Older veterans with CKD can benefit from telehealth conversations with clinicians
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Key takeaways:
- Feasibility of telehealth conversations varied by personal and environmental influences.
- Engaging veterans in conversations about care goals had a beneficial impact.
Older veterans with advanced chronic kidney disease can benefit from discussions about their care goals conducted over telehealth with health care providers, according to researchers.
“Telehealth may be one promising strategy to facilitate early goals of care conversations for patients with CKD,” Alexi Vahlkamp, MA, hospice and palliative care program coordinator at the Edward Hines, Jr. VA Hospital in Hines, Illinois, and colleagues wrote. “While goals of care conversations have historically been completed in-person, they may also be completed by telephone or telehealth as part of a seamless, accessible and veteran-centered care experience.”
Vahlkamp and colleagues observed 40 patients aged 70 years and older with advanced CKD stage 4 or 5, from a Veterans Affairs (VA) hospital nephrology clinic, as part of a mixed-methods pilot study conducted from March 18, 2022, to January 27, 2023. The prospective cohort analysis used semistructured interview sessions with four clinicians and 11 veterans (four using telehealth and seven using phone or in-person visits) to compare patient characteristics and preferences by visit modality and understand goals of care discussed.
Researchers observed a high probability of death, hospitalization or both during the study. Patient characteristics did not greatly differ across visit modalities.
Researchers highlighted two major interview findings: First, the feasibility of goals of care conversations varied by personal and environmental influences, with challenges such as lack of engagement from nonpalliative care providers and uncertainty about illness trajectory. Second, engaging veterans in conversations about care goals had a beneficial effect and offered patient reassurance regardless of visit modality.
“One suggestion could include elevating tele-palliative consultation and allowing VA sites with robust palliative care teams to offer their services virtually, with the goal of reaching rural or homebound patients or those patients without access to local palliative care,” the researchers wrote. “Additional research in this area could advance a more compressive approach to VA kidney care and offer a future model for partnerships.”
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