Communication practices and experience of connection in telehealth serious illness conversations with rural cancer patients: a qualitative study

Telehealth can overcome functional, cost, and geographic barriers to attending in-person visits for people living with cancer in rural areas. Yet this medium presents clinicians, patients, and families with a different sensory and relational environment within which to engage in serious illness conversations. Within this different context, there is a need to better understand how clinicians preserve or adapt their communication strategies to connect interpersonally with patients and ensure high-quality care. We explored the characteristics of telehealth communication that patients reported fostered human connection in serious illness conversations among rural-dwelling patients with cancer. Grounded in a Basic Science Framework for Serious Illness Communication Research, we conducted semi-structured interviews with adult rural-dwelling patients with cancer. Eligible participants were either currently receiving or had recently completed treatment for their cancer and received some part of their cancer care via teleconferencing. Using directed content analysis, we qualitatively described participants’ experiences with telehealth encounters with their providers (i.e., oncology or palliative care clinicians). We followed the consolidated criteria for reporting qualitative research (COREQ) for rigorous data collection, analysis, and reporting. We interviewed 20 participants (average duration = 29 min; range: 14–56 min). Mean age was 66 years and 60% were women. All participants identified as white and 85% identified as financially secure. Over half reported high digital health care literacy, including 65% (13/20) reporting ability to use electronic device software applications (e.g. Zoom) independently. We identified three major themes in interviews: (1) the accessibility, comfort, and convenience of telehealth contributes to patient experience of connection; (2) communication actions that enable connection in this setting are those that foster a sense of patients feeling seen as a person, and allow them to see their clinicians as humans as well; (3) patients’ experience of connection is impacted by relational, situational, and technological factors. Accessibility, clinician communication actions, and contextual factors of telehealth affect the experience of human connection in their cancer care among people with cancer who live in rural areas. This study provides a foundation to drive future research uncovering the optimal telehealth communication strategies to promote connection during virtual serious illness conversations.