JMIR Publications

ABSTRACT

Background:

Serious illness conversations (SICs) may help patients avoid unwanted treatments. We previously piloted the telehealth Serious Illness Care Program (SICP) for older adults with acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS).

Objective:

In this study, we aimed to understand the experience of the telehealth SICP from the clinician perspective.

Methods:

We studied 10 clinicians who delivered the telehealth SICP to 20 older adults with AML or MDS. Quantitative outcomes included confidence and acceptability. 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). Hypothesis testing was performed at α=0.10 (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.

Results:

Eight clinicians completed the confidence measure and seven clinicians completed the acceptability measure. We found a statistically significant increase in overall confidence [mean increase of +0.5; Standard Deviation (SD) 0.6, P=.03]. The largest increase in confidence was in helping families with reconciliation and good-bye [+1.4 (SD 1.5, P=.04)]. The majority of clinicians agreed that the format was simple (6/7, 85.7%) and easy to use (6/7, 85.7%). Clinicians felt that the telehealth SICP was effective in understanding their patients' values about end-of-life care (7/7, 100.0%). 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.

Conclusions:

The telehealth SICP increased confidence in having SICs while deepening patient-clinician relationships. Clinical Trial: ClinicalTrials.gov ID: NCT04745676