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Reducing social isolation during the COVID-19 pandemic: Assessing the contribution of courtesy phone calls by volunteers

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Context During the COVID-19 pandemic, restrictions were imposed on visits in hospitals in the province of Quebec, Canada in an effort to reduce the risk of viral exposure by minimizing face-to-face contact in order to protect patients, visitors and staff. These measures led to social isolation for patients. In order to reduce this isolation, CHUM (the Centre hospitalier de l’Université de Montréal, a teaching hospital) shifted from in-person visits to courtesy telephone calls delivered by volunteers from CHUM’s Volunteers, Recreation and Leisure Department. Objectives To study: (1) the contribution made by these calls to reducing isolation and their limitations, (2) how the calls can be improved, and (3) whether they should be maintained, based on the views of patients and volunteers. Methodology This study examined two populations. The first one consisted of 189 adult patients hospitalized at CHUM who received a courtesy phone call from a volunteer and the second one consisted of the 25 CHUM volunteers who made these calls. Quantitative data were collected from patients and volunteers through questionnaires and a Smartsheet. The patient questionnaire evaluated isolation, the courtesy phone calls, the relationship of trust with the volunteer and sociodemographic questions. The volunteer questionnaire evaluated the appropriateness of the technology for the intervention, the support and training received, the impacts of the courtesy phone call on both the patients and the volunteers, an experience report and sociodemographic information. In addition, a focus group was held with 7 volunteers. Then the verbatim were transcribed and analyzed using QDA miner software. Results From April 27, 2020 to September 5, 2020 more than 11,800 calls were made, mainly concerning hospitalization conditions or home follow-ups (n = 83), and relationships with relatives, friends, and family (n = 79). For 73.6% of hospitalized patients, the courtesy calls from volunteers were a good response to their needs, and 72% of volunteers agreed. 64.5% of patients felt less isolated and 40% of volunteers felt useful. Conclusion Our data suggest that patients felt less isolated during their hospitalization because of the courtesy calls made by the volunteers, that smartphones could also be used for video calls and, finally, that maintaining this type of service seems as relevant after as during a pandemic to provide social interactions to people isolated for medical reasons.
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RESEARCH ARTICLE
Reducing social isolation during the COVID-19
pandemic: Assessing the contribution of
courtesy phone calls by volunteers
Louise Normandin
1
, Caroline Wong
2
, Vincent Dumez
2,3
, Kathy MalasID
4
,
Alexandre Gre
´goire
2
, Julie Gre
´goire
5
, Lise Pettigrew
6
, Nicolas Allanot
6
, Ce
´cile Vialaron
1
,
Sabrina Anissa El Mansali
1,6
, Christine Nguyen
1,3
, Fabrice Brunet
3,4
, Marie-
Pascale PomeyID
1,2,7,8
*
1Innovation Axis, Research Center of The Centre Hospitalier de l’Universite
´de Montre
´al, (CHUM), Montre
´al,
Que
´bec, Canada, 2Center of Excellence on Patient Partnership and The Public, Montre
´al, Que
´bec, Canada,
3Faculty of Medicine, Universite
´de Montreal, Montre
´al, Que
´bec, Canada, 4General Directorate, Centre
hospitalier de l’Universite
´de Montre
´al, Montre
´al, Que
´bec, Canada, 5Education and Academy Directorate,
Centre Hospitalier de l’Universite
´de Montre
´al, Montre
´al, Que
´bec, Canada, 6Volunteer, Recreation and
Leisure Department, Centre Hospitalier de l’Universite
´de Montre
´al, Montre
´al, Que
´bec, Canada,
7Department of Health Management, Evaluation, and Policy, School of Public Health, Universite
´de
Montre
´al, Montre
´al, Que
´bec, Canada, 8Research Chair in Evaluation of State-of-the-Art Technologies and
Methods, Montre
´al, Que
´bec, Canada
*marie.pascale.pomey@umontreal.ca
Abstract
Context
During the COVID-19 pandemic, restrictions were imposed on visits in hospitals in the prov-
ince of Quebec, Canada in an effort to reduce the risk of viral exposure by minimizing face-
to-face contact in order to protect patients, visitors and staff. These measures led to social
isolation for patients. In order to reduce this isolation, CHUM (the Centre hospitalier de l’Uni-
versite
´de Montre
´al, a teaching hospital) shifted from in-person visits to courtesy telephone
calls delivered by volunteers from CHUM’s Volunteers, Recreation and Leisure Department.
