Presentation Title
Qualities of communication in palliative care conversations in dialysis
Abstract
Katharine L Cheung, Samantha Smoger, Manjula Kurella Tamura, Michael LaMantia, Terry Rabinowitz, Renee D. Stapleton, Robert Gramling
Abstract:
Background: Little is known about the content of communication in palliative care telehealth conversations, particularly in a population of patients receiving dialysis. Understanding the content and process of these conversations through qualitative analyses may lead to insights about how palliative care improves quality of life.
Methods: We conducted a qualitative analysis of video-recordings obtained during a pilot palliative teleconsultation program. Patient participants were recruited from five dialysis facilities affiliated with an academic medical center. The target population included patients with kidney failure receiving in-center dialysis. Palliative care clinicians conducted teleconsultation using a large wall-mounted screen with a camera mounted on a pole and positioned mid-screen in the line of sight to facilitate direct eye contact. Patients used an iPad that was attached to an IV pole positioned next to the dialysis chair. Conversations were coded for using a pre-existing framework of themes and content from the Serious Illness Conversation Guide and revised Edmonton Symptom Assessment System-renal.
Results: We recruited 39 patients to undergo a telepalliative care consultation while receiving dialysis, 34 of whom ultimately completed the teleconsultation. Four specialty palliative care clinicians (three physicians and one nurse practitioner) conducted 35 visits with 34 patients. Median (IQR) duration of conversation was 42 (28, 57) minutes. Most frequently discussed content included sources of strength (91%), critical abilities (88%), illness understanding (85%), fears and worries (85%), what family knows (85%), fatigue (77%) and pain (65%). Process features such as summarizing statements (85%) and making a recommendation (82%) were common, while connectional silence (56%), and emotion expression (21%) occurred less often.
Conclusions: Unscripted palliative care conversations in outpatient dialysis units via telemedicine exhibited many domains recommended by the Serious Illness Conversation Guide, with less frequent discussion of symptoms. Emotion expression was uncommon for these conversations that occurred in an open setting.
This study was funded by the National Palliative Care Research Center.
Primary Faculty Mentor Name
Katharine L Cheung
Secondary Mentor Name
Robert Gramling
Faculty/Staff Collaborators
Katharine L Cheung (Principal Investigator, First Author), Manjula Kurella Tamura (Co-Author), Michael LaMantia (Co-Author), Terry Rabinowitz (Co-Author), Renee D. Stapleton (Co-Author), Robert Gramling (Senior Author)
Status
Undergraduate
Student College
College of Arts and Sciences
Program/Major
Biology
Primary Research Category
Health Sciences
Qualities of communication in palliative care conversations in dialysis
Katharine L Cheung, Samantha Smoger, Manjula Kurella Tamura, Michael LaMantia, Terry Rabinowitz, Renee D. Stapleton, Robert Gramling
Abstract:
Background: Little is known about the content of communication in palliative care telehealth conversations, particularly in a population of patients receiving dialysis. Understanding the content and process of these conversations through qualitative analyses may lead to insights about how palliative care improves quality of life.
Methods: We conducted a qualitative analysis of video-recordings obtained during a pilot palliative teleconsultation program. Patient participants were recruited from five dialysis facilities affiliated with an academic medical center. The target population included patients with kidney failure receiving in-center dialysis. Palliative care clinicians conducted teleconsultation using a large wall-mounted screen with a camera mounted on a pole and positioned mid-screen in the line of sight to facilitate direct eye contact. Patients used an iPad that was attached to an IV pole positioned next to the dialysis chair. Conversations were coded for using a pre-existing framework of themes and content from the Serious Illness Conversation Guide and revised Edmonton Symptom Assessment System-renal.
Results: We recruited 39 patients to undergo a telepalliative care consultation while receiving dialysis, 34 of whom ultimately completed the teleconsultation. Four specialty palliative care clinicians (three physicians and one nurse practitioner) conducted 35 visits with 34 patients. Median (IQR) duration of conversation was 42 (28, 57) minutes. Most frequently discussed content included sources of strength (91%), critical abilities (88%), illness understanding (85%), fears and worries (85%), what family knows (85%), fatigue (77%) and pain (65%). Process features such as summarizing statements (85%) and making a recommendation (82%) were common, while connectional silence (56%), and emotion expression (21%) occurred less often.
Conclusions: Unscripted palliative care conversations in outpatient dialysis units via telemedicine exhibited many domains recommended by the Serious Illness Conversation Guide, with less frequent discussion of symptoms. Emotion expression was uncommon for these conversations that occurred in an open setting.
This study was funded by the National Palliative Care Research Center.