Geriatric Assessment-guided INtervention with Supportive Care (GAIN-S): A telehealth quality improvement study in a...

The American Society of Clinical Oncology guidelines recommend geriatric assessment (GA)-guided interventions to inform care for older adults with cancer. GA-guided intervention delivery to lower-resourced settings has been limited. We assessed the feasibility of implementing GA-guided supportive care (GAIN-S) via telehealth in a lower-resourced setting.

A quality improvement study was conducted in a low-resourced community oncology practice in the Mojave Desert. Eligible participants were 65+ years with a diagnosis of cancer, newly initiating care at the clinic. At baseline, patients completed: GA, SupportScreen, and the Fulmer SPICES assessment. A geriatric oncology nurse practitioner (GNP) reviewed GA results and implemented GAIN-S via telehealth between April 2020 and January 2023. Key outputs measured included: number of patients who completed GAIN-S; number of referrals to supportive care services and completion rate; and patient satisfaction with telehealth visits. Participants' demographics, distance traveled for care, type of cancer, stage, treatment, and telehealth satisfaction items were summarized using descriptive statistics. To evaluate the implementation process, run charts were utilized.

A total of 253 patients (median age 72, 62% non-Hispanic White, 22% lived 60+ miles from the clinic, 40% had stage III or greater, 30% received chemotherapy) completed assessments. Two hundred forty-two had initial visits with the GNP, 197 via tele-video, and 45 via telephone for a total telehealth encounter participation rate of 96%. The GNP reviewed vulnerabilities with 231 patients and generated 483 accepted referrals for supportive care services, of which over 88% of services were completed. The highest numbers of accepted referrals were to pharmacy (177), social work (154), occupational therapy (79), and physical therapy (55). Over 92% of patients were satisfied with telehealth-based GAIN-S for ease of visit, access to care with their provider, and telehealth use.

Telehealth-based GAIN-S is feasible and acceptable, providing accessible healthcare to older patients with cancer in a lower-resourced community setting. This approach highlights telehealth delivery of GAIN-S in our clinical enterprise and has implications for other such settings.