Literature on telehealth services is continuing to grow, especially in the area concerning interpersonal behaviors during telehealth sessions. Henry et al. (2017) conducted a systematic literature review to identify interpersonal health care provider behaviors and qualities related to provider-patient interaction during a telehealth session. They searched for articles which included keywords: communication, telehealth, education, and health care delivery. Of the 5,261 unique article abstracts they identified, 45 were used in their review. Among the 45 articles used, six themes were identified: pre-interactional, verbal communication, nonverbal communication, relational, environmental, and educational (Henry et al., 2017).
The Pre-interactional theme included a variety of different characteristics including beliefs, attitudes, confidence, and cultural competence that precede a positive approach toward working with patients through telehealth (Henry et al., 2017). The data suggested a relationship between clinician belief that telehealth services benefitted patients and the ease with which the clinician adapted to a role in telehealth. The stronger the belief that telehealth services can benefit the patient, the more likely it is that they will have an easier time adapting to the new role. Creativity, open-mindedness, adaptability, and flexibility were also correlated with acceptance of telehealth (Henry et al., 2017).
Henry et al. (2017) also discuss how clinicians can work towards making connections with people in distant locations. An increase in cultural awareness prior to interaction was identified as a need. This includes the importance of cultural context of the patient’s locality, community resources local to the patient, language differences, and dietary differences (Henry et al., 2017).
Three general areas of verbal communication were discussed including: types of discourse, importance of verbal skills, and the need for clear communication (Henry et al., 2017). Findings regarding verbal communication varied across studies. Some characterized telehealth visits as less patient-centered, more verbally dominated by clinicians, and patients more frequently requested information be repeated. Patients would comment that they noticed less small talk and socialization during telehealth visits and a shorter average visit time compared to face-to-face visits. However, other studies reported greater self-disclosure and more small talk by clinicians using telehealth. Telephone conversations were found to have more patient utterances, more open-ended questions, friendly jokes, and indications of listening. Overall, it is thought that more training and practice could help develop skills specific for telephone communication (Henry et al., 2017).
Examples of nonverbal communication examined included eye contact, body positioning, movement, facial gestures, voice quality, and vocal tone (Henry et al., 2017). The importance of equipment quality and placement was noted to support a ‘telepresence’ which includes non-verbal interpersonal skills. It was discussed that providers feel less control over the non-verbal aspects of telehealth sessions, and it was recommended that clinicians exaggerate motions such as nods and other actions during sessions. In general, it is recommended that clinicians develop a video presence that includes staying visually attentive, exaggerating facial expressions at times, and ensuring the patient has a clear view of the clinician’s face and body language (Henry et al., 2017).
Studies throughout the review reported ease with rapport-building through telephone communication as well as face-to-face appointments (Henry et al., 2017). It was discussed that conversations may be improved through a telephone and that non-verbal communication continues when listening is the focus. However, when working without visual cues there is a need to balance more detailed and close-ended questions with allowing the patient to talk. It was also found that caller satisfaction was higher when clinicians met expectations in five dimensions: caring, listening, clarity, collaborating, and competency (Henry et al., 2017)
Studies highlighted the importance of the environment that the clinician is in when delivering telehealth care (Henry et al., 2017). At times, patients appreciate assurances of privacy and confidentiality that go beyond the transmission of data. It was found to be problematic when clinicians delivered telehealth services while in a shared space. It is recommended that clinicians utilize headphones to increase the privacy of conversations. A clinician should do their best to make their space look like a familiar setting, instead of an unfamiliar space such as a board room. A clinician should also do their best to keep their environment distraction free, limiting interruptions that could arise during the visit.
There was a lack of consensus among the studies about what learning objectives are necessary to form clinicians with excellent interpersonal skills (Henry et al., 2017).
These findings reinforce the need for clinicians to consider visual cues and listening style when delivering telehealth services. Understanding these issues and developing adaptive mechanisms could make telehealth more readily accepted by clinicians, even when there is not a pandemic forcing them to conduct treatment this way.
Henry, B. W., Block, D. E., Ciesla, J. R., McGowan, B. A., Vozenilek, J. A. (2017). Clinician behaviors in telehealth care delivery: a systematic review. Advances in Health Science Education, 22(1), 869-888. https://doi.org/10.1007/s10459-016-9717-2
James Bender, MA
WKPIC Doctoral Intern