Palliative care via telehealth on par with in-person care

Early palliative care provided via telehealth resulted in quality-of-life scores similar to those of in-person palliative care among patients with advanced lung cancer, according to new research published in JAMA.

The National Institute of Aging defines palliative care as "focused on improving quality of life for people with serious illnesses and their care partners." This includes managing symptoms, coordinating care between multiple clinicians and working with patients to achieve their treatment goals. Increasingly, telehealth and other forms of virtual care are being used to expand access to oncology-related supportive care services, provide palliative care support to rural family caregivers and ease the transition to palliative and hospice care for pediatric cancer patients.

In this study, researchers from various institutions -- including Mayo Clinic, Massachusetts General Hospital, Northwestern Medicine and the University of California, San Francisco -- assessed whether delivering early palliative care via video-based telehealth had the same effect on quality of life among patients with advanced non-small cell lung cancer (NSCLC) as palliative care provided through in-person visits.

They conducted a randomized comparative effectiveness trial from June 14, 2018, to May 4, 2023, at 22 U.S. cancer centers. The study included 1,250 patients who had received a diagnosis of advanced NSCLC within the past 12 weeks and 548 caregivers.

The patients were divided into two groups. One group met with a specialty-trained palliative care clinician every four weeks via video-based telehealth, while the other met the clinician in an outpatient clinic. The telehealth group had one initial in-person visit to establish the patient-provider relationship.

At 24 weeks, study participants had an average of 4.7 video-based telehealth visits and 4.9 in-person visits for early palliative care. Patient-reported quality-of-life scores were equivalent between groups, with the telehealth group reporting a score of 99.7 and the in-person group reporting a score of 97.7.

Though the rate of caregiver participation in visits was lower for video-based telehealth versus in-person early palliative care, the study groups did not differ in terms of caregiver quality of life, patient coping or patient and caregiver satisfaction with care.

"It's very reassuring to know that we have this other modality to provide palliative care that is more convenient and saves money for a lot of patients, without compromising benefits to patients or caregivers," said Melanie Smith, M.D., co-author of the study and an assistant professor of medicine in the division of hospital medicine at Northwestern Medicine, in a press release.

The researchers concluded that the study results show great potential for improving access to early palliative care via telehealth. However, further research is needed to determine whether telehealth use for palliative care is feasible for different demographic groups.

"We're going to continue to follow these patients past the 24-week mark," Smith said. "We're hoping to look at subgroups to see if there were certain patients that benefited more from video versus in-person visits."

The study aligns with prior research showing that palliative care provided via audio-only telehealth helped improve the quality of life for patients with various chronic conditions.

A study published in January 2024 examined the effectiveness of an audio-only telehealth palliative care intervention in improving the quality of life for chronic obstructive pulmonary disease, heart failure and interstitial lung disease patients at high risk of hospitalization and death.

Of 306 patients in the study, 154 received the ADAPT intervention, which included six phone calls each from a registered nurse helping address chronic condition symptoms and a social worker providing structured counseling. The rest of the patients received usual care.

At six months, the mean score measuring overall quality of life improved by 6.0 points in the intervention group and 1.4 points in the usual care arm.

Anuja Vaidya has covered the healthcare industry since 2012. She currently covers the virtual healthcare landscape, including telehealth, remote patient monitoring and digital therapeutics.