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


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

In This Article


The COVID-19 pandemic is a rapidly changing and evolving health care system priority. While the adoption of telehealth in hospice and palliative care has been slow prior to COVID-19, telehealth use in both specialties is expected to continue as health policy makers, payers, and health systems look for creative ways to leverage technology to deliver primary and specialty palliative care and hospice care. The permanency of temporary reimbursement policy changes that have broadened the coverage of telehealth services for patients receiving hospice services has yet to be determined.[19,20,46] The removal of reimbursement barriers will be a key factor and facilitator of permanent adoption of telehealth especially for smaller provider organizations.

A guiding principle for the use of telehealth is the aim to use it as a tool to increase access to care for patients, families, and caregivers rather than as a replacement for in-person care. Best practices are prerequisite to ensuring that a compassionate, person-centered approach to care is not lost as care is delivered in a new way. Telehealth has been provided to persons receiving hospice and palliative care by all disciplines during the pandemic, and the best practice principles and examples developed and shared in this article are applicable for interprofessional use.

The next frontier for advancing telehealth delivery includes enveloping best practices into clinical workflows and building a stronger evidence base to measure clinical outcomes. New and existing tools including telephone triage protocols and algorithms for different telehealth modalities need to be revised, developed, and tested. Decision-making support tools for clinicians are also needed.

More robust research will be required to measure the impact of telehealth use in hospice and palliative care if use of this modality is to preponderate. More studies are needed to inform the continued development of best practices for delivering telehealth, and more practice-based evidence should be generated to evaluate the value of the best practice principles and sample practices outlined in this article. Future work to evaluate best practices should include monitoring the process of best practice implementation, as well as the outcomes of best practice use. As practice-based evidence is generated, specific attention should be given to evaluating the potential for adaptation of these best practices to other settings and considering the implementation and contextual factors that influence their utility when adopted by other hospice and palliative care providers.