Inpatient Oncology Tele-Palliative Care During a COVID-19 Surge: The Experiences of an Interdisciplinary Team

ABSTRACT

Background/Purpose: In spring 2020, New York City was a global hotspot for COVID-19 and the inpatient palliative care (PC) service at our comprehensive cancer center was rapidly transitioned to a fully virtual platform. We aimed to explore PC specialists perceived self-efficacy in meeting the psychosocial needs of acute care oncology inpatients using telehealth during the first surge of COVID-19. Methods: We used a single-site qualitative design and convenience sampling of interdisciplinary PC specialists with at least 1 year of PC experience prior to the telehealth transition. In-depth semistructured interviews were conducted via Zoom and lasted one hour. Following interview transcription, interdisciplinary coding team members used an applied thematic text analysis approach. Each coder independently reviewed, synthesized, and interpreted interview content and then convened as a group to refine the codebook and reach consensus on recurring themes. Results: Eleven PC specialists participated social worker (n = 1);pharmacist (n = 1);chaplain (n = 1);physician assistant (n = 1);physicians (n = 4);and nurse practitioners (n = 4). One-third had previous telehealth experience and n = 7 was “not at all comfortable” or “somewhat comfortable” with delivering telehealth prior to the virtual platform transition of the PC service. Major themes included telehealth barriers and positives;perceived self-efficacy;clinician distress;impact on the quality of relationships with patients, families, oncology teams, and PC colleagues;and barriers and facilitators to coping and self-care. Participants provided explicit service- and system-level recommendations to improve the quality of tele-PC consultation during future health crises. Conclusions and Implications Study findings describe personal and professional experiences related to a resource-constrained infrastructure during COVID-19 and myriad consequences of PC specialists feeling ineffective at fulfilling their roles. Cancer centers should integrate PC specialist recommendations for future telehealth services to guide care delivery in the context of crisis. Additional research must be conducted to explore the long-term impact of COVID-19 related tele-PC on both specialists and care recipients.