Clinicians'Perspectives on the Telehealth Serious Illness CareProgram for Older Adults With Myeloid Malignancies:Single-ArmPilot Study

Background: Serious illness conversations may help patients avoid unwanted treatments. We previously piloted the telehealthSerious Illness Care Program (SICP) for older adults with acute myeloid leukemia and myelodysplastic syndrome. Objective: In this study, we aimed to understand the experience of the telehealth SICP from the clinician's perspective. Methods: We studied 10 clinicians who delivered the telehealth SICP to 20 older adults with acute myeloid leukemia ormyelodysplastic syndrome. Quantitative outcomes included confidence and acceptability. Confidence was measured using a22-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 alpha=.10 (2-tailed) due to the pilot nature and small sample size. Clinicians participated inaudio-recorded qualitative interviews at the end of the study to discuss their experience. Results: A total of 8 clinicians completed the confidence measure and 7 clinicians completed the acceptability measure. Wefound a statistically significant increase in overall confidence (mean increase of 0.5, SD 0.6; P=.03). The largest increase inconfidence was in helping families with reconciliation and goodbye (mean 1.4, SD 1.5; P=.04). The majority of clinicians agreedthat the format was simple (6/7, 86%) and easy to use (6/7, 86%). Clinicians felt that the telehealth SICP was effective inunderstanding their patients'values about end-of-life care (7/7, 100%). A total of three qualitative themes emerged: (1) thetelehealth SICP deepened relationships and renewed trust; (2) each telehealth SICP visit felt unique and personal in a positiveway; and (3) uninterrupted, unrushed time optimized the visit experience. Conclusions: The telehealth SICP increased confidence in having serious illness conversations while deepening patient-clinicianrelationships