Grant Supports Pandemic-Specific App Update for Frontline Clinicians

With funding from Archstone Foundation, California State University Los Angeles Auxiliary Services (CSULA) is ramping up critical end-of-life communication resources and training for frontline clinicians via the Health Communication iOS app.

Archstone Foundation awarded a COVID-19 Response and Technology grant of $57,174 to CSULA in August to develop and integrate COVID-19 pandemic content into the app. This project builds on past Foundation support of the Health Communication app for smartphones and iPads. The app presents free, easily accessed prompts to help providers engage patient-centered care communication practices, based upon the COMFORT Communication Model (C-Connect; O-Options; M-Making meaning; F-Family caregivers; O-Openings; R-Relating; T-Team).

The COVID-19 pandemic has created a rapidly changing health care landscape that highlights the ongoing need for communication training for frontline clinicians as they navigate critical end-of-life conversations with patients and family. COVID-19, with its acute onset, is unusual compared with many chronic diseases at the end of life for older adults in that it strikes quickly, incapacitates its victims, and — due to the need to control infection — isolates those who are seriously ill from friends and family.

Health care workers are experiencing unprecedented challenges assisting in advanced care planning and palliative care for people and their families suffering from COVID-19. Communication resources for health care providers that currently exist are not COVID-specific, and those that are have been created exclusively for physicians. Though these resources have been developed in response to the pandemic, they leave out the needs and experiences of COVID-19 patients and their family members, as well as another important group of frontline providers: nurses.

Closing ‘the Big Gap’

With little time and limited training materials available to prepare frontline clinicians, Elaine Wittenberg, PhD, Associate Professor of Communication at CSULA, wanted to leverage the Health Communication app she developed to fill the gaps in pandemic communication resources and training. She simply had to determine how.

Her first step was consulting with people who have different viewpoints and skillsets. Rather than discussing the issue with other researchers, Wittenberg spoke with hospital administrators and clinicians, who might be able to “see the forest through the trees,” she says. One hospital administrator did not see the value in promoting the app among health care providers, but encouraged her to look at her resources and her strengths.

That is when Wittenberg realized that “the big gap is not how to get providers to use the Health Communication app — the big gap is how to update the app to be usable and feasible to an audience that wants it and wants to use it.” When looking at the challenge that way, the answer was clear: Nursing students, even at her own institution, have inadequate health communication training.

The updated app, she says, will address the concerns of nurses who “fear not being able to relate hope to patients and families,” especially in light of difficult end-of-life conversations around COVID-19. In such uncertain times, there is ambiguity in what information to share and how to distribute information. Does the nurse share information directly with the patient? Or does the doctor? How does the family receive information? Does the nurse or doctor or patient video chat with family members? Without communication training, nurses may not know what to say or how to say it. The Health Communication COVID-19 project will address nurses’ struggles to “maintain family dignity, and accurately share the knowledge they want to relay to the family.”

A Person-Centered Tool

The updated, web-based app funded by Archstone Foundation’s COVID-19 response grant will give practitioners a clear avenue of direction in having conversations with patients and families by providing a tool that guides them in gathering information for the care team that is more specific to the patient and family’s story, and their feelings behind it.

For example, health care providers can scan through the communication toolkit in the app and select from a series of topics, including “hard questions,” “family caregivers,” and “team collaboration.” A more detailed menu allows providers to select specific questions or scenarios that they observe, and receive tips on what to ask and how to provide information using plain, easy-to-understand language.

Health Communication will be disseminated among professional nursing and palliative care organizations, addressing the need to improve care by providing frontline practitioners with COVID-specific communication resources, and extending its reach across the U.S. and worldwide to critical care nurses.

The Health Communication COVID-19 project will also expand undergraduate nursing education to include health communication training in distance and online learning environments. To ensure efficacy and to contribute to the evidence base for health communication training, 75 undergraduate nursing students will participate in an evaluation study assessing their ability to master app content.

The app also will be marketed to three nursing faculty organizations: the American Nurses Association, the National League for Nursing, and the American Association of Colleges of Nursing. That effort is expected to increase the Health Communication app’s outreach to about 250 nurse educators and 22,500 undergraduate nursing students.

In tying together two areas that Wittenberg is passionate about — health care communication and nursing education — her app, with the Foundation’s support, has the potential to redefine and improve the way palliative care communication occurs, and contribute to the evidence base of pandemic-specific resources.