Presentation Title

Qualities of communication in palliative care conversations in dialysis

Presenter's Name(s)

Samantha F. SmogerFollow

Project 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)

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 NetID

rgramlin

Secondary Mentor Name

Robert Gramling

Status

Undergraduate

Student College

College of Arts and Sciences

Program/Major

Biology

Primary Research Category

Health Sciences

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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.