What Models Exist to Deliver Palliative Care via Telemedicine?

Definition of Telehealth and Telemedicine

Telehealth is the use of technology to support a broad range of health care services, including smartphone applications, online patient and clinician education initiatives, and clinical care delivered by providers to patients using a real-time audio or audio-visual platform. When clinicians provide care to patients on an audio or audio-visual platform, this part of telehealth is called telemedicine. This chapter focuses primarily on telemedicine for palliative care and hospice.

Brief History of Telemedicine

Telemedicine originated to improve access to medical care where it would not otherwise be available: military, prisons, and rural areas. In particular, there was an emphasis on bringing specialty care, including stroke and critical care, to settings without these services. Telemedicine was offered to patients receiving care in clinics and hospitals with specialty providers conducting remote consultations.

Since its origins, telemedicine has undergone a complete transformation, now with an emphasis on providing care to patients within their home. This transformation of telemedicine to care at home began as a way to improve access to general and specialty services for patients who live in areas with fewer clinicians. Now it is a part of health care delivery more broadly, even in urban areas. For patients with multiple medical problems, telemedicine has been suggested as a more flexible, efficient, and convenient approach. Telemedicine services eliminate the need to arrange transportation, which requires time and resources, and have been shown to decrease appointment wait times.

Rationale for Telemedicine in Palliative Care and Hospice

In many ways, telemedicine may be particularly helpful for patients with serious illness who often have unmet palliative care needs or who may be near the end of life. This patient population has significant functional impairment, which makes leaving home challenging. Dynamic changes in clinical status and symptom burden, such as worsening pain or confusion, warrant timely and frequent reassessment by clinicians to up-titrate or down-titrate medications. In addition, given the shortage of palliative care and hospice clinicians, telemedicine may provide a solution for patients with serious illness who do not live near specialty providers or do not have access to specialty providers in assisted living facilities, skilled nursing facilities, and long-term care facilities. This chapter describes the evidence base for telemedicine models for palliative care and hospice, best practices for clinicians engaging in telemedicine, as well as challenges and opportunities for telemedicine in the care of patients with serious illness.