Promoting serious illness conversations in primary care through telehealth among persons living with cognitive impairment.
advance care planning
clinical trials
dementia
outcomes
pragmatic
serious illness conversations
Journal
Journal of the American Geriatrics Society
ISSN: 1532-5415
Titre abrégé: J Am Geriatr Soc
Pays: United States
ID NLM: 7503062
Informations de publication
Date de publication:
23 Jul 2024
23 Jul 2024
Historique:
revised:
25
06
2024
received:
21
04
2024
accepted:
30
06
2024
medline:
23
7
2024
pubmed:
23
7
2024
entrez:
23
7
2024
Statut:
aheadofprint
Résumé
serious illness conversations (SIC), particularly for persons living with cognitive impairment (PLCI), inconsistently happen in primary care. Pragmatic, scalable strategies are needed to promote SIC for PLCI. Pragmatic, prospective single-arm pilot study that occurred between July 1, 2021 and May 30, 2022 across seven primary care practices in North Carolina. Community-dwelling patients aged 65 and older with known or probable mild cognitive impairment or dementia (with decision-making capacity) and their care partners (if available). SIC telehealth intervention (TeleVoice) via video or telephone to assist PLCI in discussing their current goals, values, and future medical preferences, while facilitating documentation within the EHR. Main feasibility outcomes included reach/enrollment, intervention completion, and adoption rates at the clinic and provider level. Primary effectiveness outcomes included SIC documentation and quality within the EHR and usage of advance care planning billing (ACP) codes. Of the 163 eligible PLCI approached, 107 (66%) enrolled (mean age 83.7 years, 68.2% female, 16.8% Black, 22% living in a geographic area of high socioeconomic disadvantage) and 81 (76%) completed the SIC telehealth intervention; 45 care partners agreed to participate (mean age 71.5 years, 80% female). Adoption at clinic level was 50%, while 75% of providers within these clinics participated. Among PLCI that completed the intervention, SIC documentation and usage of ACP billing codes was 100% and 96%, respectively, with 96% (n = 78) having high-quality SIC documentation. No significant differences were observed between telephone and video visits. These findings provide preliminary evidence to support the feasibility of conducting SICs through telehealth to specifically meet the needs of community-dwelling PLCI. Further investigation of the sustainability of the intervention and its long-term impact on patient and caregiver outcomes is needed.
Sections du résumé
BACKGROUND
BACKGROUND
serious illness conversations (SIC), particularly for persons living with cognitive impairment (PLCI), inconsistently happen in primary care. Pragmatic, scalable strategies are needed to promote SIC for PLCI.
DESIGN
METHODS
Pragmatic, prospective single-arm pilot study that occurred between July 1, 2021 and May 30, 2022 across seven primary care practices in North Carolina.
PARTICIPANTS
METHODS
Community-dwelling patients aged 65 and older with known or probable mild cognitive impairment or dementia (with decision-making capacity) and their care partners (if available).
INTERVENTION
METHODS
SIC telehealth intervention (TeleVoice) via video or telephone to assist PLCI in discussing their current goals, values, and future medical preferences, while facilitating documentation within the EHR.
MAIN OUTCOMES
RESULTS
Main feasibility outcomes included reach/enrollment, intervention completion, and adoption rates at the clinic and provider level. Primary effectiveness outcomes included SIC documentation and quality within the EHR and usage of advance care planning billing (ACP) codes.
RESULTS
RESULTS
Of the 163 eligible PLCI approached, 107 (66%) enrolled (mean age 83.7 years, 68.2% female, 16.8% Black, 22% living in a geographic area of high socioeconomic disadvantage) and 81 (76%) completed the SIC telehealth intervention; 45 care partners agreed to participate (mean age 71.5 years, 80% female). Adoption at clinic level was 50%, while 75% of providers within these clinics participated. Among PLCI that completed the intervention, SIC documentation and usage of ACP billing codes was 100% and 96%, respectively, with 96% (n = 78) having high-quality SIC documentation. No significant differences were observed between telephone and video visits.