Objectives
To study: (1) the contribution made by these calls to reducing isolation and their limitations,
(2) how the calls can be improved, and (3) whether they should be maintained, based on the
views of patients and volunteers.
Methodology
This study examined two populations. The first one consisted of 189 adult patients hospital-
ized at CHUM who received a courtesy phone call from a volunteer and the second one con-
sisted of the 25 CHUM volunteers who made these calls. Quantitative data were collected
from patients and volunteers through questionnaires and a Smartsheet. The patient ques-
tionnaire evaluated isolation, the courtesy phone calls, the relationship of trust with the vol-
unteer and sociodemographic questions. The volunteer questionnaire evaluated the
appropriateness of the technology for the intervention, the support and training received, the
PLOS ONE
PLOS ONE | https://doi.org/10.1371/journal.pone.0266328 May 4, 2022 1 / 14
a1111111111
a1111111111
a1111111111
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OPEN ACCESS
Citation: Normandin L, Wong C, Dumez V, Malas
K, Gre
´goire A, Gre
´goire J, et al. (2022) Reducing
social isolation during the COVID-19 pandemic:
Assessing the contribution of courtesy phone calls
by volunteers. PLoS ONE 17(5): e0266328. https://
doi.org/10.1371/journal.pone.0266328
Editor: Rosemary Frey, University of Auckland,
NEW ZEALAND
Received: February 6, 2021
Accepted: March 20, 2022
Published: May 4, 2022
Copyright: ©2022 Normandin et al. This is an open
access article distributed under the terms of the
Creative Commons Attribution License, which
permits unrestricted use, distribution, and
reproduction in any medium, provided the original
author and source are credited.
Data Availability Statement: All relevant data are
within the paper and its Supporting Information
files.
Funding: MPP, FB, AG, KM, VD. This study was
funded by the Canadian Institutes of Health
Research (VR4 - 172769). Additionally, funding for
the study was provided by MPP from a Senior
Career Award financed by the Quebec Health
Research Fund (FRQS), the Centre de Recherche
du Centre Hospitalier de l’Universite
´de Montre
´al
and the ministère de la Sante
´et des Services
impacts of the courtesy phone call on both the patients and the volunteers, an experience
report and sociodemographic information. In addition, a focus group was held with 7 volun-
teers. Then the verbatim were transcribed and analyzed using QDA miner software.
Results
From April 27, 2020 to September 5, 2020 more than 11,800 calls were made, mainly con-
cerning hospitalization conditions or home follow-ups (n = 83), and relationships with rela-
tives, friends, and family (n = 79). For 73.6% of hospitalized patients, the courtesy calls from
volunteers were a good response to their needs, and 72% of volunteers agreed. 64.5% of
patients felt less isolated and 40% of volunteers felt useful.
Conclusion
Our data suggest that patients felt less isolated during their hospitalization because of the
courtesy calls made by the volunteers, that smartphones could also be used for video calls
and, finally, that maintaining this type of service seems as relevant after as during a pan-
demic to provide social interactions to people isolated for medical reasons.
Introduction
Faced with the unprecedented health situation related to the SARS-CoV-2 pandemic [1], the
government of the province of Quebec, Canada declared a health emergency on March 13,
2020 (section 118 of the Public Health Act (chapter S-2.2) [2]. With the implementation of this
exceptional measure and to protect the health of the population (section 123), the government
ordered the prohibition of visits to hospitals and long-term care centers (CHSLDs) [2] in
order to limit the spread of COVID-19 in these institutions. However, these measures can lead
to the isolation of individuals, which has adverse effects on mental health [3]. Moreover, previ-
ous studies have shown that feelings of loneliness have negative consequences on both mental
and physical health and that they can significantly increase the risk of death, particularly
among older men [4]. In this context, and to reduce social isolation and feelings of loneliness
among hospitalized patients, while limiting the risk of contamination, the Centre hospitalier
de l’Universite
´de Montre
´al (CHUM), facilitated by its School of Artificial Intelligence in
Healthcare [5] and all its departments, including the Centre of Excellence on Patient and Pub-
lic Partnership, implemented several social and technological innovations, one of which con-
sists in organizing courtesy phone calls from volunteers at CHUM’s Volunteers, Recreation
and Leisure Department. This Department has 975 volunteers, who are all trained prior to
their volunteering in patient experience and interaction and are supported continuously in the
organization by five permanent employees. It intervenes at the clinical level by welcoming, ori-
enting and visiting patients, visitors and attendants as well as by participating in facilitation
and leisure activities or by helping with vaccination campaigns, public events, administrative
tasks for certain sectors, etc.
