As a hospice and palliative medicine physician, I can say that the telehealth flexibilities brought about by the pandemic for our patient population have been transformative. Changes in technology, regulations, reimbursement and culture have allowed greater flexibility and access to specialist palliative care teams for people pursuing disease-directed and even curative treatment for serious illnesses like cancer.
Palliative care provides help to people and their families as they deal with a serious diagnosis like heart failure, dementia or liver cirrhosis by addressing their symptoms, as well as practical, emotional and spiritual concerns. Palliative clinicians also create space for people to talk about what is important to them so that they can choose medical treatments that match their values.
Palliative care is delivered by an expert interprofessional team, including physicians, nurse practitioners, physician assistants, social workers, counselors, nurses, spiritual care providers, pharmacists and others. Telemedicine has allowed patients who are all at high risk for the worst complications of COVID-19 due to their serious illness to get whole-person care from a variety of team members while also allowing them more control over their exposure to others. As COVID becomes endemic and emergency changes in regulation and reimbursement, which have permitted the expansion of telehealth, are coming to an end, it is critical that we preserve access to telehealth for all patients at home rather than limiting it only to those in rural areas or those getting mental health support.
Telehealth serves people with mobility challenges
For people with serious illnesses for whom mobility is an issue, it is important to maintain the possibility of getting care virtually, when medically appropriate, so that they can have easier access to their palliative care team at home or in their long-term care facility. These patients and their families are typically dealing with a number of physicians and other clinicians, and one more trip outside the home can exacerbate pain and other symptoms, add to stress, worsen financial challenges and increase work absences for family members. Pandemic telehealth flexibilities have allowed clinicians across the country to demonstrate that palliative care can be delivered effectively virtually, and patients often prefer the telehealth option to get needed evaluation and medication changes for their rapidly changing symptoms.
Telemedicine has also allowed clinic-based physicians and other healthcare providers to have better continuity of care when long-term patients whose disease progresses can no longer come into the clinic and need their care to come to them. For people who are at end of life and receiving hospice care, telehealth has allowed clinicians to see patients more quickly for evolving symptoms and to provide support to families in innovative ways.
Access challenges
In many areas of the United States, we continue to have difficulty providing access to high-quality, home-based palliative care services and hospice services. While access to affordable broadband continues to be an issue, telehealth by synchronous video and audio-only telephone, when needed, has provided more equitable access to palliative support at home with greater flexibility and less stress. With workforce shortages in all areas of healthcare exacerbated by the pandemic, it will be important that we take the lessons learned from the explosion of telehealth over the past three-plus years and be wise about the best way to provide care to patients and their families moving forward. It won’t be all in-person or all virtual care, but likely a combination of the two.
Maintaining telehealth changes such as being able to care for patients in their homes for non-psychiatric diagnoses no matter what community they live in, payment parity for in-person and virtual visits, and the ability to prescribe controlled medications for virtual patients will allow the flexibility needed to provide safe and effective care to the most people possible. How telehealth evolves as we have more access to data and with the evolution of AI remains to be seen, however maintaining and improving access to telehealth for people who need palliative care at home is a crucial part of helping people with serious illness and their families live well no matter their age, diagnosis, or prognosis.
Holly Yang, MD, is president of the American Academy of Hospice and Palliative Medicine. She has practiced in hospice care and home-based palliative care and currently provides care for patients in the outpatient clinic and hospital settings as part of a palliative care team in San Diego, CA. She also teaches hospice and palliative care interprofessional trainees with a focus on serious illness communication.
