CAN (LET’S) was invited to take part in a follow-up focus group to provide input on how to evaluate the process of the Virtual Care Educational Products project. The evaluation team wanted to gather perspectives from patients, caregivers and learners experience in participating in this research project.

Results of this research will be presented at medical education conferences and published in academic journals. The following is an abbreviated version of the report.

Introduction
The COVID-19 pandemic has resulted in rapid and widespread adoption of virtual care, and clinicians will continue with hybrid care in the future. With this reality comes new challenges, responsibilities as well as opportunities. The goal of the project is to partner with patients, caregivers and learners to co-design learning materials to support virtual care education.

This report is a summary of the result of the second phase of the study: Focus group and individual interviews.

Emergent themes:
Analyzing focus group and individual interviews identified 7 themes demonstrating patients and caregivers experience navigating virtual care.

Theme 1: Technological benefits
Overall, participants expressed positive remarks toward virtual healthcare and recommended continuous in a hybrid format. General reported benefits include greater accessibility, decreased travel time and cost, efficiency, more selections for healthcare services, and greater inclusivity as more members of the care team and family can attend appointments. Participants also referred to increased mental comfort as another beneficial feature of virtual care. They believed this format provides a safer space for people with anxiety, members of 2SLGBTQIA+ community, and vulnerable and immunosuppressed patients.

Participants also identified some disadvantages to virtual care, including a digital divide (i.e., unequal access to suitable technology due to age, ability, socioeconomic status, and network access), lack of best practice in virtual care, confidentiality and privacy, and lack of physical contact and physical assessment.

Theme 2: Communication Skills and Strategies:
Communication skills and strategies refer to participants comments about enhancing communication skills and abilities in virtual format so that the information is being conveyed and shared clearly.

Sub-themes related to this theme include active listening, verbal and non-verbal communication skills, and follow-up appointment summary.

Almost all participants placed a very high value on healthcare practitioners’ communication skills and believed that the nature of the virtual care might cause distraction and ambiguity in communication. Hence, in virtual care, active listening skills, asking open-ended questions, speaking more slowly and clearly, and adding more pauses during conversations are more critical than in a non-virtual format.

When asked about the most important skills students need to know about virtual care, many participants referred to active listening skills, being present and committed.

Several participants also talked about the importance of receiving a follow up email that summarizes everything that are discussed during the virtual meeting.

Theme 3: Participants noted that they “want to be treated with respect” and believed that factors such as proper introductions, demonstrating compassion, getting to know
patients, respecting their needs and expectations, and privacy and confidentiality are critical in establishing rapport, trust and mutual respect in virtual care.

In addition, participants emphasized that virtual care is not just about “writing prescriptions and making a diagnosis”; having a holistic (whole person) view is the key. Highlighting the importance of humanizing the process and making a connection with patients.

Theme 4: Inclusion
The inclusion theme refers to participants’ comments on establishing and strengthening approaches to inclusion, diversity, equity, and accessibility in virtual care. Subthemes related to the inclusion theme include equity, equal power dynamics, and inclusive terminology.

Participants talked about a divide that virtual care may create due to unequal accessibility to suitable technology based on socio-economic status, age, ability, technology and network access. Biases were another factor that participants believed could create a divide and exclude a patient from the care team.

Theme 5: Information/Education/Support
The sheer power of education to change behaviours, actions, and thoughts is why this research project is critical for the future of virtual care. When it comes to quality healthcare, participants highlighted how important it is to have all affiliated care team members be thoroughly informed which can include the lead staff physician to the patient in the spotlight. Participants shared several clear benefits of sharing information.
A person teaching an older adult how to use Zoom on a laptop.

On the other hand, patients should be taught how to access and navigate the virtual platform chosen for the appointment (i.e., how to set up Zoom). From another perspective, medical students are the future of our healthcare and should be educated on best practices to prevent the formation of ill habits.

Theme 6: Professional Presentation
When it comes to healthcare, maintaining a professional practice is of utmost importance to ensure patients feel welcomed and trusting. For virtual care, participants took to note how significant it was for how a physician presents oneself across the phone and in front of the camera. Patients will notice if one is not looking into the camera, or is multitasking by filling out paperwork, or if the attire chosen is more suited for going to the beach; these actions are not appreciated.

Several participants claimed distaste when a lack of coordination was apparent across a healthcare team. Although an advantage of virtual care is its ability to conduct interprofessional care more easily, all team members must be on the same page before interacting with a patient. The spread of different opinions can damage the trust a patient has.

Theme 7: Autonomy
As one of the four pillars of medical ethics, autonomy, the respect for patient’s freedom, plays a significant role in virtual care. With the push to use telephone, email, and videoconferencing platforms for healthcare appointments since the onset of the COVID-19 pandemic, physicians now have more options to choose from for how they can administer their service. However, participants have noted that this choice can be maladaptive if physicians abuse virtual care for their own benefit. Not all patients are comfortable with a telephone or Zoom call and in many instances, they would prefer an in-person visit due to varying and valid reasons. As a result, participants advocated for a more collaborative decision- making process for selecting the method of service.

Enabling personal preference blends itself into other core principles that should be practiced such as welcoming patient’s thoughts, encouraging new questions, and addressing serious concerns. With regards to virtual care, the inherent issue about privacy and confidentiality was echoed across all patients. Is the physician recording our conversation? Is there another individual listening to the conversation?

