Advanced care planning (ACP) can be successfully delivered to older patients with hematologic malignancies using telehealth, according to the results of a study published in Blood Advances. The qualitative, single-center study of older patients with acute myeloid leukemia (AML) and myelodysplastic syndromes (MDS) demonstrated that those who have limited experience using technologies are willing and able to learn how to navigate telehealth to have ACP conversations with their physicians.
“Clinicians in our study were concerned that serious illness conversations may decrease patients’ hope and positivity,” said author Marissa LoCastro, a medical student at the University of Rochester in New York. “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.”
Ms. LoCastro and colleagues recruited older patients who were being treated for AML and MDS at the Wilmot Cancer Institute, their caregivers, and oncology and palliative care clinicians to assess and adapt the Serious Illness Care Program (SICP) for use via telehealth. The SICP is a multi-component communication intervention developed to improve conversations about the personal values of patients with serious illnesses as part of ACP and to identify patients at high risk of dying within one year. The authors investigated whether the use of telehealth could improve access to and quality of ACP conversations with clinicians.
Older patients with AML and MDS generally receive more high-intensity care including hospitalizations at the end of life, while hospice and other end-of-life support options are underused.
“Early ACP is not consistently implemented into care for patients with AML and MDS in the U.S.,” said author Kah Poh Loh, MBBCh, BAO, of the University of Rochester Medical Center.
Fifteen patients, five caregivers, and 25 clinicians (16 oncology, nine palliative care) participated in the study, which included 60-minute semi-structured interviews that focused on telehealth and feedback on the SICP.
Overall, participants reported that they liked the SICP and that it would be helpful for patients with AML and MDS to share their values with their care team. Patients communicated that serious illness conversations and ACP helped them better understand their AML or MDS diagnosis and prognosis. The participants also stated that serious illness conversations and ACP should be a routine part of patient care.
According to one patient participant, “The conversations, I think they’re valuable because [they] open things up. You have a better understanding [of] what to expect and what to do. There [are] no questions because you know what to do, because I have told you or I have indicated that this is what I want done or not done depending on the situation.”
Patients also said they wanted their oncology clinicians to be trained to have serious illness conversations with them and that these discussions should be led by their primary oncologist who is knowledgeable about their diagnosis, treatment journey, and personal priorities.
The authors are conducting a follow-up, single arm pilot study of the adapted SICP for older adults with AML and MDS, also at the Wilmot Cancer Institute, which is planned to enroll 20 patients, caregivers, and their outpatient oncology clinicians. They are also conducting a parallel study in which inpatient advanced practitioners implement the SICP.
“Findings from both of these studies will inform a larger study on how best to implement the SICP as an intervention to potentially improve outcomes and quality of life for these patients,” Ms. LoCastro said.
Any conflicts of interest declared by the authors can be found in the original article.
Anna Azvolinsky, PhD, is a freelance medical and science journalist based in New York City.
LoCastro M, Sanapala C, Mendler JH, et al. Adaptation of serious illness care program to be delivered via telehealth for older patients with hematologic malignancy [published online, 2022 Dec 15]. Blood Adv. doi: 10.1182/bloodadvances.2022008996.