A Pilot of a Telehealth-Hospice Transition Intervention for Children and Young Adults with Cancer.

BACKGROUND AND AIMS: Telehealth can improve care for patients with progressive cancer enrolling in hospice. Coordinated telehealth visits (patient/family-hospital-hospice) may improve communication, satisfaction with and interdisciplinary hospice collaboration. This pilot examines the impact of three coordinated telehealth visits on these outcomes. METHODS: This is a prospective pilot study of 0-29-year-old patients with cancer initiating hospice care between 2021-2023. Adult patients, caregivers, oncology and palliative care clinicians, hospice nurses and administrators were surveyed about feasibility and acceptability with telehealth (Technology Acceptance Model 2) after first and third telehealth visits. Hospice satisfaction (Consumer Assessment of Healthcare Providers and Systems) was completed by caregivers after visit 3 and during bereavement. Healthcare professionals completed the Assessment of Interprofessional Team Collaboration Scale II (AITCS-II). Survey responses were summarized and differences in scores were analyzed. RESULTS: Of 40 eligible patients, 24 enrolled, 19 completed visit 1, and 13 completed visit 3. Fourteen caregivers and two adult patients completed visit 1 surveys; nine caregivers and two adult patients completed visit 3 surveys. Participants highly rated telehealth acceptability after visit 1 (Median: 4.5, IQR: 4.0-4.7) and 3 (Median: 4.4, IQR: 4.0-4.7). Hospice services were rated as highly satisfactory at visit 3 (Median: 4.0, IQR: 3.7-4.0) and during bereavement (Median: 3.7, IQR: 3.5-4.0). Healthcare professionals (n = 85 surveys) reported excellent interprofessional collaboration (Hospital clinicians median: 99/115 and hospice teams 111/115). CONCLUSIONS: Participants found coordinated telehealth visits to be feasible, acceptable, and satisfactory. Telehealth may be utilized as an acceptable alternative to clinic visits and fosters hospital-hospice collaboration.

Patients are unaware of clinical recommendations and resources.

AIMS: The Emory Family Medicine Clinic (EFMC) sought to identify perceptions of recent patient-provider communications for patients with diabetes, factors influencing patient compliance with clinical recommendations, and patients' desire for additional resources to facilitate diabetes management. METHODS: Four focus group discussions were held June-August 2018 (3-9 participants each, 21 total). EFMC patients with uncontrolled diabetes received a phone invitation. A template analytic strategy, characterized by an initial set of codes based on interview content and expected types of responses and inductive codes, was used to thematically code the data. RESULTS: Most participants were single (62%), college educated (62%), had incomes less than $60,000 (76%), and were younger than 50 years old (62%). For themes related to barriers to compliance the participants mentioned the "business of medicine," convenience factors, food choices, accountability, feeling overwhelmed, costs, location/transportation, and miscommunications. Prevailing themes regarding facilitating compliance included a desire for help with self-accountability and prioritization of recommendations. The major desired patient resource was peer-support groups. CONCLUSION: Patient understanding of the impact diabetes has on their life can affect adherence to treatment; hence patient education is critical. Payment policies should support innovative educational clinical visits with patients.