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. 2024 Feb 15;130(4):636-644.
doi: 10.1002/cncr.35116. Epub 2023 Nov 21.

The association between telemedicine, advance care planning, and unplanned hospitalizations among high-risk patients with cancer

Erin M Bange  1 , Yimei Li  2   3 , Pallavi Kumar  4   5 , Abigail Doucette  5 , Peter Gabriel  5 , Ravi Parikh  5   6 , Eric H Li  7 , Ronac Mamtani  3 , Kelly D Getz  2   3
Affiliations

The association between telemedicine, advance care planning, and unplanned hospitalizations among high-risk patients with cancer

Erin M Bange et al. Cancer. .

Abstract

Background: Despite the widespread implementation of telemedicine, there are limited data regarding its impact on key components of care for patients with incurable or high-risk cancer. For these patients, high-quality care requires detailed conversations regarding treatment priorities (advance care planning) and clinical care to minimize unnecessary acute care (unplanned hospitalizations). Whether telemedicine affects these outcomes relative to in-person clinic visits was examined among patients with cancer at high risk for 6-month mortality.

Methods: This retrospective cohort study included adult patients with cancer with any tumor type treated at the University of Pennsylvania who were newly identified between April 1 and December 31, 2020, to be at high risk for 6-month mortality via a validated machine learning algorithm. Separate modified Poisson regressions were used to assess the occurrence of advance care planning and unplanned hospitalizations for telemedicine as compared to in-person visits. Additional analyses were done comparing telemedicine type (video or phone) as compared to in-person clinic visits.

Results: The occurrence of advance care planning was similar between telemedicine and in-person visits (6.8% vs. 6.0%; adjusted risk ratio [aRR], 1.25; 95% CI, 0.92-1.69). In regard to telemedicine subtype, patients exposed to video encounters were modestly more likely to have documented advance care planning in comparison to those seen in person (7.5% vs. 6.0%; aRR, 1.48; 95% CI, 1.03-2.11). The 3-month risk for unplanned hospitalization was comparable for telemedicine compared to in-person clinic encounters (21% vs. 18%; aRR, 1.06; 95% CI, 0.81-1.38).

Conclusions: In this study, care delivered by telemedicine, compared to in-person clinic visits, produced comparable rates of advance care planning conversations without increasing hospitalizations, which suggests that vulnerable patients can be managed safely by telemedicine.

Keywords: acute care utilization; advance care planning; end-of-life care; health services; telemedicine.

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Conflict of interest statement

Conflicts of Interest:

EMB reported serving as a consulted for Flatiron Health

RM reported serving as a consultant for Seagen, Astellas, and BMS; receiving personal fees from Flatiron Health, Astellas and Seattle Genetics, and BMS; and receiving a research grant from Merck outside the submitted work.

YL, PK, AD, PG, KG have no conflicts of interest to disclose

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