A literature review found palliative care can be delivered effectively through telemedicine.
U.S. patients are becoming more comfortable with telemedicine. A majority of the more than 4,300 respondents to a 2017 BMC Health Services Research survey, for example, expressed willingness to engage in telemedicine encounters with physicians with whom they have an established relationship, and this mode of delivery has been found to offer benefits such as heading off unnecessary trips to the ER.
Regarding palliative care specifically, Kristine Swartz, MD, Assistant Professor, Department of Family and Community Medicine, Division of Geriatrics and Palliative Medicine with Jefferson Health in Philadelphia, and Brooke Worster, MD, FACP, Assistant Professor, Department of Family Medicine and Medical Oncology with Jefferson Health, found that extending these services via telemedicine to patients with advanced cancer enhances symptom management, comfort, and patient and family satisfaction.
“We have embarked on using telehealth in our outpatient palliative care clinic and were interested in what evidence was out there to support it,” Dr. Swartz says. “Palliative care patients often have high burdens of symptoms and, as a result, limitations in functional status that make it difficult to physically come to appointments. It makes sense that bringing the care to the patient using telemedicine would help with this vulnerable population.”
Drs. Swartz and Worster found that in addition to easing the burden of travel, telemedicine maximizes access to care.
“There is a significant shortage of specialty-trained palliative care physicians, especially practicing outside of the inpatient hospital setting,” Dr. Worster says. “Thus, using technology to make this available to patients in less resource-rich, rural areas is important.”
“Telemedicine and telemonitoring are likely to play a larger role in how we provide care in this country moving forward, driven by patient demand and certain specialty physician shortages. It is imperative to become comfortable with the technology as well as the art of practicing medicine virtually.”
— Kristine Swartz, MD, Assistant Professor, Department of Family and Community Medicine, Division of Geriatrics and Palliative Medicine with Jefferson Health
Complementing In-person Care
A key component of telemedicine is the sense of support and confidence it can impart when an in-person visit with a provider is not possible, the researchers found.
“When facing chronic, serious illness, patients and families often feel alone in managing their symptoms,” Dr. Swartz says. “They have higher satisfaction when they have more opportunities to interact with their healthcare providers.”
Underscoring that point, among the research the physicians reviewed was a Japanese study of end-stage cancer patients receiving palliative telemedicine services. The study documented increased patient satisfaction and reduced costs, as well as improved symptom scores.
In terms of barriers, older patients tended to be less receptive to use of the relevant technologies, according to Dr. Swartz, but that is not an insuperable obstacle.
“It should not be assumed that just because they are older they cannot participate,” she adds. “Often, enlisting the help of a more technology-comfortable family member can solve the problem.”