Conclusion:
The abundant of rich information gained from these focus groups brings to the light the positives and negatives of virtual care. The main belief shared across all groups was that virtual care is here to stay with the critical understanding that improvements must be made. The numerous benefits offered such as increased accessibility and greater inclusivity reinforces virtual care. On the other hand, issues such as a lack of patient preference to disparities with technological access proves the necessity to evaluate virtual care. It is clear that the COVID-19 pandemic forced virtual care to abruptly be incorporated into the healthcare system without much deliberation. However, as with all aspects of the healthcare system, we as patients, caregivers, learners, clinicians, and educators must do our diligence in making changes to yield a better future.

CAN (LET’S) and Vancouver Pride Society have been working together since CAN (LET’S) was hired in 2019 to do accessibility audits of their events.

In February, we met with Joseph, their Community Engagement Manager. We talked about plans for this summer’s Pride events and CAN’s (LET’S) roles and responsibilities.

We look forward to continue working on accessibility at Pride events. Pride should be available and equitable for all 2SLGBTQIA+ folks and our allies. We will have updates over the next few months. Stay tuned!

In 2022, CAN (LET’S) took part in a patient / public consultation focus group for the project “Bringing patients and society back into the social accountability of a medical school.” 1 of the questions at the focus group was about guiding principles for engagement and as a consequence of the consultations 8 guiding principles have been identified.

The researchers are now in the stage of disseminating the results of the project. They plan to create a set of resources (power point slides, speakers notes, handouts etc), that they and others can use when making presentations to different groups.

Focus group members, patient and public members, gathered to create a video speaking to the guiding principles. This video will be utilized with academic audiences so that they can hear directly from people with lived experience about the importance of the principles.

The Stigma Organizational Assessment Cycle (SOAC) project is the result of a community call to action for stigma reduction advocacy in BC. Their goal is to support organizations to learn how their programs and services may be contributing to stigma and discrimination and identify opportunities and actions for change.

This project aims to develop a learning cycle for BC organizations to assess, and then address stigma and discrimination within their organizations. They will base this learning cycle on an accreditation or audit process and create tools and resources – including a peer-based surveyor team — for organizations to discuss areas of potential improvement related to stigma and discrimination, gather data to support learning, and provide mechanisms for action planning to implement real change.
The idea for SOAC emerged at the Stigma Reduction Interventions Deliberative Dialogue hosted by PAN (Pacific AIDs Organization) in 2019. The catalyst for the Deliberative Dialogue was our work leading the BC People Living with HIV Stigma Index, a community-based research study.

CAN (LET”S) was contacted by this exciting new project to contribute to better health and social outcomes for people in BC by sharing stories of our members experiences with stigma.

The Spinal Cord Injury Association has a long history of helping people with spinal cord injuries and related disabilities and their families, adjust, adapt, and thrive. As part of this, they have a sexual health website. SCI requested that CAN review the sexual health website to ensure it is equitable and informative for 2SLGBTQIA+ folks.

CAN (LET’S) was contacted on behalf of the Sustainability Ambassadors Program at the University of British Columbia. The team is creating an open access Sustainability and Society Guidebook that explores the intersections of climate and social justice. Their goal in creating this guidebook is to amplify the voices of marginalized people and empower youth to take ownership of their learning and become agents of change in their communities.

They wanted to collaborate with Creating Accessible Neighbourhoods and have us share our experiences and wisdom about how disability justice is connected with climate justice and sustainability. Stories will be integrated into their research, alongside a set of actions readers can take to shape safer and more equitable communities.

CAN (LET’S) was contacted by the Acting Academy Manager at Realwheels Theatre. They emailed regarding our Disability Awareness workshop. As their students get to know one another and work together, Realwheels believed that a workshop on this subject would be beneficial to the class. They were specifically looking for a workshop with lived experience. CAN’s (LET’S) presentation are filled with lived experience, both from our facilitators and our members. We find that stories, and the emotions those stories evoke, make a greater long-term impact on participants. We were referred to Realwheels Theatre by the Co-Executive Director of Kickstart Disability Arts and Culture. We will be setting up a date for the workshop soon.

In December, CAN (LET’S) was contacted by an employment consultant of Inclusion Langley Society. The consultant was referred to CAN (LET’S) by a participant of our Breaking Barriers workshop. The consultant wanted to reach out to see if we would meet with them and a client about the work that we do because the client is interested in going into a similar line of work. The consultant had heard CAN (LET’S) at the “Building a Safe Culture in Employment Services” seminar hosted by Focus Disability Network Society. They thought we would be a great organization for their client to speak to. We set up a time for the three of us to have a conversation. In the end, the client will be volunteering with CAN (LET’S) in the Spring on our Disability History workshop creation. We are glad to have them onboard and provide them with experience in a social justice organization.

Affirming Connections reached out to talk with CAN (LET’S). Affirming Connections is an organization that seeks to support people of faith, ministries, and organizations who work to eliminate religious discrimination and exclusion. CAN (LET’S) has been booked to speak at their Affirming Leaders Day on May 21. The event is a faith-based development & connection day for 2SLGBTQIA+ folks and allies.

They are still working on this year’s theme, but they are interested in conversations about accessibility, solidarity and intersectionality between 2SLGBTQIA+ folks and other marginalized communities. CAN (LETS) will provide a session focused on how faith communities can be more actively accessible and how this work might synchronize with their efforts to affirm 2SLGBTQIA+ members of their community.