Exploring patient, family, and palliative care professional’s experiences of rapport in telehealth encounters

Abstract

Introduction: Telehealth has experienced unprecedented growth in response to the COVID-19 pandemic, as at that time healthcare moved away from in-person interactions to protect patients and staff. However, there has been concern from health professionals about the possible disruption to developing rapport when using telehealth with patients and families at home. This is particularly so in palliative care, where rapport is considered essential to patient and family care. Aim: This study set out to explore the experiences of rapport between patients, families, and health professionals during telehealth encounters. The intention was to generate new knowledge and theoretical insights to improve the development of rapport during telehealth interactions in palliative care. Methods: The study used an Interpretive Description approach with 3 phases: 1) patient and family interviews, 2) health professional focus groups and interviews, and 3) applying findings to the Theory of Human Relatedness. Findings: This study provides several original findings. Firstly, a new conceptual definition of rapport was developed, grounded in the rapport experiences of patients and families during telehealth calls. Further, patients and families identified the “vibe” of the health professional as vital to the development of rapport during telehealth calls. The “vibe” was related to the presence and skill of the health professionals, not the technology used to communicate. Palliative care health professionals identified the complexities of telehealth calls and the soft skills required to develop rapport. Importantly, the adapted Rapport and Relatedness model identified interactions with a lack of rapport or pseudo-rapport which were unsatisfactory, and potentially harmful for patients and families, as well as health professionals. Conclusion: This thesis adds important new knowledge about what constitutes rapport and how it is experienced during telehealth calls. Rapport is a vital soft skill that requires health professionals to be present and reflexive, with an associated need for training in rapport and telehealth. Interactions with rapport were the preferred state of relatedness during telehealth calls, and further research is recommended into interactions with pseudo-rapport or no rapport. Taken together, the findings of this thesis provide evidence that rapport, as defined in this study, can not only be achieved using telehealth, but rapport is fundamental to safe person-centred telehealth encounters.