Telehealth Can Drive More Meaningful Serious Illness Conversations in MDS, AML

Using telehealth to have conversations about serious illnesses with patients may help increase clinician confidence in having these types of conversations, suggest findings from a small pilot study.¹

Researchers collected feedback from 20 clinicians implementing a telehealth serious illness conversation with their patients with acute myeloid leukemia and myelodysplastic syndrome (MDS). The group found the intervention was considered simple and easy, and helped clinicians better understand the unique needs of their patients at end of life. The findings were published in JMIR Formative Research.

The researchers of the study have previously published patient insights from these visits. Patients reported comfortability with the telehealth-delivered conversation, finding it both feasible and usable and agreeing they would recommend it to others.²

Marissa LoCastro, MD | Image Credit: University of Wisconsin School of Medicine and Public Health

“Clinicians in our study were concerned that serious illness conversations may decrease patients’ hope and positivity,” said study author Marissa LoCastro, MD, about the original analysis. “Yet we found that the participating patients felt that these conversations would increase their understanding of their disease and wanted their oncologists to have these discussions with them.”³

In their newly published paper, the researchers now provide perspectives from the clinicians facilitating the serious illness conversation with these patients. Key insights reported by clinicians included that conversations occurring during a serious illness care program do not usually happen during routing clinic visits, each visit felt personal to their patient’s unique needs, and having uninterrupted time is crucial. However, the clinicians often cited barriers to having enough time with their patients. Visits spanned a median of 36 (range, 19-71) minutes. To help optimize time, suggest the researchers, clinicians could use note templates for documentation during the telehealth conversation, similar to that used for emergency medical record documentation.

Eight clinicians completed a 22-item survey about their confidence in SIC conversations, which was based on a 7-point scale, with 7 indicating the most confidence. The group reported a statistically significant increase in confidence after the telehealth conversation. Among the clinicians, there was a mean (SD) increase of 0.5 (0.6) (P = .03).

The intervention yielded the biggest improvement for feeling comfortable in helping families with reconciliation and saying goodbye. Prior to the intervention, helping with reconciliation and goodbye (mean, 3.9 [1.4]) was among the top concerns for clinicians. Following the telehealth conversation, confidence increased an average of 1.4 (1.5) (P = .04).

Clinicians also voiced the most concern with estimating prognosis (mean, 3.9 [1.2]) prior to the conversation, which remained a chief concern following the conversation (mean, 4.4 [1.3]). The researchers underscored the complex nature of estimating prognosis—often a top priority for older patients with cancer—and noted certain standardized tools, such as the Revised International Prognostic Scoring System for MDS, which can help aid in estimating prognosis.

“This is of vital importance because prognosis is necessary for clinicians to offer effective treatment recommendations and for patients and their loved ones to make advanced care planning decisions,” explained the researchers. “Indeed, most of the available data strongly suggest that patients with cancer want to receive prognostic information from their clinicians, and therefore prognosis needs to be effectively addressed through serious illness conversations. It is therefore vital that clinicians work to become comfortable with, and skilled at, sharing uncertainty around prognosis. Doing so has been shown to increase patient engagement and satisfaction.”

The clinicians were most confident in showing empathy both before (mean, 6.1 [0.8]) and after (mean, 6.0 [0.8]) the intervention. The group also reported high confidence in discussing the discontinuation of disease-modifying treatment (mean, 6.0 [0.9]) following the intervention.

Among the 7 clinicians who provided feedback on the intervention itself, through an 11-item survey on a 5-point scale, all agreed that the intervention was valuable to help understand patient values for end-of-life care. Most agreed or strongly agreed that the format was simple (86%) and easy to use (86%). More than half (57%) agreed or strongly agreed that the intervention help promote timely discussions about end of life.

References

1. LoCastro M, Wang Y, Yu T, et al. Clinicians’ perspective on the telehealth serious illness care program for older adults with myeloid malignancies: single-arm pilot study. JMIR Form Res. Published online June 27, 2024. doi:10.2196/58503

2. LoCastro M, Mortaz-Hedjri S, Wang Y, et al. Telehealth serious illness care program for older patients with hematologic malignancies: a single-arm pilot study. Blood Adv. 2023;7(24):7595-7607. doi:10.1182/bloodadvances.2023011046

3.Azvolinsky A. Telehealth advanced care planning conversations benefit older patients with AML, MDS. ASH Clinical News. March 2023. Accessed July 3, 2024. https://ashpublications.org/ashclinicalnews/news/6962/Telehealth-Advanced-Care-Planning-Conversations