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Randomized Controlled Trial
. 2022 Dec;64(6):577-587.
doi: 10.1016/j.jpainsymman.2022.08.005. Epub 2022 Aug 17.

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

Isaac S Chua  1 , Molly Olmsted  2 , Rachel Plotke  3 , Yael Turk  3 , Chardria Trotter  3 , Simone Rinaldi  4 , Mihir Kamdar  4 , Vicki A Jackson  4 , Emily R Gallagher-Medeiros  3 , Areej El-Jawahri  4 , Jennifer S Temel  4 , Joseph A Greer  4
Affiliations
Randomized Controlled Trial

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

Isaac S Chua et al. J Pain Symptom Manage. 2022 Dec.

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.

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Conflict of interest statement

Disclosures and Acknowledgments Research reported in this publication was funded through the Patient-Centered Outcomes Research Institute (PCORI) Award (PLC-1609-35995) and was supported by the Palliative Care Research Cooperative Group, which is funded by the National Institute of Nursing Research of the National Institutes of Health under award number U2CNR014637. All statements in this publication are solely the responsibility of the authors and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute (PCORI), its Board of Governors, or Methodology Committee. No competing financial interests exist.

Figures

Fig 1
Fig. 1
Distribution of palliative care (PC) visit modalities across COVID-19 patient subgroups. For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.
See this image and copyright information in PMC

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