CONCLUSION
CONCLUSIONS
These findings provide preliminary evidence to support the feasibility of conducting SICs through telehealth to specifically meet the needs of community-dwelling PLCI. Further investigation of the sustainability of the intervention and its long-term impact on patient and caregiver outcomes is needed.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : NIA NIH HHS
ID : U54AG063546
Pays : United States
Informations de copyright
© 2024 The American Geriatrics Society.
Références
Dhana K, Beck T, Desai P, Wilson RS, Evans DA, Rajan KB. Prevalence of Alzheimer's disease dementia in the 50 US states and 3142 counties: a population estimate using the 2020 bridged‐race postcensal from the National Center for Health Statistics. Alzheimers Dement. 2023;19(10):4388‐4395. doi:10.1002/alz.13081
Sullivan DR, Kim H, Gozalo PL, Bunker J, Teno JM. Trends in noninvasive and invasive mechanical ventilation among Medicare beneficiaries at the end of life. JAMA Intern Med. 2020;181:93‐102. doi:10.1001/jamainternmed.2020.5640
Khandelwal N, Curtis JR, Freedman VA, et al. How often is end‐of‐life Care in the United States Inconsistent with Patients' goals of care? J Palliat Med. 2017;20(12):1400‐1404. doi:10.1089/jpm.2017.0065
Sampson EL, Candy B, Davis S, et al. Living and dying with advanced dementia: a prospective cohort study of symptoms, service use and care at the end of life. Palliat Med. 2018;32(3):668‐681.
Teno JM, Mor V, Ward N, et al. Bereaved family member perceptions of quality of end‐of‐life care in US regions with high and low usage of intensive care unit care. J Am Geriatr Soc. 2005;53(11):1905‐1911.
Wright AA, Keating NL, Ayanian JZ, et al. Family perspectives on aggressive cancer care near the end of life. JAMA. 2016;315(3):284‐292. doi:10.1001/jama.2015.18604
Jacobsen J, Bernacki R, Paladino J. Shifting to serious illness communication. JAMA. 2022;327(4):321‐322. doi:10.1001/jama.2021.23695
Berry CE, Montgomery SH, Santulli R, Cullinan A. Adapting the serious illness conversation guide for dementia care. Am J Hospice Palliat Med. 2024;41(8):942‐951. doi:10.1177/10499091231200214
Piers R, Albers G, Gilissen J, et al. Advance care planning in dementia: recommendations for healthcare professionals. BMC Palliat Care. 2018;17:1‐17.
Dixon J, Karagiannidou M, Knapp M. The effectiveness of advance care planning in improving end‐of‐life outcomes for people with dementia and their carers: a systematic review and critical discussion. J Pain Symptom Manage. 2018;55(1):132‐150.e1.
Bernacki RE, Block SD. Communication about serious illness care goals: a review and synthesis of best practices. JAMA Intern Med. 2014;174(12):1994‐2003.
Rosa WE, Izumi S, Sullivan DR, et al. Advance care planning in serious illness: a narrative review. J Pain Symptom Manage. 2023;65(1):e63‐e78. doi:10.1016/j.jpainsymman.2022.08.012
Schultz SK, Llorente MD, Sanders AE, et al. Quality improvement in dementia care: dementia management quality measurement set 2018 implementation update. Am J Psychiatry. 2020;177(2):175‐181. doi:10.1176/appi.ajp.2019.19121290
van der Steen JT, Nakanishi M, Van den Block L, et al. Consensus definition of advance care planning in dementia: a 33‐country Delphi study. Alzheimers Dement. 2024;20(2):1309‐1320.
Song D, Yu T, Zhi S, et al. Experiences and perspectives on the optimal timing for initiating advance care planning in patients with mild to moderate dementia: a meta‐synthesis. Int J Nurs Stud. 2024;154:104762.
