Video and In-Person Palliative Care Delivery Challenges before and during the COVID-19 Pandemic

Isaac S Chua; Molly Olmsted; Rachel Plotke; Yael Turk; Chardria Trotter; Simone Rinaldi; Mihir Kamdar; Vicki A Jackson; Emily R Gallagher-Medeiros; Areej El-Jawahri; Jennifer S Temel; Joseph A Greer

doi:10.1016/j.jpainsymman.2022.08.005

Video and In-Person Palliative Care Delivery Challenges before and during the COVID-19 Pandemic

J Pain Symptom Manage. 2022 Dec;64(6):577-587. doi: 10.1016/j.jpainsymman.2022.08.005. Epub 2022 Aug 17.

Authors

Affiliations

¹ Division of General Internal Medicine and Primary Care, Department of Medicine (I.S.C.), Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (I.S.C.), Boston, Massachusetts, USA; Harvard Medical School (I.S.C., S.R., M.K., V.A.J., A.E.J., J.S.T., J.A.G.), Boston, Massachusetts, USA. Electronic address: ichua@bwh.harvard.edu.
² University of Massachusetts Medical School (M.O.), Worcester, Massachusetts, USA.
³ Massachusetts General Hospital (R.P., Y.T., C.T., S.R., M.K., V.A.J., E.R.G.M., A.E.J., J.S.T., J.A.G.), Boston, Massachusetts, USA.
⁴ Harvard Medical School (I.S.C., S.R., M.K., V.A.J., A.E.J., J.S.T., J.A.G.), Boston, Massachusetts, USA; Massachusetts General Hospital (R.P., Y.T., C.T., S.R., M.K., V.A.J., E.R.G.M., A.E.J., J.S.T., J.A.G.), Boston, Massachusetts, USA.

Abstract

Context: Palliative care (PC) clinicians faced many challenges delivering outpatient care during the coronavirus-19 (COVID-19) pandemic.

Objectives: We described trends for in-person and video visit PC delivery challenges before and during the COVID-19 pandemic in the U.S.

Methods: We performed a secondary data analysis of patient characteristics and PC clinician surveys from a multisite randomized controlled trial at 20 academic cancer centers. Patients newly diagnosed with advanced lung cancer (N = 653) were randomly assigned to receive either early in-person or telehealth PC and had at least monthly PC clinician visits. PC clinicians completed surveys documenting PC delivery challenges after each encounter. We categorized patients into 3 subgroups according to their PC visit dates relative to the onset of the COVID-19 pandemic in the U.S.-pre-COVID-19 (all visits before March 1, 2020), pre/post-COVID-19 (≥1 visit before and after March 1, 2020), and post-COVID-19 (all visits after March 1, 2020). We performed Pearson's chi-squared, Fisher's exact, and Kruskal-Wallis tests to examine associations.

Results: We analyzed 2329 surveys for video visits and 2176 surveys for in-person visits. For video visits, the pre-COVID-19 subgroup (25.8% [46/178]) had the most technical difficulties followed by the pre/post-COVID-19 subgroup (17.2% [307/1784]) and then the post-COVID-19 subgroup (11.4% [42/367]) (P = 0.0001). For in-person visits, challenges related to absent patients' family members occurred most often in the post-COVID-19 subgroup (6.2% [16/259]) followed by the pre/post-COVID-19 subgroup (3.6% [50/1374]) and then the pre-COVID-19 subgroup (2.2% [12/543]) (P = 0.02).

Conclusion: Technical difficulties related to PC video visits improved, whereas in-person visit challenges related to absent patients' family members worsened during the pandemic.

Keywords: COVID-19; coronavirus-19; palliative care; telehealth; telemedicine.

Publication types

Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Ambulatory Care
COVID-19*
Humans
Palliative Care
Pandemics
Telemedicine*

Grants and funding

U2C NR014637/NR/NINR NIH HHS/United States