Clinicians’ perspectives on the Telehealth Serious Illness Care Program for older adults with myeloid malignancies.
Authors: LoCastro Marissa , Wang Ying , Yu Tristan , Mortaz Soroush , Mendler Jason , Norton Sally , Bernacki Rachelle , Carroll Thomas , Klepin Heidi D. , Wedow Lucy , Goonan Sean , Erdos Hannah , Bagnato Brenda , Liesveld Jane , Huselton Eric , Kluger Benzi , Loh Kah Poh 
Published: June 2024

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Background: Serious illness conversations (SICs) may help patients avoid unwanted treatments at end-of-life (EOL). Nonetheless, SICs happen infrequently, often due to lack of time and fear of taking away hope. We previously piloted the telehealth Serious Illness Care Program (SICP), a systematic method to promote SICs, for older adults with acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS). The aim of this analysis was to understand the experience of the telehealth SICP from the clinician perspective. Methods: We piloted the telehealth SICP in a single-arm study of 20 older adults (>=60 years old) with AML/MDS. Eligible clinicians (oncologists and advanced practitioners) cared for >=1 older adult with AML/MDS in the last year. Consented clinicians were scheduled for a 2.5- to 3-hour virtual training session to learn how to use the Serious Illness Conversation Guide (SICG). The SICG is a script to elicit patient values and care preferences. After training, clinicians were scheduled for telehealth SICP visits with eligible patients and available caregivers. At the end of the study, clinicians completed an audio-recorded interview to discuss their experience. Qualitative analysis of the interviews was undertaken using MAXQDA software (VERBI Software GmBH). Quantitative measures included: 1) Clinician confidence in having SICs (before first study visit and end of study) and 2) Clinician acceptability (end of study). Clinician confidence was measured using a 22-item survey (range 1-7, higher score better). Acceptability was measured using a 11-item survey (5-point Likert scale). Results: Mean age of clinicians was 42 years [N=10, Standard Deviation (SD) 12.7]. The majority were White (90%), non-Hispanic (100%), and female (60%). Mean number of patients per clinician was 1.9 (SD 1.4, range 0-4). Three qualitative categories emerged: 1) The telehealth SICP deepened relationships and renewed trust, 2) Each telehealth SICP visit felt unique and personal in a positive way, and 3) Uninterrupted, unrushed time is preferred to optimize the experience of visits. Quantitative data revealed a statistically significant increase in clinician confidence overall, with a mean increase of 0.5 (SD 0.6, p=0.03). The largest increase in confidence was in helping families with reconciliation and saying good-bye [+1.4 (SD 1.5), p=0.04]. The majority of clinicians agreed that the format was simple (6/7, 86%) and easy to use (6/7, 86%). Clinicians felt they gained useful information from asking about the patient’s goals (6/7, 86%) and that the telehealth SICP was effective in understanding their patient’s values about EOL care (7/7, 100.0%). Conclusions: Clinicians felt the telehealth SICP deepened their relationships with patients and increased their confidence in having SICs. The majority of clinicians found it to be a simple and easy way to understand patient values about their care. Clinical trial information: NCT04745676 .