COMMUNICATION CONUNDRUMS OF COVID-19- BARRIERS TO COMMUNICATING WITH DEAF AND HARD OF HEARING PATIENTS DURING A PANDEMIC

ABSTRACT

CASE A 53-year-old female with a past medical history of neonatal meningitis complicated by congenital deafness was admitted for evaluation of disorientation. Collateral history provided by family revealed progressive fatigue and labial itching for 1 month. Physical examination revealed excoriated, irregular nodules of the labia with partial obstruction of the vaginal canal. CT of abdomen and pelvis revealed a large mass involving the posterior wall and floor of the bladder with extension to the vagina and vulva, inguinal lymphadenopathy, and multiple liver masses. The admitting team attempted communicating with the patient using a virtual American Sign Language (ASL) interpreter via an iPad and written communication, but both were limited by the patient's vision impairment. The patient was able to lip-read, but this approach was complicated by the need for mask-wearing during the COVID-19 pandemic. The care team was reluctant to remove their masks to avoid putting the patient's health at risk, as her vision impairment would have required them to stand close. The team attempted to arrange for family to assist with communication, but this was limited by hospital policy restricting visitors due to COVID-19. Eventually, an interdisciplinary goals-of-care meeting was held with the patient and her family to discuss diagnosis with the assistance of in-person ASL interpreters. The patient had a better understanding of her diagnosis with in-person interpretation but expressed feeling excluded from her care plan and lack of empathy in communication from her providers. IMPACT/DISCUSSION: This care team was faced with multiple barriers to conveying a life-changing diagnosis and holding a meaningful goals-of-care discussion with the patient. The goal was to convey a diagnosis and create a plan through shared decision-making as promptly and empathetically as would be done for a patient without these barriers to communication. Despite exhausting the available resources for communicating with the deaf population, the ability to communicate at the same standard as patients without their medical condition remained limited. It is important to identify the limitations to communication in this case to improve communication with deaf patients. Unavailability of in-person ASL interpreters during the night, lack of staff education regarding resources available to facilitate communication between providers and patients who are deaf, prevention of communicating emotion with ASL due to mask-wearing, and prevention of family member visitation, who often develop their own effective ways of communicating, due to hospital policy were all barriers to effective communication in this case. CONCLUSION: This case illustrates the challenges imposed by COVID-19 safety precautions on communicating with patients who experience deafness as well as the need for new resources and staff education on current resources available, both inside and outside of their institutions, to assist with communicating with deaf patients.