Best Practices for Using Telehealth in Hospice and Palliative Care

Michelle Webb, DNP, RN, BC-CHPCA; Susan Lysaght Hurley, PhD, GNP-BC; Jennifer Gentry, DNP, ANP-BC, GNP, ACHPN; Melanie Brown, LCSW; Cynthia Ayoub, BSN, RN, BC-CHPCA

Disclosures

Journal of Hospice and Palliative Nursing. 2021;23(3):277-285. 

In This Article

Abstract and Introduction

Abstract

Hospice and palliative care providers throughout the United States have continued to provide compassionate patient- and family-centered care during the COVID-19 (coronavirus disease 2019) pandemic while adapting to the need for scrupulous infection control measures and the accelerated use of telehealth. Prior to the pandemic, hospice and palliative care adopted telehealth slowly compared with other specialties, but its rapidly increasing utilization during the COVID-19 pandemic has long-term implications for access to primary and specialty palliative care, particularly for patients in rural communities and populations experiencing inequitable access to services. Telehealth also shows great promise for leveraging technology to provide care more effectively and efficiently. As more provider organizations become equipped with telehealth infrastructure, and as advocacy for broader reimbursement of these services grows, telehealth services for hospice and palliative care are expected to continue. This article highlights the work of expert clinicians from multiple hospice and palliative care organizations to develop best practices for conducting telehealth visits in inpatient and community settings. The authors propose that best practices be compiled and considered to ensure quality-driven, evidence-based clinical practice guidelines with interprofessional applicability.

Introduction

Telehealth has been a slowly adopted health care delivery mode in hospice and palliative care, but the COVID-19 (coronavirus disease 2019) pandemic has exponentially accelerated its use. How telehealth is delivered and evaluated during this pandemic will have ramifications for further regulatory support and for the integration of technology as a standard part of hospice and palliative care.

Telehealth and related terms specific to the delivery of hospice and palliative care services using technology have been defined differently by many entities.[1–4] Most definitions are broad and inclusive, although some differentiate telehealth from telemedicine, whereas others use the terms interchangeably.

Telehospice has been defined as "the use of telehealth technologies to overcome geographic distances in the delivery of hospice care."[5] (p38) Telepalliative care is a term that has been applied to the application of telehealth technologies to palliative care.[6] An emerging term is the "virtual visit," as a specific component of telehealth. A virtual visit takes place between a patient and clinician via communications technology where video and audio connectivity allows meetings to occur in real time from virtually any location.[7] In developing the principles and best practices outlined in this article, the broadest and most inclusive definition of telehealth as "technology-enabled health and care management and delivery systems that extend capacity and access"[2] (p1) has been applied.

Telehealth services can be provided to persons needing hospice or palliative care services using various technologies, including but not limited to, telephones, video, and remote patient symptom-monitoring applications (including those that allow for the use of biometric data collection tools). While there is a need for more data, telehealth services have demonstrated great potential to address the challenge of ensuring access to and delivery of primary and specialist palliative care and hospice care.[8] Providers have primarily used telehealth in the past to ease challenges of geography and distance to provide effective, efficient, and timely support to patients and families living in rural areas.[9]

However, telehealth has been used during the pandemic to address new challenges resulting from the need to reduce the risk of COVID-10 transmission. Even prior to the current COVID-19 pandemic, hospice caregivers expressed interest in the use of video-chat features on smartphones to communicate in instances when an in-person visit was not possible.[9] One of the recognized prepandemic benefits for patients receiving telehealth is the ability of technology to monitor functional decline and symptoms of disease progression between scheduled in-person visits.[9] Such screening may identify important changes and needs before they become urgent, allowing for earlier intervention. Telehealth has emerged during the public health emergency (PHE) resulting from the COVID-19 pandemic as another critical access point to hospice and palliative services for patients and families.

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