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Golden Rules

Optimizing Telehealth, Communication Amid COVID-19

Weinstein, Barbara E. PhD

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doi: 10.1097/01.HJ.0000719832.63281.90
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The need for wearing face masks and physical distancing due to the pandemic has compounded the communication challenges already faced by many older adults with hearing loss. With COVID-19 hospitalization rates higher among older adults—and highest among those aged 85 and older—the COVID-19 infection and fatality rates by age distribution tell a very important story that largely informs the resulting health care trends, particularly telehealth (CDC, 2020). The momentum for telehealth and the need for virtual clinical encounters have created a watershed moment for clinicians and patients alike. As hearing health care experts—who were among the host of health care professionals who had to pivot to telehealth—we are well-positioned to be among the specialists who can optimize audio and video technology and guide this evolving landscape to help improve the health outcomes of people with hearing loss (CDC, 2020).

Figure 1
Figure 1:
Accessibility tips for virtual meetings (printed with permission from the Canadian Academy of Audiology and the Authors Janine Verge, Dana Song, and Anne Griffin). COVID-19, hearing loss, communication.
Table 1
Table 1:
Tips to Improve Hearing Access during Virtual Sessions.

Organizations such as the Academy of Communication in Healthcare (ACH) and the International Association for Communication in Healthcare (EACH) are working toward improving how health care professionals communicate with stakeholders. EACH is committed to promoting effective, patient-centered, and evidence-based health communication, whereas ACH focuses on research and the teaching of relationship-centered health communication. Their view, which I share, is that health care delivery can be improved through better communication and relationships.

While their mission is important and their websites offer various resources to enhance communication, the lens through which communication is viewed by the ACH and EACH does not visualize communication as a feedback loop requiring a speaker, a medium, and a listener. Their focus is on impacting the patient experience by ensuring that patients listen carefully and that clinicians deliver information in a way that the patient can comprehend. While these are important, it's crucial to note that the ear and hearing are not mentioned as integral to listening and understanding, and the emphasis is placed on the behavior of the health care provider (for example, see ACH's telehealth communication tips online: In contrast, our dual concern as audiologists should be how the clinician hears/listens and understands, and how the patient hears/listens and understands.

As such, consider the more inclusive guidance for virtual health care visits in Table 1 and with an excellent infographic (Fig. 1) by Verge, Song, and Griffin (Canadian 2020;6[6]: 1-17).

With the rapid transition to virtual care after shelter-in-place orders came down, telehealth has become a communication medium of choice for many providers to help mitigate the spread of the coronavirus while prioritizing health and wellness (J Am Geriatr Soc. 2020 Jun;68[6]:E27-E29). The benefits of video communication to augment face-to-face encounters cannot be denied. Telehealth also provides an opportunity for us to see how our recommendations are received and implemented. As communication specialists and health care providers, we should make sure that our patients are counseled to be proactive in communicating with health care providers virtually. We should also attempt to fill the vacuum in the health care space by communicating effectively so that patients and providers are informed on how best to maximize hearing, listening, and understanding during clinical encounters. Let's take advantage of opportunities despite the many downstream consequences of the COVID-19 pandemic.

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