To implement these courtesy phone calls to all hospitalized patients, CHUM’s Volunteer
Recreation and Leisure Department sent an e-mail to all 1,000 volunteers inviting them to par-
ticipate in this new form of volunteering. Normally the hospital’s volunteers would provide lis-
tening and support at bedside. A total of 70 volunteers expressed an interest in getting
involved. The Volunteer Activities and Recreation Department then developed a training
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sociaux du Que
´bec. https://cihr-irsc.gc.ca/f/193.
html The funders had no role in study design, data
collection and analysis, decision to publish, or
preparation of the manuscript.
Competing interests: The authors have declared
that no competing interests exist.
program in the form of a 3-hour webinar that would to enable volunteers to: (1) understand
the context of the pandemic and its impact on hospitalized patients, their loved ones, caregiv-
ers and the community, (2) understand the objectives of the courtesy phone calls and their
role; (3) learn how to use the Smartsheet platform [6] (accessing lists of patients, calling for fol-
low-up), and (4) participate in a study. In addition, webinars following the initial training
allow interested volunteers to share their experiences during courtesy calls with other volun-
teers as a way to improve their interventions.
For the volunteers, the courtesy phone calls consisted of receiving a list of hospitalized
patients each day and calling them according to their availability. When the patient could be
reached, the volunteer would introduce himself or herself, inquire about the patient’s condi-
tion and enter into a general discussion based on the needs. Following each courtesy phone
call, the volunteer would document the length of the call and the topics discussed. Although
various initiatives aimed at reducing social isolation, such as telephone contact [7,8] and video
telephony using robots [9], were implemented in health systems during the COVID-19 pan-
demic [10], to our knowledge, few initiatives have been implemented in hospital settings [8,
11,12].
Therefore, the objective of this study is to evaluate the perceived contribution of these cour-
tesy phone calls to reducing the effects of social isolation among hospitalized patients in the
context of the first wave of COVID-19 as well as the volunteers’ perceptions of the contribu-
tion made by these calls. More specifically, this study investigates patients’ and volunteers’
points of view on: (1) the perceived contribution and limitations of these calls in terms of
patient isolation, (2) how they could be improved, and (3) whether they should continue in the
future.
Materials and methods
Study populations
This study examined two populations. The first one consisted of adult patients hospitalized at
CHUM who received a courtesy phone call from a volunteer in the period from May 28 to Sep-
tember 5, 2020 and the second one consisted of the CHUM volunteers who made these calls.
Patient recruitment
The criteria for selecting patients for the study were: patients whose courtesy call with a volun-
teer lasted at least 5 minutes. At the end of the call, the volunteer asked the patient whether he
or she would agree to be called by the research team to assess his or her perceptions of the con-
tribution made by the call. If the person agreed, a member of the research team would contact
the person within 24 hours of the call to present the research project and obtain oral consent
for participation in the study. If the patient agreed to participate, the questionnaire was com-
pleted immediately by phone with a member of a research team. Up to three follow-up calls
were made.
Volunteer recruitment
All the volunteers who participated in the courtesy phone calls were approached to participate
in the study by managers in the Volunteers, Recreation and Leisure Department. No exclusion
criteria were applied.
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Questionnaires
A review of the literature did not identify any questionnaires that met the specific objectives of
our study, so we drew inspiration from two questionnaires: one dealing with psychological dis-
tress [13] and the other with the partnership relationship with stakeholders [14]. The goal was
to construct two questionnaires that would take into consideration the health crisis context.
