Exploring Nurse and Patient Experiences of Developing Rapport During Oncology Ambulatory Care Videoconferencing Visits: Protocol for a Qualitative Study

Rapport: A conceptual definition from the perspective of patients and families receiving palliative care

OBJECTIVE

To explore patient and family perceptions of rapport in interactions with health professionals and use the findings to develop a conceptual definition of rapport.

METHODOLOGY

We undertook a qualitative Interpretive Description study; semi-structured interviews were conducted between November 2020 and May 2021. Participants included 18 patients and 11 family members recruited using a random approach from four hospice locations in Aotearoa, New Zealand. Interviews were audio recorded, transcribed, and analysed to develop a conceptual definition of rapport using guidelines (Podsakoff et al., (2016). A COREQ checklist was completed.

RESULTS

Four dimensions of rapport were identified which formed the basis of a conceptual definition: 1) the type of relating, 2) the essence of rapport experienced, 3) key communication characteristics, and 4) the effect on interactions.

CONCLUSION

Based on patient and family experiences of rapport, this study formulated a conceptual definition of rapport. This definition will support clinical education and practice and inform future research related to rapport.

PRACTICE IMPLICATIONS

A conceptual definition of rapport can provide clarity for both research and clinical practice. It may be used as a tool for health professionals to reflect upon their experiences with rapport and develop expertise in this area.

The role of telehealth on quality of life of palliative care patients during the COVID-19 pandemic: an integrative review

Telehealth looks to be a viable tool to meet patients’ expectations and requirements during home treatment; however, there are obstacles to overcome. Palliative care has been described as ‘high touch’ rather than ‘high tech’, which may restrict healthcare workers’ enthusiasm in integrating technological advances into the development and refinement of interventions. As a result, the goal of this integrative review was to map and evaluate existing research on the use of telemedicine and telehealth in palliative care patients during the COVID-19 outbreak. This review was guided using the PRISMA Model and CASP guidelines. A total of 17 articles on the use of telehealth in palliative care satisfied the inclusion and exclusion criteria of the review. This integrative review provided more evidence for the function and application of telehealth in palliative care. It demonstrated the resiliency of individuals in swiftly adjusting to a new system or application and the adaptability of healthcare systems and providers in establishing an alternate means of providing treatment to patients during a crisis.

Nurse-Led Telehealth Interventions During COVID-19: A Scoping Review

Since the outbreak of COVID-19, telehealth expanded rapidly and was adopted as a substitute for in-person patient and nurse visits. However, no studies have mapped nurse-led telehealth interventions during the pandemic. This study aimed to identify and summarize the strengths and weaknesses of nurse-led telehealth interventions for community-dwelling outpatients during the COVID-19 pandemic. This study used a scoping review methodology and was guided by the Preferred Reporting Items for Systematic Reviews and Meta-analyses Scoping Review Extension. Five electronic databases were searched to find studies published in English peer-reviewed publications between January 2020 and February 2022. A total of 490 articles were retrieved, of which 23 empirical studies were selected based on the inclusion/exclusion criteria. Primary studies from nine countries with a variety of research designs were included. Four strengths and three weaknesses of nurse-led telehealth interventions for patients during COVID-19 were identified. For telehealth services to provide effective, efficient, and quality patient care, future research and nursing practice need to overcome the identified weaknesses of current nurse-led telehealth interventions. More rigorous evidence-based research and updated and standardized guidelines for nurses' telehealth services will help improve the quality of patient care. Nurse managers, leaders, and policymakers can use the findings of this scoping review to refine the current telehealth services system.

Exploring Nurse and Patient Experiences of Developing Rapport During Oncology Ambulatory Care Videoconferencing Visits: A Qualitative Study (Preprint)

Background

Although videoconferencing between oncology patients and nurses became routine during the pandemic, little is known about the development of clinician-patient rapport in this care environment. Evidence that virtual visits may challenge nurses’ ability to form connections with patients, demonstrate empathy, and provide support suggests that videoconferencing may not ensure optimal care for persons with cancer. Establishing rapport during videoconferencing visits (VCVs) is important in oncology nursing, as rapport enables the nurse to provide emotional support and assistance to patients as they navigate their cancer journey.

Objective

This study investigated the nature of nurse-patient rapport in ambulatory cancer care videoconferencing telehealth visits. Objectives included exploring (1) how patients with cancer and nurses describe experiences of and strategies for cultivating rapport and (2) similarities and differences between rapport in videoconferencing and in-person visits (IPVs).

Methods

In this qualitative descriptive study, interviews were conducted from October 2021 to March 2022 with 22 participants, including patients with cancer (n=10, 45%) and oncology nurses (n=12, 55%), about their experiences of rapport building during VCVs. All interviews were analyzed using conventional content analysis. Data from nurses and patients were analyzed separately using identical procedures, with a comparative analysis of patient and nurse results performed in the final analysis.

Results

Most patients in the study had experienced 3-5 video visits within the past 12 months (n=7, 70%). Half of the nurse participants (n=6, 50%) reported having participated in over 100 VCVs, and all had experiences with videoconferencing (ranging from 3 to 960 visits) over the past 12 months. In total, 3 themes and 6 categories were derived from the patient data, and 4 themes and 13 categories were derived from the nurse data. Comparisons of themes derived from participant interviews identified similarities in how nurses and patients described experiences of rapport during VCVs. Three themes fit the collective data: (1) person-centered and relationship-based care is valued and foundational to nurse-patient rapport in oncology ambulatory care regardless of how care is delivered, (2) adapting a bedside manner to facilitate rapport during VCVs is feasible, and (3) nurses and patients can work together to create person-centered options across the care trajectory to ensure quality care outcomes. Barriers to relationship building in VCVs included unexpected interruptions from others, breaks in the internet connection, concerns about privacy, and limitations associated with not being physically present.

Conclusions

Person-centered and relationship-based approaches can be adapted to support nurse-patient rapport in VCVs, including forming a personal connection with the patient and using active listening techniques. Balancing the challenges and limitations with the benefits of videoconferencing is an essential competency requiring additional research and guidelines.

International Registered Report Identifier (IRRID)

RR2-10.2196/27940