Texting with teen patients strengthens connections

VANCOUVER – BC Children’s Hospital is testing a two-way texting platform to build deeper relationships with patients through weekly texts. Early evidence and ongoing research is revealing that small texts can have big impacts for providers and patients.

Often, young patients are hesitant to join support groups; moreover, they often forget to keep their clinicians up-to-date about changes in their health.

Recently, cardiologist Dr. Katey Armstrong realized that weekly texts with her patients at the Heart Centre could help maintain the lines of communication and improve their long-term outcomes. (Dr. Armstrong is pictured in photo with Astrid De Souza, prior to the COVID pandemic.)

“At BC Children’s Hospital, we interact closely with the parents and caregivers, often starting from the time our patients are babies,” said Dr. Armstrong.

“But what happens as the patients grow up, and need to become more independent? How do we build relationships with them directly, in addition to their parents and caregivers?”

One recent review of adolescent transplant recipients transitioning from child to adult care found that some of these young adults were becoming less engaged with their own care, missing appointments and routine bloodwork. As a result, eight to 10 percent would lose their graft organs as teens or young adults – a catastrophic outcome.

“Even before teens transition to adult care, ongoing communication is crucial for ensuring their health,” said Astrid De Souza, a clinical exercise physiologist in cardiology at BC Children’s Hospital.

“Kids in cardiology have complex health situations that require a team of people to take care of them,” said De Souza. “But we see a lot of these patients might not fully understand their own heart condition and care – it’s often their parents dragging them to appointments.”

The Heart Centre team launched a research project, starting with focus groups to learn from teens about their communication preferences.

“Rather than assuming or guessing, we just asked what the patients wanted – and they said texting,” explained Dr. Armstrong.

A Vancouver non-profit called WelTel provided the technical platform for secure, bi-directional clinical texting, and the team at BC Children’s Heart Centre set up pilot research projects, enrolling patients.

Weekly, these patients get texts asking “How are you?”

When a patient replies, a team of clinicians reads and triages responses, to address any care concerns or questions, provide encouragement, or schedule in-person appointments if needed.

Early research shows patients and providers alike love texting, and texting has become part of the support system for some patients.

Weekly texts are game-changing for care providers, too.

“In my years of practice, if one thing has really transformed the way I interact with my patients, it’s being able to chat to them on this platform,” said Dr. Armstrong. “We get to text about their care, but also about things like their birthday plans and favourite bands. Building those relationships is key for our patients to see themselves in the drivers’ seat of their own healthcare.”

A strong relationship makes all the difference to help patients with ongoing, at-home aspects of care like exercise, said De Souza. It only takes about 15 minutes per week for her to text with patients – significantly less time than phone calls or appointments.

“When those patients come in for an appointment, I can start a real conversation,” she said. “Most importantly, we get to show teens that we care and we’re listening to them.” After more than 15 years as a clinical exercise physiologist, De Souza finds that texting finally enables her to provide the care in ways she’s always wanted to.

The BC Children’s Heart Centre team are continuing to learn and build the evidence base for how to best care for and communicate with their teen patients, and is expanding the research to additional patient groups.

“The possibilities are endless,” said De Souza “It’s a little idea, but this research has such big potential to revolutionize how we’re providing care.”

BC Children’s Hospital Research Institute is part of BC Children’s Hospital and the Provincial Health Services Authority, supported by BC Children’s Hospital Foundation and working in close partnership with the University of British Columbia. With more than 350,000 square feet devoted to research, our institute is the largest of its kind in Western Canada – in terms of people, productivity, funding and size.

Cardiac Services BC works to ensure all British Columbians have access to the best possible cardiac care by working with the health authorities to improve the way cardiac services are managed and accessed throughout the province. It also ensures quality access and sustainability within B.C.’s cardiac care system and promotes knowledge translation and system transformation.