The questionnaires were developed with input from three CHUM patient partners for the
patient questionnaire and from two volunteers for the volunteer questionnaire. The question-
naires were pre-tested on samples of patients (n = 10) and volunteers (n = 4) to ensure that the
questions would be understood and to estimate the time required to answer them.
The patient questionnaire comprises eight questions that evaluate isolation (n = 1) [13], the
courtesy calls (n = 2) and the relationship of trust with the volunteer (n = 1) [14]. It also
includes sociodemographic questions (n = 4). At the end of the questionnaire, the patient can
add a comment. The questionnaire takes about 5 minutes to complete (S1 and S2 Files).
The volunteer questionnaire evaluates 6 dimensions and comprises 13 questions. It takes
approximately 5 minutes to complete and documents, for each call, the appropriateness of the
technology for the intervention (n = 3), the support and training received (n = 3), the impacts
of the courtesy phone call on both the patients and the volunteers (n = 3), an experience report
(n = 2) and sociodemographic information (n = 2). In addition, there is a space for comments
at the end of the questionnaire (S3 and S4 Files).
Responses to each question in both questionnaires are given on a 5-point Likert scale
(completely disagree / somewhat disagree / neutral / somewhat agree / completely agree). Par-
ticipants could also answer: I don’t want to answer / I don’t know / Does not apply.
Focus group of volunteers
At the end of the first wave of the pandemic, the volunteers were invited to participate in a
focus group to assess their reasons for participating in these calls, the difference between mak-
ing phone calls versus face-to-face visits, and how the relationship of trust between volunteers
and patients was established during the calls (S5 File). The focus group consisted of seven vol-
unteers and was facilitated by two people with experience in qualitative research (MPP and
LN). It lasted 60 minutes and was video recorded.
Data analysis
For the survey data, descriptive statistics were calculated using REDCap (Research Electronic
Data Capture), an application for building and managing the online surveys and databases
used to administer questionnaires, organize data collection and analyze data [15].
The focus group’s discussions were transcribed verbatim by LN, reviewed by MPP, and ana-
lyzed using QDA miner software [16]. MPP and LN identified, independently of each other,
quotes that could illustrate the answers to the questions. They then met to discuss their respec-
tive choices and determine which quotes best illustrated the participants’ ideas. The same pro-
cess was followed for the comments provided on the questionnaires. The consolidated criteria
for reporting (COREQ) checklist [17] was used to report the methodology used with the focus
group.
Ethics approval
This study received ethical approval from the Research Ethics Committee (20.040) of the Cen-
tre de recherche du Centre hospitalier de l’Universite
´de Montre
´al (CRCHUM).
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Results
Characteristics of the participants
In the study period from May 28 to September 5, 2020, 663 patients received phone calls from
volunteers. Of these, 126 (19%) had left the hospital at the time of data collection, 176 (27%)
did not respond, 37 (5%) indicated that they did not receive a courtesy phone call, and 135
(20%) refused to respond due to health or hearing problems or lack of interest and time.
Therefore, a total of 189 patients agreed to answer the questionnaire, for a participation rate of
28.5%.
The patients ranged in age from 19 to 100 years, with a mean age of 66 years. 9% of patients
(n = 16) were hospitalized for COVID-19, while the rest were hospitalized for other conditions.
The patients hospitalized for COVID-19 were 57–96 years of age, with an average age of 78
years.
A total of 69 volunteers expressed an interest in participating in the courtesy phone calls, 57
of whom made calls and filled out the Smartsheet after each call. 25 responded to the question-
naire (participation rate = 44%). 76% (n = 19) of the respondents were women.
Courtesy phone calls delivered by volunteers
General results. Between April 27, 2020 and September 5, 2020, more than 11,800 calls
were made, for a total of 39,730 minutes of conversation (equal to 662 hours) and an average
of 9 minutes per call.
The 6 topics most frequently discussed during the courtesy phone calls were the conditions
of their hospitalization or follow-up at home (n = 83), relationships with family and friends
(n = 79), illness and symptoms (n = 49), feelings of isolation (n = 24), emotions (n = 13), and
distractions in general, such as news, movies, and television (n = 12).
Patients’ answers. For 73.6% of the hospitalized patients, the courtesy phone calls from
volunteers were an appropriate response to their needs. 64.5% felt less isolated and 59.3% cre-
ated a bond of trust with the volunteer (Fig 1).
