Adaptation of Serious Illness Care Program to be delivered via telehealth for older patients with hematologic malignancy

Abstract

Older patients with acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS) experience intense inpatient healthcare at the end-of-life (EOL) . Early advance care planning (ACP) may improve care at EOL for patients with AML and MDS. The Serious Illness Care Program (SICP) is a multicomponent, communication intervention developed to improve conversations about values for patients with serious illnesses. The SICP has been shown to improve the quality and frequency of ACP discussions. We adapted the SICP for delivery via telehealth to older patients with AML and MDS. We conducted a single-center qualitative study of 45 participants (25 clinicians, 15 older patients with AML and MDS, and 5 caregivers). Participants, whether clinicians, patients, or caregivers, agreed that the SICP would help older patients with AML and MDS to share their personal values with their care team. Four qualitative themes emerged from our data: 1) Serious illness conversations can be conducted via telehealth, 2) Older patients have limited experience using technology but are willing and able to learn, 3) Patients feel that serious illness conversations will help them understand their AML or MDS diagnosis and prognosis better, and 4) Serious illness conversations should be common and routine, not extra-ordinary. The adapted SICP may provide older patients with AML and MDS an opportunity to share what matters most to them with their care team and may assist oncologists in aligning patient care with patient values. The adapted SICP is the subject of an ongoing single-arm pilot study at the Wilmot Cancer Institute.

Patient and families’ perspectives on telepalliative care: A systematic integrative review

“…64 The palliative care context was broad including; specialised palliative care in hospital and home settings ( n = 19), 3,27,41,42,45,49–55,58,59,61,63,66,67,74 general palliative care ( n = 7), 4,32,39,57,69,72 specialised and general palliative care ( n = 12), 33,35,36,38,43,44,46–48,62,64,70 , peer support ( n = 1), 37 early palliative care ( n = 3) 34,40,68 and Advance Care Planning (ACP) ( n = 4). 56,65,71,73 Patients’ diagnoses consisted mainly of cancer ( n = 19), 34,35,37 –39,42,44 –46,48–50,52,53,55,60,…”

“…The included studies ( n = 44) comprised of 19 qualitative, 3,4,27,32 –47 5 quantitative 48 –52 and 20 mixed-methods studies, 53 –74 spanning 18 countries in; North America, 4,39 –41,46–48,50,53–56,58,59,61–63,65,66,68 …”

“…3,4,32,33,36,47,51,57–59,62,63,67,70,71 Family members, where specified, were mainly patients and spouses, but also patients and; adult children, siblings, parents, friends or neighbours or other family members. 3,27,32,34,35,38,39,43,44,46–49,53–55,57 –59,61,64,67,68,71,73 Video consultations accounted for the most frequently used technology solution, alone ( n = 11), 35,36,43,46,51,62 –64,67,70,71 and in combination with other technologies; video consultations and telephone ( n = 4), 47,52,53,57 video consultations, websites and online forums ( n = 3), 38,58,59 video consultations, emails, applications (apps), and remote monitoring ( n = 2), 4,…”

“…The included studies (n = 44) comprised of 19 qualitative, 3,4,27,32-47 5 quantitative [48][49][50][51][52] and 20 mixedmethods studies, spanning 18 countries in; North America, 4,[39][40][41][46][47][48]50,[53][54][55][56]58,59,[61][62][63]65,66,[68][69][70][71][72][73][74] South America, 51 Europe, 3,27,[33][34][35][36][37][38]49,52,57,60 Africa, 32,44 Asia 45,67 and Australia. 64 The palliative care context was broad including; specialised palliative care in hospital and home settings (n = 19), 3,...…”

Supportive Care for Cancer Patients Via Telehealth

“…The biggest patient-perceived benefit of the use of telehealth for serious illness conversations is their comfort. The ability to be in their own space, surrounded by family, with the continuity of their regular provider over video visit was the next-best thing when in-person appointments were not feasible 13 . Predictors for preference of in-person visits over virtual included not having personal access to the patient portal, not having high-speed internet, being LatinX versus White, and being 75 years or older 2 …”