The Telephone (Still) Has Its Advantages

Excerpts of ‘Advance Care Planning by Telephone’ by Vital Decisions’ A. Zuckoff

Americans living through the coronavirus pandemic are rediscovering the virtues of the telephone. The nation’s two largest phone service providers have reported that the number and length of telephone calls has increased. Executives at polling firms across the country have reported a 25% increase in the productivity of their interviewers. People are more likely to answer the phone, agree to participate, and complete the interview—and many of those who answer the phone want to keep talking even after the survey has ended.

Medical and counseling professionals suddenly unable to meet with patients and clients face-to-face have turned to telehealth applications in unprecedented numbers. Much of the attention has been given to video chat. But for the purpose of counseling a patient or client about behavior or the choices they face, the telephone has advantages of its own.

The Effectiveness of Telephonic Counseling & Motivational Interviewing 

Contrary to many peoples’ assumptions, research shows that counseling over the telephone can be as effective as in-person counseling in both medical and psychological contexts.

Study after study finds similar outcomes for telephone versus in-person counseling…for hereditary cancer genetic risk, weight loss, breast cancer survivors, psychotherapy and cognitive behavior therapy — all with equivalent effects on treatment adherence and outcomes.

Motivational interviewing is a brief counseling approach with strong empirical support for improving engagement and outcomes in substance use, health behavior change, mental health, and other settings. It has also been found to be effective when delivered by telephone.

The Practitioner and Client Experiences 

Two themes are common in research on practitioner perceptions of telephone counseling: Prior to delivering telephone counseling, practitioners tend to expect it to be less effective than counseling face-to-face; upon delivering telephone counseling, practitioners perceive it more positively.

One study reports that the focus on telephone communication allowed more personal conversations with patients and shifted patient expectations of care toward self‐management.

Quantitative studies regularly show no significant differences in patients’ ratings of satisfaction with counseling when comparing telephone and face-to-face interventions. In one study, more than half of participants preferred the former to the latter.

Clients perceived the advantages in counseling via the telephone as convenience (the ability to have services at home), accessibility (due to low cost), control (the ability to remain unseen by the counselor and to determine the length of the session), and reduction of inhibition (feeling more private and less inhibited in talking about important issues).

Telephonic Advance Care Planning

Telephonic counseling is a natural fit for patient-centered advance care planning.

In 2015, one program studied insurance plan case managers trained to offer comprehensive advance care planning (ACP) to Medicare members. During a 12-month period, over ⅓ of members took advantage of an offered ACP conversation.  Program results included:

Case managers reported only positive comments and feedback from participating members, physicians, and the community at-large during the pilot phase of the program; no negative reports or comments were received during implementation, although no formal satisfaction survey was conducted.

For the past decade, Vital Decisions has been delivering ACP services telephonically to people with advanced illness. The Living Well Program reaches clients and their loved ones in the privacy and comfort of their homes and guides them through a series of semi-structured telephonic conversations of varying lengths, based on individual preference.

To achieve the goal of ensuring that the care individuals receive is aligned with their values as their illness progresses and their care decisions shift, specialists employ motivational interviewing to help those they serve to articulate their values, define their goals and preferences for future medical treatment, discuss these goals and preferences with loved ones and healthcare providers, and document them in advance directives.

From 2010-2019, 121,649 individuals enrolled in the Living Well Program, with over 300,000 people with advanced illness, family members, and physicians playing an active role.

Among Medicare Advantage health plan members offered our program and deemed medically eligible from September 2018 – September 2019, 77% agreed to participate and their mean satisfaction score was 4.5 (range = 1-5). Living Well clients had 22.5% fewer inpatient admissions and 18.1% fewer ER visits, and were 3.6 times more likely to elect hospice care, compared with case matched controls.

Want to read the full scientific paper? Get a downloadable PDF here.