JMIR Formative Research (Jun 2024)

Clinicians’ Perspectives on the Telehealth Serious Illness Care Program for Older Adults With Myeloid Malignancies: Single-Arm Pilot Study

  • Marissa LoCastro,
  • Ying Wang,
  • Tristan Yu,
  • Soroush Mortaz-Hedjri,
  • Jason Mendler,
  • Sally Norton,
  • Rachelle Bernacki,
  • Thomas Carroll,
  • Heidi Klepin,
  • Lucy Wedow,
  • Sean Goonan,
  • Hannah Erdos,
  • Brenda Bagnato,
  • Jane Liesveld,
  • Eric Huselton,
  • Benzi Kluger,
  • Kah Poh Loh

DOI
https://doi.org/10.2196/58503
Journal volume & issue
Vol. 8
p. e58503

Abstract

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BackgroundSerious illness conversations may help patients avoid unwanted treatments. We previously piloted the telehealth Serious Illness Care Program (SICP) for older adults with acute myeloid leukemia and myelodysplastic syndrome. ObjectiveIn this study, we aimed to understand the experience of the telehealth SICP from the clinician’s perspective. MethodsWe studied 10 clinicians who delivered the telehealth SICP to 20 older adults with acute myeloid leukemia or myelodysplastic syndrome. Quantitative outcomes included confidence and acceptability. Confidence was measured using a 22-item survey (range 1-7; a higher score is better). Acceptability was measured using an 11-item survey (5-point Likert scale). Hypothesis testing was performed at α=.10 (2-tailed) due to the pilot nature and small sample size. Clinicians participated in audio-recorded qualitative interviews at the end of the study to discuss their experience. ResultsA total of 8 clinicians completed the confidence measure and 7 clinicians completed the acceptability measure. We found a statistically significant increase in overall confidence (mean increase of 0.5, SD 0.6; P=.03). The largest increase in confidence was in helping families with reconciliation and goodbye (mean 1.4, SD 1.5; P=.04). The majority of clinicians agreed that the format was simple (6/7, 86%) and easy to use (6/7, 86%). Clinicians felt that the telehealth SICP was effective in understanding their patients’ values about end-of-life care (7/7, 100%). A total of three qualitative themes 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 optimized the visit experience. ConclusionsThe telehealth SICP increased confidence in having serious illness conversations while deepening patient-clinician relationships. Trial RegistrationClinicalTrials.gov NCT04745676; https://www.clinicaltrials.gov/study/NCT04745676