The majority of patients (69.7%) had no problem with receiving a courtesy phone call from
a volunteer. However, a few patients highlighted certain disadvantages, such as a lack of inter-
est in these calls (5%, n = 9), fear over the confidentiality of the information exchanged (1%,
n = 2), too many calls received (3%, n = 5), not enough calls received (2%, n = 4), the call being
too short (2%, n = 3), the inappropriate timing of the call (3%, n = 5), different volunteers on
each call (3%, n = 5), the volunteer’s difficulty in understanding the patient (1%, n = 1), and a
preference for speaking with a professional (1%, n = 2).
Three types of ideas emerged from the comments made by patients at the end of the ques-
tionnaire: (1) the contribution made by these calls, (2) the limitations of this type of social sup-
port, and (3) the nature of these calls (Table 1).
Volunteers’ answers
The results from the questionnaires show that 84% of the volunteers were satisfied with their
interventions with patients. For 80% of them, they believe that the patients felt less isolated as a
result of their interventions. 84% felt comfortable with the roles and responsibilities assigned
to them (Fig 2).
80% felt that the training they received was sufficient for interacting with patients, and 76%
felt they were sufficiently well equipped to respond to patient needs. 72% of the volunteers
found that the web platform met their needs (Fig 3).
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For the volunteers, their involvement had a positive impact in terms of making them feel
useful (40%, n = 10), giving to others what they themselves had received (24%, n = 6), develop-
ing new skills (12%, n = 3), feeling valued (8%, n = 2) and feeling less isolated (8%, n = 2).
However, among those who identified negative impacts, 20% did not feel up to the task or,
more marginally, 4% of the volunteers did not feel sufficiently supported in their interventions,
4% felt that they were insufficiently trained, 4% felt that they were under too many constraints,
and 4% feared that they did not fully understand their contribution.
Fig 1. Patients’ perceptions of the volunteer courtesy phone calls.
https://doi.org/10.1371/journal.pone.0266328.g001
Table 1. Comments made by patients on the courtesy phone calls.
Contribution made Limitations of the calls Nature of the calls
“The volunteers’ calls are
sweet and courteous.” (ID
623)
“I would like to continue
receiving calls from
volunteers.” (ID 439)
“The volunteers are great.”
(ID 660)
“[. . .] I have family and friends calling me,
but I find the concept interesting.” (ID
597)
“The calls from volunteers are a good
initiative, but personally, I have enough
support and don’t need it.” (ID 228)
“I don’t need volunteers’ calls, I already
have enough support. But I understand
that it’s useful for people who have few
relatives.” (ID 374)
“The conversation was boring.” (ID
71)
“I need to talk to professionals more
than volunteers.” (ID 169)
“I prefer to talk to a professional, like
a psychologist.” (ID 478)
“[. . .] our discussion was particularly
brief.” (ID 92)
“It is a different volunteer with each
call, so you can’t create much of a
bond of trust.” (ID 333)
The quotes have been translated from French.
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Lastly, three main themes emerged in the focus group: (1) the contribution made by these
calls; (2) the difficulties encountered; and (3) the improvements that could be made to the
intervention.
In terms of the contribution made by these calls, one of the volunteers said: "It reassures
patients to know that they are not alone. The response from patients, even if they don’t talk to
me for long, is always good. They usually appreciate it a lot." (Volunteer 1). The volunteers
also enjoyed making the courtesy calls. One volunteer said, "I’ve had calls that were beyond my
expectations in terms of going to the essence of what two humans can say to each other. At
one point I chatted with a fellow for an hour. It was delightful." (Volunteer 5). Another said, "It
gives me great satisfaction. [. . .] 90% of the patients are happy. Some of them want to tell us
their life story, but after 25 minutes we have to move on to another call." (Volunteer 2). More-
over, it seems that these calls lead to specific behaviours:
“On the phone, men react differently than they do in person. They are more talkative. Face
to face, women are more talkative than men." (Volunteer 3)
Fig 2. Volunteers’ perceptions of the courtesy phone calls they madeto patients.
