Experiences of caregivers and hospice leaders with telehealth for palliative care: a mixed methods study.

BACKGROUND: Telehealth was expanded worldwide during the COVID-19 pandemic to deliver essential care remotely to patients, including those receiving palliative care. Bipartisan groups of politicians in the United States call for continuing the expanded Medicare coverage of telehealth services beyond the pandemic period. The aim was to understand telehealth's benefits and risks to hospice and palliative care patients and their families. METHODS: We conducted a cross-sectional survey of 595 caregivers of seriously ill patients and interviewed 25 hospice leaders across the United States. We used multiple linear regression to analyze the survey data and qualitative methods to determine themes from the interview data. RESULTS: Our survey showed that a good internet connection, better access to video, and the patient being younger than 65 years old were associated with greater satisfaction with telehealth. The hospice leader interviews highlighted that telehealth can enhance or detract from quality care, depending on the function; confusion over telehealth policies and concern for abuse exists; and telehealth during the pandemic has spurred on technology-enabled innovation and improvements, especially for resource-constrained hospice and palliative care organizations. CONCLUSIONS: Telehealth used during the pandemic showed that it may work for certain hospice and palliative care services. As telehealth coverage expands, it is important to address its risks and shortcomings upfront. When designed and implemented with the patient and equity in mind, telehealth has the potential to improve access to hospice and palliative care for all.

Perspectives on Telehealth for Hospice and Palliative Care: Where It Adds Value (ODS6)

Outcomes 1. Describe the areas of confusion and concern about using telehealth for hospice and palliative care 2. Explain components related to telehealth (eg, video, internet, and device accessibility) that relate to better satisfaction with telehealth 3. Discuss opportunities for telehealth to enhance care for seriously ill patients receiving hospice and palliative care Telehealth has been expanded during the COVID-19 pandemic to deliver essential care to sick patients, including older adult hospice and palliative care patients. Hospice and palliative care industry leaders and bipartisan groups of politicians call for increasing Medicare coverage of telehealth services to make permanent the reduced restrictions on virtual services during the pandemic. In follow-up to their recent national studies focused on racial and ethnic equity in hospice care, this public health and economics research team presents the reality of telehealth during the pandemic and the confusion and concern going forward for hospice leaders and informal caregivers of seriously ill patients. They will highlight the challenges and opportunities of delivering quality hospice and palliative care by using telehealth to traditionally underserved groups. The session will present findings from the authors’ 2021 survey of 600 informal caregivers and interviews with 25 hospice executives across the United States about telehealth for hospice care. As one interviewee put it, “It's really hard to put the horse back in the barn at this point”;telehealth is not going away. This session will help clinicians gain awareness and understanding of their peers and other stakeholders’ perspectives on experiencing telehealth in hospice care.

Hospice Response to COVID-19: Promoting Sustainable Inclusion Strategies for Racial and Ethnic Minorities.

There is a disproportionate burden of illness and death among racial/ethnic minorities related to COVID-19. The importance of reaching groups suffering the most with resources such as advance directive guidance, telehealth, and culturally sensitive education materials is vital to providing quality, inclusive care. A crisis presents an opportunity to unite and problem-solve to help avoid the dire consequences facing inaction. In this way, inclusive responses by hospices, social workers, other community partners during the COVID-19 pandemic can help reach and alleviate the pain of those groups most afflicted. We offer hospice inclusion strategies that align with general pandemic response trends that may lead to greater hospice inclusion beyond this public health emergency.