Telehealth Palliative Care in Nursing Homes: A Scoping Review

Lyle Walton; Katherine Courtright; George Demiris; Emily F Gorman; Amy Jackson; Joan G Carpenter

doi:10.1016/j.jamda.2023.01.004

Telehealth Palliative Care in Nursing Homes: A Scoping Review

J Am Med Dir Assoc. 2023 Mar;24(3):356-367.e2. doi: 10.1016/j.jamda.2023.01.004. Epub 2023 Feb 6.

Authors

Lyle Walton¹, Katherine Courtright², George Demiris³, Emily F Gorman⁴, Amy Jackson⁵, Joan G Carpenter⁶

Affiliations

¹ The University of Alabama at Birmingham, Birmingham, AL, USA; Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA.
² Palliative and Advanced Illness Research (PAIR) Center, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
³ School of Nursing, University of Pennsylvania, Philadelphia, PA, USA.
⁴ Health Sciences and Human Services Library, University of Maryland, Baltimore, MD, USA.
⁵ University of Maryland School of Nursing, Baltimore, MD, USA.
⁶ University of Maryland School of Nursing, Baltimore, MD, USA; Corporal Michael J. Crescenz Veterans Affairs Medical Center, Philadelphia, PA, USA. Electronic address: joan.carpenter@umaryland.edu.

Abstract

Objectives: Many adults older than 65 spend time in a nursing home (NH) at the end of life where specialist palliative care is limited. However, telehealth may improve access to palliative care services. A review of the literature was conducted to synthesize the evidence for telehealth palliative care in NHs to provide recommendations for practice, research, and policy.

Design: Joanna Briggs Institute guidance for scoping reviews, and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews frameworks were used to guide this literature review.

Settings and participants: Reviewed articles focused on residents in NHs with telehealth palliative care interventionists operating remotely. Participants included NH residents, care partner(s), and NH staff/clinicians.

Methods: We searched Medline (Ovid), Embase (Elsevier), Cochrane Library (WileyOnline), Scopus (Elsevier), CINHAL (EBSCOhost), Trip PRO, and Dissertations & Theses Global (ProQuest) in June 2021, with an update in January 2022. We included observational and qualitative studies, clinical trials, quality improvement projects, and case and clinical reports that self-identified as telehealth palliative care for NH residents.

Results: The review yielded 11 eligible articles published in the United States and internationally from 2008 to 2020. Articles described live video as the preferred telehealth delivery modality with goals of care and physical aspects of care being most commonly addressed. Findings in the articles focused on 5 patient and family-centered outcomes: symptom management, quality of life, advance care planning, health care use, and evaluation of care. Consistent benefits of telehealth palliative care included increased documentation of goals of care and decrease in acute care use. Disadvantages included technological difficulties and increased NH financial burden.

Conclusions and implications: Although limited in scope and quality, the current evidence for telehealth palliative care interventions shows promise for improving quality and outcomes of serious illness care in NHs. Future empirical studies should focus on intervention effectiveness, implementation outcomes (eg, managing technology), stakeholders' experience, and costs.

Keywords: Telehealth; nursing homes; palliative care; post-acute and long-term care; serious illness.

Publication types

Review
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Humans
Nursing Homes
Palliative Care
Quality of Life
Telemedicine*
Terminal Care*

Abstract

Publication types

MeSH terms

Grants and funding