Improving the Telehealth Delivery of Care for Older Veterans with Cancer and Cognitive Impairment

Alzheimer’s disease and related dementias (ADRD) and cancer impose a heavy burden on patients and their caregivers and are major contributors to US healthcare expenditures. Given the rapidly growing aging population at risk for both conditions, there is a critical need to understand how to improve care for those with

comorbid cancer and cognitive impairment. Patients with dual diagnoses of cancer and cognitive impairment including ADRD have worse outcomes and unique care needs that require more person-centered care. The unique care needs of patients with comorbid cancer and cognitive impairment cannot be met with current

oncology clinic workflow and staffing and time constraints. Oncology care must address the unique care needs of these patients through multi-dimensional interventions for the clinic environment, providers, patients, and caregivers that can be customized to different degrees of cognitive dysfunction and available supports.

Increased telehealth use within VA hospitals has helped relieve some of the burdens on patients and caregivers, and telehealth oncology care is expected to be an integral, growing part of VA oncology care in the foreseeable future. However, there is limited evidence and guidance on telehealth use for complex patients like

those with cancer and cognitive impairment including ADRD. In fact, the rapid telehealth expansion may unintentionally exacerbate the already complex care needs of high-need Veterans. There is a critical need to proactively design care processes to address the needs of these vulnerable patients. The goal of this project is

to improve the telehealth delivery of cancer care for older, cognitively impaired Veterans on active cancer treatment by 1) understanding the telehealth oncology experiences of patients with cognitive impairment, their caregivers, and clinicians, and 2) developing and testing a multi-dimensional intervention that can be

customized to different degrees of cognitive dysfunction and available supports. Eligible participants are clinicians providing telehealth oncology care and patients who meet the following inclusion criteria: age 65 or older, on active cancer treatment, has received any part of their care through telehealth (phone or video),

Montreal Cognitive Assessment (MoCA) score