Telemedicine-enabled synchronous medical oncology and home hospice visits.

Abstract

12100 Background: Hospice is underutilized at end-of-life by patients with cancer. Among the barriers to earlier acceptance of hospice may be the perceived loss of the therapeutic alliance and emotional support provided by the oncology team once the hospice team starts care. With the growing utilization of telemedicine, we sought to understand patient, caregiver, hospice nurse, and oncologist perceptions of synchronizing home hospice visits by the hospice nurse with remote telemedicine visits performed by the oncologist in their clinic. Methods: Thirty-four newly enrolled hospice patients (age 57-90+; 20 female & 14 male; 28 white non-Hispanic,1 white Hispanic, 3 black/African American, 2 other; 19 married, 3 single, 3 divorced, 1 significant other, 7 widowed, 1 other) and 34 caregivers were consented to an IRB-approved study between 5/14/21-9/9/24. Home hospice nurse visits were coordinated with the oncologist’s clinic schedule and telemedicine visits were securely conducted through Epic MyChart functionality. Mixed methodology was utilized with patients, caregivers, hospice nurses and oncologists completing five-point Likert-scale surveys at baseline and subsequent serial surveys for patients and caregivers. Results: All groups rated improvement in overall communication. Likert scores for ease and quality of communication improved for oncologists (3.0 to 1.5) and nurses (2.0 to 1.0). Therapeutic alliance scores for patients and caregivers were stable and improved for oncologists (2.5 to 1.5) and nurses (2.0 to 1.5). Conclusions: Patients and caregivers expressed highly favorable ratings of hospice experience at baseline and improvement with telemedicine visits. There was no degradation in patient and caregiver therapeutic alliance scores, suggesting preservation of patient experience. Improvement among oncologists and hospice nurses was seen for both communication and therapeutic alliance scores once synchronous telemedicine hospice visits were instituted. These findings suggest that all four groups found value in oncologist-hospice patient telemedicine visits. Qualitative interviews and thematic analysis of caregivers’ impressions of the program continue to identify how better to support patients and caregivers during home hospice care. Quantitative results. Baseline Score Improvement in Score Median (IQR) Median (IQR) Patient Communication Overall 2.0 (1.25-2.75) 1.0 (0.5-1.0) Therapeutic Alliance Support received from oncologist 2.0 (1-3) 0.0 (-0.5-2.5) Caregiver Communication Overall 2.0 (1.75-3) 1.0 (0.0-1.0) Therapeutic Alliance Support received from oncologist 1.0 (1-3) 0.0 (0.0-0.0) Oncologist Communication Overall 3.0 (2-4.75) 2.0 (0.0-3.0) Therapeutic Alliance Connection 2.5 (2.0-3.0) 1.0 (0.0-2.0) Hospice Nurse Communication Overall 2.0 (2-2.75) 1.0 (0.0-1.0) Therapeutic Alliance Connection with patient & family 2.0 (1-2) 0.5 (0.0-1.0) IQR – interquartile range.