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“Women are easier to approach than men, but this is not always the case. Some evenings,
there are as many men as women who will talk to me." (Volunteer 1)
They also emphasized the difficulties encountered making calls compared to face-to-face
exchanges. This was also reflected in the comments provided in the questionnaires (Table 2).
Fig 3. Volunteers’ perceptions of the conditions under which the calls were made.
https://doi.org/10.1371/journal.pone.0266328.g003
Table 2. Feedback from volunteers on the limits of courtesy phone calls.
Comments in questionnaires Focus group
“The calls were appreciated by most patients, but nothing
can replace physical contact for getting people to feel less
isolated.” (Volunteer 9)
“Volunteer work over the phone is not as pleasant as in
person. For many older patients, it isn’t easy.” (Volunteer
21)
“The biggest challenge is not being able to use body
language to build trust with the patient.” (Volunteer 38)
“Many patients were on the defensive, and feared they
would be tricked. Listening on the phone and a face-to-
face visit is as different as day and night. It isn’t easy for
the patient or the caller.” (Volunteer 8)
“At the beginning it’s difficult. You look for an angle for
getting the patients talking. I found my angle: I use
humour.” (Volunteer 2)
“What I find difficult on the phone, it’s that we’re not
there, you can’t see if people are asleep. [. . .]. I’m not
comfortable on the phone because you can’t see the
person. A face-to-face approach is easier.” (Volunteer
1)
“We don’t see the non-verbal clues, and we invite
ourselves into the person’s room (we don’t know if a
nurse is present) without seeing the person’s
condition.” (Volunteer 3)
“The discussions are shorter than face-to-face
conversations.” (Volunteer 4)
“I find calling patients every day a burden. [. . .] We are
cut off from the person’s humanity.” (Volunteer 5)
The quotes have been translated from French.
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In terms of ways to improve the intervention, several volunteers mentioned the importance
of having the same volunteer call a patient throughout his or her stay in order to build a rela-
tionship of trust. This makes it possible to: "In some cases, [. . .] to continue the conversation
we had last time. (. . .) It’s a warmer call, because it’s someone who recognizes me" (Volunteer
1). Such a mechanism brings us closer to a face-to-face visit:
"When a patient had been hospitalized for a long time, I would visit him or her every time I
went to CHUM. There was a bond of trust. The patient was happy to see me arrive. Some
didn’t want to see volunteers, but if they knew it was me, they’d tell me to come in. It’s true
that we’re not there to make friends, but as volunteers, sometimes it helps." (Volunteer 1)
Even if it is not a friendship, being able to talk with patients you already know can avoid the
discomfort of the first call:
"There would be a level of trust that would take hold. The discussion would no longer be at
the same level on the second call, especially with patients who are hospitalized for a long
time. On the phone, we don’t know the person, and they don’t know us, either. There is
some initial discomfort. [. . .] One person asked me if I was going to call her back.” (Volun-
teer 4).
"At the beginning of the pandemic, I was volunteering at a community center for seniors.
Calls are made once a week. I had the same list every week. I enjoyed the experience. I
could see that when we talked to people a little bit more, they were more natural and more
trusting. I go out of my way to see people I know. I feel that the presence of a volunteer, like
me, was comforting to the patient because it provides continuity. Patients like to talk to us
again." (Volunteer 5)
However, this perception was not shared by one of the volunteers:
“We drifted away from the goal of making courtesy calls. I’m not in a helping or active lis-
tening relationship with someone who I’m going to follow for weeks. I don’t want to have a
special relationship and find myself dealing with people’s problems. I don’t want to be their
friend. I will avoid getting too involved with someone. It would get too personal.” (Volun-
teer 2)
Lastly, on the issue of whether these courtesy calls should be maintained, the volunteers
expressed an interest in maintaining them throughout the COVID-19 crisis, and also sug-
gested going beyond that, but as a complement to on-site visits for some volunteers who can-
not travel or to be in contact with patients who are feeling isolated. The younger volunteers
also wanted these calls to continue, as they give them greater flexibility in their interventions
with patients.
Discussion
Overview of the findings
This study evaluates both volunteer and patient perceptions of the implementation of tele-
phone calls, known as courtesy phone calls, by volunteers to patients in an attempt to limit the
effects of the ban on family visits during the first wave of the COVID-19 pandemic.
