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

> **NIH VA IK2** · VETERANS AFFAIRS MED CTR SAN FRANCISCO · 2024 · —

## Abstract

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 <26, able to speak English and provide consent. We will start
with a convergent parallel mixed-methods study to interview and survey clinicians, older Veterans with cancer
and cognitive impairment undergoing active treatment via telehealth, and their caregivers (Aims 1-2). We will
use these data to develop an intervention guided by principles of the Consolidated Framework for
Implementation Research and Capability-Opportunity-Motivation model of Behavior change (Aims 1-2). We will
then pilot test this multi-dimensional intervention using adaptive design principles (Aim 3). Cognitive
impairment will be stratified by milder (MoCA 18<26) versus more severe cognitive impairment (MoCA <18) as
care need...

## Key facts

- **NIH application ID:** 10861674
- **Project number:** 1IK2HX003672-01A2
- **Recipient organization:** VETERANS AFFAIRS MED CTR SAN FRANCISCO
- **Principal Investigator:** Li-Wen Huang
- **Activity code:** IK2 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2024-08-01 → 2029-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10861674

## Citation

> US National Institutes of Health, RePORTER application 10861674, Improving the Telehealth Delivery of Care for Older Veterans with Cancer and Cognitive Impairment (1IK2HX003672-01A2). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10861674. Licensed CC0.

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