clinical practice and patient is vital to the success of palliative care .
I was among a few who were a bit sceptical about how this could work in palliative care , and we saw an opportunity to research whether it would work well or not and , if so , for whom it would work best or work least well .
So we undertook a mixed method study . We had two approaches : one was a survey after people had had a telehealth consultation with their doctor . We asked both the doctor and the patient to answer a series of questions about how well it worked , and what they thought went well , and how satisfied they were or not .
Then we also carried out interviews both with doctors and patients . Some of the things we found were perhaps not surprising . For example , we found that people from regional and rural areas thought telehealth was fantastic .
But we were a little surprised that we found a high level of satisfaction and high acceptability . Interestingly , both doctors and patients were quite satisfied with palliative care through telehealth . Patients were more likely to find it acceptable and satisfactory than their doctors , but there was a series of things where they thought it worked very well , and some things didn ’ t work so well .
So , they thought it worked well if it was just a routine appointment when there were no urgent or problematic concerns that needed to be addressed — particularly for people living in rural or regional parts of Australia .
They ’ re less likely to be satisfied if their health was unstable . So patients and their doctors thought that if the pain was a bit problematic , other symptoms were alarming , or people were distressed , telehealth was insufficient . Patients didn ’ t like it if it needed to be a significant communication type of consultation . If it was exploring plans and goals for the future , they didn ’ t think it was such a great medium .
The qualitative work was interesting because that showed that telehealth enabled more follow-up and continuity of care between patients and their doctors ; mindful that this was when a lot of the community palliative care services were under the pump .
If people were getting sicker , normally you would not keep asking people to come back to appointments because it ’ s a burden and hard work . Instead , you would refer those patients or ask for their community support , their community palliative care , to take on the primary mantle of care .
But because community palliative care was pretty stretched during Covid , and also because telehealth enabled even people who were quite frail to have ongoing relationships with their doctors , telehealth facilitated that access – which was a bit of a surprise .
During our studies , we could follow people for longer because they didn ’ t have to come to the hospital . So we often try to make it easy for people in terms of their appointments ; if they were coming to the hospital for a set of scans or those sorts of things , in the usual world , we would see people at those times because they ’ re at the hospital already , rather than asking them to come back on a separate occasion to see us .
Another positive aspect of telehealth was that it strengthened the connection between patients and their palliative care doctor . Typically , when someone needs to go to a hospital for a medical appointment , their usual palliative care doctor might not be available . So that would mean that they ’ d see a different doctor , whereas with telehealth , they would come and have their scans , but then they would see their usual doctor by telehealth on the other day . So , it enabled continuity in that way as well .
So it made accessing palliative care easier and enhanced the connection between the palliative care doctor and the patient ? Absolutely . It makes it easier for the patient to have the same ongoing relationship with the person and to access the healthcare . They ’ re not spending half their day going to the hospital .
In hospitals , you have to walk around a lot , and there are always distances and long waiting times . So if you ’ re not feeling well , that might be the tipping point that you think , ‘ Oh , I ’ m not up for it today .’
Indeed , we asked patients , and several respondents said , ‘ If it had meant that I had to come to the hospital , I would have had to cancel my appointment because I wouldn ’ t be feeling well enough .’
How likely is it that palliative care using telehealth will be incorporated more in the future ? I think the success would be a combination of both because of telehealth ’ s downsides . If people had new or challenging symptoms , then patients didn ’ t rate the telehealth service so highly . Many of them
“ Telehealth served well when it was a routine check-up and health was stable .
were done on the phone rather than via a visual sort of medium , such as Zoom . And it ’ s not nearly so good on the phone .
In that case , it ’ s harder to understand what ’ s going on fully . You can ’ t see each other ’ s expressions . Especially for people where English may not be the first language , we use many visual cues to help us understand the intention of what ’ s being said , and you can ’ t get that on the phone .
The other downsides of using the phone – because we use phones so much throughout our day-to-day lives – people said they lost the formality of the appointment if it was on the phone . They weren ’ t ready for it , or they hadn ’ t got themselves thinking about what questions they wanted to ask .
Sometimes they might be out walking the dog or at the shops , and suddenly they ’ d forgotten about their telehealth appointment . They also talked about how seeing people face-to-face is much more reassuring ; that the personal relationship offers a lot of reassurance and safety .
I think some combination going forward is likely the best , but we need to add structure to that . The appointments are giving us two different ways of having a consultation , and both of them have potentially got benefits , but we need to get the most out of both .
So , perhaps every third consultation should be another in-person check-in or some regular opportunity to reengage in that interpersonal way .
On the other side , though , could the loss of formality help enhance the doctor-topatient relationship ? Yes , potentially . If patients are in their own homes , they may feel more comfortable doing that . So I think both ways have potential benefits , and we need to work out how to do it properly .
I think the other thing is that we must ensure that we support people to access telehealth , not just telephone health . Because there are also people who can ’ t afford broadband or don ’ t have the data on their phone to have visual consultations .
We need to be aware of that and have the proper support and infrastructure to enable people to access it fully . ■
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