Wendrich‐van Dael A, Bunn F, Lynch J, Pivodic L, Van den Block L, Goodman C. Advance care planning for people living with dementia: an umbrella review of effectiveness and experiences. Int J Nurs Stud. 2020;107:103576. doi:10.1016/j.ijnurstu.2020.103576
McMahan RD, Tellez I, Sudore RL. Deconstructing the complexities of advance care planning outcomes: what do we know and where do we go? A scoping review. J Am Geriatr Soc. 2021;69(1):234‐244. doi:10.1111/jgs.16801
Malhotra C, Shafiq M, Batcagan‐Abueg APM. What is the evidence for efficacy of advance care planning in improving patient outcomes? A systematic review of randomised controlled trials. BMJ Open. 2022;12(7):e060201. doi:10.1136/bmjopen‐2021‐060201
McMahan RD, Hickman SE, Sudore RL. What clinicians and researchers should know about the evolving field of advance care planning: a narrative review. J Gen Intern Med. 2024;1‐9:652‐660.
Smith AK. Should we still believe in advance care planning? J Am Geriatr Soc. 2022;70(5):1358‐1360. doi:10.1111/jgs.17727
Gotanda H, Walling AM, Reuben DB, Lauzon M, Tsugawa Y. Trends in advance care planning and end‐of‐life care among persons living with dementia requiring surrogate decision‐making. J Am Geriatr Soc. 2022;70(5):1394‐1404. doi:10.1111/jgs.17680
Heyland DK. Advance care planning (ACP) vs. advance serious illness preparations and planning (ASIPP). Healthcare (Basel). 2020;8:218.
Sellars M, Chung O, Nolte L, et al. Perspectives of people with dementia and carers on advance care planning and end‐of‐life care: a systematic review and thematic synthesis of qualitative studies. Palliat Med. 2019;33(3):274‐290. doi:10.1177/0269216318809571
Lakin JR, Koritsanszky LA, Cunningham R, et al. A systematic intervention to improve serious illness communication in primary care. Health Aff (Millwood). 2017;36(7):1258‐1264.
Howard M, Bernard C, Klein D, et al. Barriers to and enablers of advance care planning with patients in primary care: survey of health care providers. Can Fam Physician. 2018;64(4):e190‐e198.
Risk J, Mohammadi L, Rhee J, Walters L, Ward PR. Barriers, enablers and initiatives for uptake of advance care planning in general practice: a systematic review and critical interpretive synthesis. BMJ Open. 2019;9(9):e030275.
Konno R, Inoue K, Matsushita Y, et al. Barriers to advance care planning in older adults with dementia, their families and healthcare professionals: an umbrella review of qualitative evidence. Res Aging. 2024;46(5‐6):339‐358.
https://www.sykes.com/reports/2020-telehealth-survey/. Accessed 5/20/2020.
Kakulla BN. 2019 Tech Trends and the 50+. AARP Research; 2019. doi:10.26419/res.00269.001
Block BL, Smith AK, Sudore RL. During COVID‐19, outpatient advance care planning is imperative: we need all hands on deck. J Am Geriatr Soc. 2020;68(7):1395‐1397. doi:10.1111/jgs.16532
Shigekawa E, Fix M, Corbett G, Roby DH, Coffman J. The current state of telehealth evidence: a rapid review. Health Aff (Millwood). 2018;37(12):1975‐1982. doi:10.1377/hlthaff.2018.05132
Bossen AL, Kim H, Williams KN, Steinhoff AE, Strieker M. Emerging roles for telemedicine and smart technologies in dementia care. Smart Homecare Technol Telehealth. 2015;3:49‐57. doi:10.2147/shtt.S59500
Guisado‐Fernandez E, Blake C, Mackey L, et al. A smart health platform for measuring health and well‐being improvement in people with dementia and their informal caregivers: usability study. JMIR Aging. 2020;3(2):e15600. doi:10.2196/15600
Williams K, Blyler D, Vidoni ED, et al. A randomized trial using telehealth technology to link caregivers with dementia care experts for in‐home caregiving support: FamTechCare protocol. Res Nurs Health. 2018;41(3):219‐227. doi:10.1002/nur.21869
Weiss EF, Malik R, Santos T, et al. Telehealth for the cognitively impaired older adult and their caregivers: lessons from a coordinated approach. Neurodegener Dis Manag. 2021;11(1):83‐89. doi:10.2217/nmt‐2020‐0041
Karimi M, Lee EC, Couture SJ, et al. National Survey Trends in Telehealth Use in 2021: Disparities in Utilization and Audio vs. Video Services. US Department of Health & Human Services; 2022.
