Experiences with Telehealth for Outpatient Palliative Care: Findings from a Mixed-Methods Study of Patients and Providers across the United States.

Background: The COVID-19 pandemic introduced a rapid adoption and scale-up of telehealth for palliative care services in the United Sates. Objectives: To examine and compare in-person versus telehealth experience among outpatient palliative care programs and patients. Design: Mixed-methods study (1) comparing patient experience survey data received between September 2020 and February 2021 from patients who received only in-person care versus those who received only telehealth and (2) qualitative interviews with outpatient palliative care providers. Data for this study were collected as part of a larger effort to develop quality measures for outpatient palliative care in the United States. Setting/Subjects: Outpatient palliative care patients and programs. Measurements: We measured patients' experiences of "feeling heard and understood" by their palliative care provider and team and their overall rating of their provider and team. We also conducted in-depth semistructured interviews with 47 palliative care providers across 25 outpatient palliative care programs. Results: Of 1753 patient experience surveys, 26% reflected telehealth only versus 74% in-person only. Patients in both groups reported highly positive experiences; there were no differences in "feeling heard and understood" or the overall ratings of the provider and team between the telehealth-only and in-person-only groups. Palliative care program leaders described the benefits and challenges of telehealth, including increased efficiency, the ability to incorporate family members, and challenges conducting a physical examination. Conclusion: Data from this study provide preliminary evidence of overall positive experiences of telehealth for outpatient palliative care among patients and providers; future research is needed to examine the sustainability of telehealth for palliative care.

Protecting the mental and physical well-being of frontline health care workers during COVID-19: Study protocol of a cluster randomized controlled trial.

INTRODUCTION: The COVID-19 pandemic has placed health care workers at unprecedented risk of stress, burnout, and moral injury. This paper describes the design of an ongoing cluster randomized controlled trial to compare the effectiveness of Stress First Aid (SFA) to Usual Care (UC) in protecting the well-being of frontline health care workers. METHODS: We plan to recruit a diverse set of hospitals and health centers (eight matched pairs of hospitals and six pairs of centers), with a goal of approximately 50 HCW per health center and 170 per hospital. Participating sites in each pair are randomly assigned to SFA or UC (i.e., whatever psychosocial support is currently being received by HCW). Each site identified a leader to provide organizational support of the study; SFA sites also identified at least one champion to be trained in the intervention. Using a "train the trainer" model, champions in turn trained their peers in selected HCW teams or units to implement SFA over an eight-week period. We surveyed HCW before and after the implementation period. The primary outcomes are posttraumatic stress disorder and general psychological distress; secondary outcomes include depression and anxiety symptoms, sleep problems, social functioning problems, burnout, moral distress, and resilience. In addition, through in-depth qualitative interviews with leaders, champions, and HCW, we assessed the implementation of SFA, including acceptability, feasibility, and uptake. DISCUSSION: Results from this study will provide initial evidence for the application of SFA to support HCW well-being during a pandemic. TRIAL REGISTRATION: (Clinicaltrials.govNCT04723576).

Trust in experts, not trust in national leadership, leads to greater uptake of recommended actions during the COVID-19 pandemic.

Evidence suggests that people vary in their desire to undertake protective actions during a health emergency, and that trust in authorities may influence decision making. We sought to examine how the trust in health experts and trust in White House leadership during the COVID-19 pandemic impacts individuals' decisions to adopt recommended protective actions such as mask-wearing. A mediation analysis was conducted using cross-sectional U.S. survey data collected between March 27 and 30, 2020, to elucidate how individuals' trust in health experts and White House leadership, their perceptions of susceptibility and severity to COVID-19, and perceived benefits of protecting against COVID-19, influenced their uptake of recommended protective actions. Trust in health experts was associated with greater perceived severity of COVID-19 and benefits of taking action, which led to greater uptake of recommended actions. Trust in White House leadership was associated with lower perceived susceptibility to COVID-19 and was not associated with taking recommended actions. Having trust in health experts is a greater predictor of individuals' uptake of protective actions than having trust in White House leadership. Public health messaging should emphasize the severity of COVID-19 and the benefits of protecting oneself while ensuring consistency and transparency to regain trust in health experts.

La evidencia sugiere que las personas varían en su deseo de emprender acciones de protección durante una emergencia de salud y que la confianza en las autoridades puede influir en la toma de decisiones. Buscamos examinar cómo la confianza en los expertos en salud y la confianza en el liderazgo de la Casa Blanca durante la pandemia de COVID­19 impactan las decisiones de las personas para adoptar las acciones de protección recomendadas, como el uso de máscaras. Se realizó un análisis de mediación utilizando datos de encuestas transversales de EE. UU. Recopilados entre el 27 y el 30 de marzo de 2020 para dilucidar cómo la confianza de las personas en los expertos en salud y el liderazgo de la Casa Blanca, sus percepciones de susceptibilidad y gravedad al COVID­19, y los beneficios percibidos de protegerse contra COVID­19, influyó en su adopción de las acciones de protección recomendadas. La confianza en los expertos en salud se asoció con una mayor gravedad percibida de COVID­19 y los beneficios de tomar medidas, lo que llevó a una mayor aceptación de las acciones recomendadas. La confianza en el liderazgo de la Casa Blanca se asoció con una menor susceptibilidad percibida al COVID­19 y no con la adopción de las acciones recomendadas. Tener confianza en los expertos en salud es un factor de predicción mayor de la adopción de acciones de protección por parte de los individuos que tener confianza en el liderazgo de la Casa Blanca. Los mensajes de salud pública deben enfatizar la gravedad de COVID­19 y los beneficios de protegerse a sí mismo, al tiempo que se garantiza la coherencia y la transparencia para recuperar la confianza en los expertos en salud.