Communication Tools to Support Advance Care Planning and Hospital Care Amidst the Covid-19 Pandemic: A Design Process

Abstract The Covid-19 pandemic has exposed the medical and social vulnerability of an unprecedented number of people. Consequently, there has never been a more important time for clinicians to engage patients in advance care planning (ACP) discussions about their goals, values, and preferences in the event of critical illness. Health systems and expert organizations have sought to rapidly mobilize resources to support ACP as a critical focus of quality and safety efforts in the early days of this pandemic. We adapted an evidence-based structured communication tool, the Serious Illness Conversation Guide (SICG), to address Covid-related ACP challenges. A user-centered design process utilized feedback from a diverse group of key external stakeholders to develop Covid-19-specific structured ACP tools for ambulatory and acute care settings. Three themes derived from their feedback shaped communication content: sharing risk about Covid-19-related critical illness; engaging in care planning and life-sustaining treatment decisions; and maintaining person-centered language to foster relationships and elicit what matters most to patients. To address communication barriers related to Covid-19 - including use of personal protective equipment and virtual visit technologies that can constrain empathic communication techniques often associated with in-person communication - we developed implementation guidance for clinicians to prepare for conversations. Access to well-designed communication tools and implementation strategies during stressful times can equip clinicians to foster connection with patients and promote shared decision-making. While not an antidote to this crisis, such high-quality ACP may be one of the most powerful tools we have to prevent or ameliorate suffering due to Covid-19.