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Strengths of the intervention
Both the patients and the volunteers greatly appreciated receiving and placing the courtesy
phone calls. For the patients, what they appreciated most was being able to feel less isolated,
and being able to establish a relationship, even a short one, with someone who was willing to
listen and talk with them. For the volunteers, the calls also helped them feel less isolated and
more useful during the pandemic when their presence on hospital premises was forbidden.
These findings corroborate other studies of calls implemented during this pandemic. One
involves telephone calls made by medical students to seniors. This study found that seniors’
feelings of social isolation were reduced [7]. In another study, a medical student volunteer pro-
gram was established to provide remote social support to hospitalized patients in order to help
combat isolation. This study mentions that many hospitalized patients felt isolated and asked
to speak with the medical student again [11]. The other initiative was undertaken by staff
members, who called patients daily during their hospital stay, to maintain a human connection
with the patients while limiting face-to-face patient care interactions [8]. This study reports
that upwards of 90% of the patients called said that they would appreciate receiving another
call on the following day. Furthermore, patients said that they looked forward to these calls as
a bright spot in their day. The differences between our study and the other studies in terms of
the need for call-backs can be explained by population characteristics (long stays versus short
stays) and by the characteristics of the callers, since the health professionals had already estab-
lished a relationship of trust with the people called.
Another finding from this study, as noted by the volunteers, was their ability to make better
contacts with male patients by telephone than they could in face-to-face visits. According to
the female volunteers, this removes some of the discomfort men experience in opening up.
The telephone medium makes them less reluctant to express themselves and talk about
themselves.
Moreover, the initiative is quick and easy to deploy when organizations have a structured
department of trained volunteers supported by the executive office and senior leadership. Vol-
unteers were easily recruited in sufficient numbers, their retention rate was good over the
study period, the equipment used was already in place, and the relatively short training
responded to the needs in the field. The only thing added was the coordination of calls by a
volunteer manager.
Limitations of the intervention
There were a number of difficulties encountered with telephone calls made by volunteers in a
short-stay hospital. The volunteers remarked that it was more difficult to get in touch with
patients, to speak with them again, and to adjust their approach based on the individual’s per-
sonal situation on a local call, knowing the patient’s environment. In addition, not all patients
needed courtesy calls: some were in a clinical condition that prevented them from answering
the phone, and others had a social network that already served this purpose through phone
calls. Some patients also underscored how it can be difficult to establish a connection with a
new person on each call, or that they would have preferred calls from professionals. To our
knowledge, the literature does not mention such results.
This same observation was made by the volunteers, which led them to reflect on the nature
of their intervention. There was a certain tension between those who would like to establish a
relationship beyond a single call and those who think that they must maintain a certain dis-
tance from the hospitalized person to avoid entering into a helping relationship. This issue was
not resolved, and probably requires a nuanced response that would allow for several types of
courtesy calls.
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Improving the intervention
The platform used to stay in touch with hospitalized patients was basic, and consisted of using
a web platform and the telephones already in the hospital rooms, with no video. However, dur-
ing the pandemic, CHUM received smartphones to encourage contact between patients and
their families and between patients and healthcare professionals. They were deployed in the
first wave, around the same time as the courtesy phone calls. These phones could also be used
to allow for visual contact through a video connection if the person so desires. Such initiatives
have been implemented in other locations where volunteers were able to use telehealth plat-
forms to continue their activities during the COVID-19 pandemic [18]. Such virtual volunteer-
ing offers emotional support and comfort to patients who do not have friends or family they
can contact or who cannot contact their loved ones due to a lack of access to technology.
Interest in maintaining the intervention
The patients who received the calls and did not have a social network were in favour of main-
taining such an initiative. As for the volunteers, although they unanimously preferred face-to-
face visits, they recognized that these calls were useful in situations where their physical pres-
ence is not possible or as a complement to site visits, as they allow them to maintain their com-
mitment and ensure that they reach as many hospitalized people as possible. Furthermore,
both during and after this pandemic, virtual volunteering can protect immunocompromised,
isolated, or otherwise high-risk patients and volunteers, while continuing to allow them to
either receive or provide emotional and educational services.
