Comparison of Telemedicine with In-Person Outpatient Palliative Care Visits for Children with Cancer (Sch420)

ABSTRACT

Outcomes: 1. Define quality metrics and health outcomes as they relate to outpatient pediatric palliative oncology care. 2. Analyze differences in palliative interventions delivered in telemedicine versus in-person visits and investigate potential reasons for these differences. Background(s) Contrary to the inpatient focus of most pediatric palliative care (PPC) teams, children with cancer receive the majority of their care in the clinic, highlighting the importance of outpatient PPC for this population. Although many models of care exist, telemedicine use in PPC became nearly universal during the COVID-19 pandemic. While early studies suggest feasibility and acceptability, little is known about the quality of PPC delivered via telemedicine to children with cancer. Objective(s) To compare telemedicine with in-person outpatient palliative care visits in pediatric oncology patients. Method(s) Descriptive retrospective chart review of outpatient PPC visits at a large freestanding children's hospital occurring via telemedicine or in clinic during 2020 and 2021 for children with a primary palliative care diagnosis of cancer. Reason for visit and palliative intervention will be evaluated for telemedicine and in-person visits. Outcomes, including intensive care unit (ICU) and emergency department visits, death in the ICU, and hospice referrals, will be compared among patients with only telemedicine visits, only in-person visits, and both visit types through 2022. Descriptive statistics will be reported. Result(s) Of 394 patients with outpatient PPC visits in 2020 or 2021, 82 were determined to have a primary oncologic diagnosis 44% solid tumors, 35% leukemia/lymphoma, and 21% CNS tumors. In total, 254 outpatient visits (212 in person, 42 telemedicine) were completed. Five patients had only telemedicine visits, 52 had only in-person visits, and 25 had both visit types. Overall, 72% of patients are deceased to date;of those, 25% (telemedicine 0%, in person 27%, both types 28%) died in the ICU. Additional results are pending. Conclusion(s) Given the small number of patients seen solely via telemedicine, we anticipate difficulty in detecting true differences in health outcomes but are hopeful differences may be more apparent on the encounter level due to a more robust sample size.Copyright © 2023