than the test that was canceled. And I found out the test was canceled, not from the doctor, but from the nurse. And she had no idea why it was canceled. . . . Now I’m even more concerned. I’m like, ‘What’s going on?’”
Quotation 6 Nurse	Importance of communication	“But I think it’s made it super challenging to really know what people want and not having patients, family members come in and be able to be assured that we're doing what we’re doing right, we can’t 24/7 keep people informed as much as we’d love to.”
Communication tools
Quotation 7 Family member	Mode of communication	“And at least in the ICU, they tried . . . I think with me on two occasions, to use an iPad for communication. And I could see my mom’s face, she perked right up. And as soon as she saw me, I could see she perked up. ‘Oh, it's so nice to see you and nice to chat with you.’ But that really meant a lot to her.”
Quotation 8 Family member	Mode of communication	“I know they had started to offer things like Facetime, and I didn’t have access to that.”
Quotation 9 Physician	Mode of communication	“I think that there’s more of an opportunity, probably, to do that sort of stuff even post-COVID, is to use those alternate tools of communication if family can’t always be there, and long-distance family, right? How often do you have the family that’s in California or the family that’s in Europe or in Asia and being able to communicate via video conference?”
Quotation 10 Physician	Mode of communication	“They didn’t get along so the [parent and sibling] of the patient were in person in the room and the partner, who the family did not like whatsoever, was on Zoom. We actually positioned it so I was sitting facing the [parent and sibling] and then the Zoom camera or computer was between us. . . . Every single time the partner would speak, you would see the [parent and sibling] throw their arms up and roll their eyes. I told the social worker at the end of the meeting, That worked perfectly because [the partner] couldn’t see that. They couldn’t see [the partner]. It actually probably mitigated a lot of arguments that could have happened.”
Quotation 11 Physician	Mode of communication	“The patient can be on the video even if they’re in an ICU and not able to communicate that well themselves. And sometimes I will try to set that up so I can talk to the family first and then put it with the patient and then maybe talk to them again.”
Quotation 12 Nurse	Audio and/or video quality	“We just recently got an iPad for the unit. So we at least have an ability to have video chats with family. So we set it up for the patient and assuming that their family also has an iPad or something of that nature, which is not always the case, that they can at least have face-to-face videos.”
Quality of communication
Quotation 13 Nurse/Physician	Loss of visual cues	“I mean, even on Zoom, it’s a bit clunky. I can’t read your body language the same.”
Quotation 14 Physician	Communication content	“I think the biggest downside to that is that I didn’t know exactly what the residents were saying to the family. I couldn’t micromanage them like that. In terms of if there were ever misunderstandings, I wasn’t able to clarify it at the time, but I think that was the only practical way to keep everyone involved.”
Changing roles and responsibilities
Quotation 15 Family member	Patients as family communicators	“Working with the public and having information relayed, from [elderly] [family members], that it’s their [family member] in the ICU, that’s where I would say, the F-minus in a rating got, was information was very difficult to get, and information came through very tired, sleep-deprived, [elderly] [family members] with their [family member] in an ICU.”
Quotation 16 Nurse	Shifting responsibility across healthcare team	“I think in general, a huge responsibility on the bedside nursing staff to make sure that everything was as transparent as it could be over the phone, even though they can’t see them.”
Facilitators or barriers to implementing alternative communication
Quotation 17 Family member	Time constraints	“And then it’s like, ‘Sorry, we don’t have the time,’ and that's the best answers I got. Some of them it's like, ‘Stop calling. We don’t have time to waste.’ They’re supposed to have sympathy and understand. They’re about the care of the patients. That’s not caring for your patient, for not allowing them to have a contact, at least by voice.”
Quotation 18 Physician	Miscommunications	“The patient was not speaking neither English nor French. It was very difficult to communicate with her and, despite having Zoom, it was very difficult. So we allowed the patient’s son to come to visit her.”
Quotation 19 Family member	Additional supports	“A person available to speak to the patients if their families could not visit, and to encourage them to use the technology, to walk them through it, to guide them in the use, to make them more comfortable with it. I don’t know about other people, but our father being of an earlier generation, doesn’t use technology very much, not even the telephone. So he doesn’t get the full advantage of what possibilities there could be for connection with the family.”
Quotation 20 Physician	Additional supports	“If you had on rounds a computer on wheels and you could have people slotted in to come on to rounds at a particular time, that would be great, and then they could be there virtually as they would be normally. We haven’t operationalized that almost ever because of the uncertainty about exactly the time and don’t want to make people wait and then a little bit the technology with speakers and video cameras and stuff. So we’ve not done that but it would be something that would be a look to the future that we could conceivably do. But it would require us to be probably much more attentive to the schedule of patient to patient to patient than we are right now.”

Definition of abbreviations: COVID-19 = coronavirus disease; ICU = intensive care unit.