So even if these initiatives were developed during a pandemic, earlier experiments have
shown the value of being able to maintain contact with people who are isolated. For example,
this is the case in mental health, where psychosocial interventions using technologies such as
"Phone Pal" allow people experiencing a psychotic episode to establish a remote connection
with volunteers [19] and help them feel less isolated.
Limitations of our study
This study was carried out during the first wave of COVID-19 at CHUM. A follow-up is there-
fore required to ensure that we can reproduce the results at another time and will not see a
decline in the effect during the second wave of the pandemic. Other limitations include the
low questionnaire response rate for the patients that can be explain by the difficulties encoun-
tered reaching hospitalized patients by phone, either because of their health condition or
because they have already been discharged from hospital. Although the participation rate in
this study was 28.5%, this is similar to the rate in a Canadian survey conducted in healthcare
facilities among adults hospitalized for maternity, medical, or acute surgical care, where the
response rates for telephone conversations in Ontario and Alberta were 18% and 44%, respec-
tively [20].
Another limitation is our inability to assess the impact of these calls on the perceived isola-
tion of hospitalized patients before and after the call, and whether the number of calls received
could affect this dimension. Finally, our focus group collected the perceptions of seven volun-
teers without knowing if we had reached the point of data saturation. However, the volunteer
manager validated the results and did not add any other themes.
Although it is always difficult to generalize results from a single study, especially since our
patient response rate is quite low, we are confident that similar results would be found in other
contexts because they highlight subtleties that provide for a good understanding of the phe-
nomenon under study.
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Recommendations
In light of our findings, we believe that these calls are relevant during a pandemic to limit the
risk of infection and reduce feelings of isolation among all hospitalized patients. This measure
can be enhanced through the use of smartphones, which also allow visual contact between
patients and volunteers during a pandemic. Outside the pandemic context, these calls can
complement volunteer site visits to reach at-risk populations, such as people who need to be in
isolation. Finally, it would be worthwhile to measure the impact of these calls on anxiety
through PROMs such as HADS [21] and people’s ability to regain more control over their
health.
Conclusion
Our data suggest that the courtesy calls made by the volunteers made patients feel less isolated
during their hospitalization. Furthermore, these calls met the needs of patients. As for the vol-
unteers, the intervention allowed them to maintain their commitment to patients and feel use-
ful. These calls can also be implemented in other contexts besides a pandemic as a way for
people who are isolated for medical reasons to continue having social interactions.
Supporting information
S1 File. Patients questionnaire–English version.
(DOC)
S2 File. Patients questionnaire–French version.
(DOC)
S3 File. Volunteers questionnaire–English version.
(DOC)
S4 File. Volunteers questionnaire–French version.
(DOC)
S5 File. Volunteers focus group guide.
(DOC)
S1 Database. Patients database.
(XLSX)
S2 Database. Volunteers database.
(XLSX)
Acknowledgments
We are grateful to all the patients and volunteers who have participated in this study. Finally,
we thank Jim Kroening for the translation of this manuscript.
Author Contributions
Conceptualization: Kathy Malas, Fabrice Brunet, Marie-Pascale Pomey.
Formal analysis: Louise Normandin, Ce
´cile Vialaron, Marie-Pascale Pomey.
Funding acquisition: Caroline Wong, Vincent Dumez, Kathy Malas, Alexandre Gre
´goire,
Fabrice Brunet, Marie-Pascale Pomey.
Methodology: Marie-Pascale Pomey.
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Project administration: Kathy Malas, Fabrice Brunet.
Resources: Caroline Wong, Vincent Dumez, Alexandre Gre
´goire, Julie Gre
´goire, Lise Petti-
grew, Nicolas Allanot.
Supervision: Nicolas Allanot, Marie-Pascale Pomey.
Validation: Marie-Pascale Pomey.
Writing – original draft: Louise Normandin, Ce
´cile Vialaron, Marie-Pascale Pomey.
Writing – review & editing: Louise Normandin, Caroline Wong, Vincent Dumez, Kathy
Malas, Alexandre Gre
´goire, Julie Gre
´goire, Lise Pettigrew, Nicolas Allanot, Ce
´cile Vialaron,
Sabrina Anissa El Mansali, Christine Nguyen, Fabrice Brunet, Marie-Pascale Pomey.
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