Telehealth outpatient palliative care in the COVID-19 pandemic: patient experience qualitative study

Abstract

ObjectivesOutpatient in-person early palliative care improves quality of life for patients with advanced cancer. The COVID-19 pandemic forced a rapid shift to telehealth visits; however, little is known about how telehealth in outpatient palliative care settings should be optimised beyond the pandemic. We aimed to explore, from the perspective of patients attending an outpatient palliative care clinic, the most appropriate model of care for in-person versus telehealth visits.MethodsA qualitative study using the grounded theory method. One-on-one, semistructured qualitative interviews were conducted with 26 patients attending an outpatient palliative care clinic at a tertiary cancer centre recruited from two groups: (1) those with >1 in-person appointment prior to 1 March 2020 and >1 telehealth appointment after this date (n=17); and (2) patients who had exclusively telehealth appointments (n=9). Purposive sampling was used to incorporate diverse perspectives.ResultsOverall, participants endorsed a flexible hybrid approach incorporating both in-person and telehealth visits. Specific categories were: (1) in-person outpatient palliative care supported building interpersonal connections and trust; (2) telehealth palliative care facilitated greater efficiency, comfort and independence and (3) patient-preferred circumstances for in-person visits (preferred for initial consultations, visits where a physical examination may be required and advance care planning discussions), versus telehealth visits (preferred during periods of relative heath stability).ConclusionsThe elements of in-person and telehealth outpatient palliative care clinic visits described by patients as integral to their care may be used to develop models of hybrid outpatient palliative care delivery beyond the pandemic alongside reimbursement and regulatory guidelines.

Telehealth palliative care interventions for patients with advanced cancer: a scoping review

“…[1][2][3] This is especially important given the increased delivery of outpatient telehealth palliative care as a consequence of the pandemic. [59][60][61] Usage of the TIDieR checklist allowed for a critical appraisal of the completeness of description of each intervention and its replicability for future studies to improve the quality of future research in telehealth palliative care and improve its translation into practice. 62,63 Although there was generally a description of how and by whom the intervention was provided, information was usually missing regarding the timing of interventions in the disease trajectory, their duration, frequency of follow-up, and whether providers were available after-hours.…”