Centers for Medicare & Medicaid. Medicare telemedicine health care provider fact sheet [Internet]. 2020. https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet
Azvolinsky A. Telehealth advanced care planning conversations benefit older patients with AML, MDS. 2023.
Younan S, Cardona M, Sahay A, Willis E, Ni CD. Advanced care planning in the early phase of COVID‐19: a rapid review of the practice and policy lessons learned. Front Health Serv. 2023;3:1242413.
Walton L, Courtright K, Demiris G, Gorman EF, Jackson A, Carpenter JG. Telehealth palliative care in nursing homes: a scoping review. J Am Med Dir Assoc. 2023;24(3):356‐367. e2.
Sunner C, Giles MT, Kable A, Foureur M. Does telehealth influence the decision to transfer residents of residential aged care facilities to emergency departments? A scoping review. Int J Older People Nurs. 2023;18(1):e12517.
Barnes DE, Zhou J, Walker RL, et al. Development and validation of eRADAR: a tool using EHR data to detect unrecognized dementia. J Am Geriatr Soc. 2020;68(1):103‐111. doi:10.1111/jgs.16182
Wilkinson T, Ly A, Schnier C, et al. Identifying dementia cases with routinely collected health data: a systematic review. Alzheimers Dement. 2018;14(8):1038‐1051. doi:10.1016/j.jalz.2018.02.016
Reuben DB, Gill TM, Stevens A, et al. D‐CARE: the dementia care study: Design of a Pragmatic Trial of the effectiveness and cost effectiveness of health system‐based versus community‐based dementia care versus usual dementia care. J Am Geriatr Soc. 2020;68(11):2492‐2499. doi:10.1111/jgs.16862
Coley RY, Smith JJ, Karliner L, et al. External validation of the eRADAR Risk score for detecting undiagnosed dementia in two real‐world healthcare systems. J Gen Intern Med. 2023;38(2):351‐360. doi:10.1007/s11606‐022‐07736‐6
Gabbard J, Pajewski NM, Callahan KE, et al. Effectiveness of a nurse‐led multidisciplinary intervention vs usual care on advance care planning for vulnerable older adults in an accountable care organization: a randomized clinical trial. JAMA Intern Med. 2021;181(3):361‐369. doi:10.1001/jamainternmed.2020.5950
Oude Rengerink K, Kalkman S, Collier S, et al. Series: pragmatic trials and real world evidence: paper 3. Patient selection challenges and consequences. J Clin Epidemiol. 2017;89:173‐180. doi:10.1016/j.jclinepi.2016.12.021
Higgins T, Larson E, Schnall R. Unraveling the meaning of patient engagement: a concept analysis. Patient Educ Couns. 2017;100(1):30‐36. doi:10.1016/j.pec.2016.09.002
de Wit M, Cooper C, Tugwell P, et al. Practical guidance for engaging patients in health research, treatment guidelines and regulatory processes: results of an expert group meeting organized by the World Health Organization (WHO) and the European Society for Clinical and Economic Aspects of osteoporosis, osteoarthritis and musculoskeletal diseases (ESCEO). Aging Clin Exp Res. 2019;31(7):905‐915. doi:10.1007/s40520‐019‐01193‐8
Proctor E, Silmere H, Raghavan R, et al. Outcomes for implementation research: conceptual distinctions, measurement challenges, and research agenda. Adm Policy Ment Health. 2011;38(2):65‐76. doi:10.1007/s10488‐010‐0319‐7
Chan CL, Taljaard M, Lancaster GA, Brehaut JC, Eldridge SM. Pilot and feasibility studies for pragmatic trials have unique considerations and areas of uncertainty. J Clin Epidemiol. 2021;138:102‐114. doi:10.1016/j.jclinepi.2021.06.029
Glasgow R, Harden S, Gaglio B, Rabin B, Smith M, Porter G. RE‐AIM planning and evaluation framework: adapting to new science and practice with a 20‐year review. Front Public Health. 2019;7:7.
Glasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion interventions: the RE‐AIM framework. Am J Public Health. 1999;89(9):1322‐1327.
Weiner BJ, Lewis CC, Stanick C, et al. Psychometric assessment of three newly developed implementation outcome measures. Implement Sci. 2017;12(1):108. doi:10.1186/s13012‐017‐0635‐3
Pajewski NM, Lenoir K, Wells BJ, Williamson JD, Callahan KE. Frailty screening using the electronic health record within a Medicare accountable care organization. J Gerontol A Biol Sci Med Sci. 2019;74(11):1771‐1777. doi:10.1093/gerona/glz017
Xu Z, Sun W, Zhang D, Wong SY. Recruitment and adherence of randomized controlled trials for mild cognitive impairment: a systematic review and meta‐analysis. Int J Geriatr Psychiatry. 2020;35(10):1141‐1150. doi:10.1002/gps.5336
Pitkala KH, Strandberg TE. Clinical trials in older people. Age Ageing. 2022;51(5):afab282. doi:10.1093/ageing/afab282
Wiltsey Stirman S, Baumann AA, Miller CJ. The FRAME: an expanded framework for reporting adaptations and modifications to evidence‐based interventions. Implement Sci. 2019;14(1):58. doi:10.1186/s13012‐019‐0898‐y
Ladin K, Bronzi OC, Gazarian PK, et al. Understanding the use of Medicare procedure codes for advance care planning: a National Qualitative Study. Health Aff (Millwood). 2022;41(1):112‐119. doi:10.1377/hlthaff.2021.00848
C‐TAC. C‐TAC Supports Telehealth Flexibilities Extension. The Coalition to Transform Advanced Care (C‐TAC) website. https://thectac.org/asset/blog/c-tac-supports-telehealth-flexibilities-extension/; 2024.
Lam K, Lu AD, Shi Y, Covinsky KE. Assessing telemedicine unreadiness among older adults in the United States during the COVID‐19 pandemic. JAMA Intern Med. 2020;180(10):1389‐1391.
Kim H‐N, Freddolino PP, Greenhow C. Older adults' technology anxiety as a barrier to digital inclusion: a scoping review. Educ Gerontol. 2023;49(12):1021‐1038. doi:10.1080/03601277.2023.2202080
Julie SY, Pittman CA, Price CL, Nieman CL, Oh ES. Telemedicine and dementia care: a systematic review of barriers and facilitators. J Am Med Dir Assoc. 2021;22(7):1396‐1402. e18.
Liang J, Aranda MP. The use of telehealth among people living with dementia‐caregiver dyads during the COVID‐19 pandemic: scoping review. J Med Internet Res. 2023;25:e45045. doi:10.2196/45045
Angelopoulou E, Papachristou N, Bougea A, et al. How telemedicine can improve the quality of Care for Patients with Alzheimer's disease and related dementias? A narrative review. Medicina (Kaunas). 2022;58(12):1705. doi:10.3390/medicina58121705
Wardlow L, Roberts C, Archbald‐Pannone L. Perceptions and uses of telehealth in the Care of Older Adults. Telemed J E Health. 2023;29(8):1143‐1151. doi:10.1089/tmj.2022.0378
Laver K, Liu E, Clemson L, et al. Does telehealth delivery of a dyadic dementia care program provide a noninferior alternative to face‐to‐face delivery of the same program? A randomized, controlled trial. Am J Geriatr Psychiatry. 2020;28(6):673‐682. doi:10.1016/j.jagp.2020.02.009
Ganguli I, Orav EJ, Hailu R, et al. Patient characteristics associated with being offered or choosing telephone vs video virtual visits among Medicare beneficiaries. JAMA Netw Open. 2023;6(3):e235242. doi:10.1001/jamanetworkopen.2023.5242