“She Always Knew I Would Call”: The Role of Family Liaisons in Serious Illness Communications During the COVID-19 Pandemic (GP719)

OUTCOMES: 1. Recognize at least 3 ways in which continuity of care is important in serious illness communication in end-of-life care for patients and families 2. Describe the role of the family liaison in supporting medical teams and patients’ families around end-of-life care communication IMPORTANCE: Due to visitor restrictions across hospitals during the COVID-19 pandemic, many families of critically ill patients could not be physically present with loved ones who were near the end of life (EOL). Clinicians also struggled with relying on telecommunication to deliver prognosis and offer support to grieving families. In an effort to optimize care teams, non–palliative care clinicians became family liaisons to provide phone or video updates to families of patients in the intensive care unit (ICU). OBJECTIVE(S): To understand the role of family liaisons in end-of-life communication during the COVID-19 pandemic. METHOD(S): We conducted semistructured audio interviews with 23 clinicians (with additional interviews under way), 7 of whom were redeployed family liaisons, who worked with ICU patients at two U.S. academic hospitals that experienced surges in COVID-19 admissions. Transcripts were analyzed via thematic analysis. RESULTS: When patients’ families could not visit in person and were not able to grasp the seriousness of the patients’ rapidly deteriorating conditions, ICU clinicians experienced heightened distress and worried about providing care discordant with patients’ EOL wishes. Additionally, staff shortage and frequent team changes made it difficult for clinicians to provide timely and consistent updates via phone or video. Family liaisons, mostly recruited into the role due to the circumstances of COVID-19, reported that they served as a figure of continuity for families and medical teams and found meaning in their role by establishing trust and rapport with families, providing daily updates, and preparing families for goals-of-care conversations despite language or cultural differences. One ICU clinician reported that liaisons “took the burden and worry away” for teams and families. CONCLUSION(S): Continuity of care is essential in serious illness communication and may be provided by non–palliative care clinicians to help mitigate challenges during EOL care. IMPACT: Our findings highlight the need for institutional resources to help support the family liaison role.