Video and In-Person Palliative Care Delivery Challenges Before and During the COVID-19 Pandemic

J Pain Symptom Manage. 2022 Aug 16:S0885-3924(22)00858-2. doi: 10.1016/j.jpainsymman.2022.08.005. Online ahead of print.

ABSTRACT

CONTEXT: Palliative care (PC) clinicians faced many challenges delivering outpatient care during the coronavirus-19 (COVID-19) pandemic.

OBJECTIVES: We described trends for in-person and video visit PC delivery challenges before and during the COVID-19 pandemic in the U.S.

METHODS: We performed a secondary data analysis of patient characteristics and PC clinician surveys from a multisite randomized control trial at 20 academic cancer centers. Patients newly diagnosed with advanced lung cancer (N=653) were randomly assigned to receive either early in-person or telehealth PC and had at least monthly PC clinician visits. PC clinicians completed surveys documenting PC delivery challenges after each encounter. We categorized patients into 3 subgroups according to their PC visit dates relative to the onset of the COVID-19 pandemic in the U.S.-pre-COVID-19 (all visits before 3/1/20), pre/post-COVID-19 (≥1 visit before and after 3/1/20), and post-COVID-19 (all visits after 3/1/20). We performed chi-squared analyses to examine associations.

RESULTS: We analyzed 2329 surveys for video visits and 2176 surveys for in-person visits. For video visits, the pre-COVID-19 subgroup (25.8% [46/178]) had the most technical difficulties followed by the pre/post-COVID-19 subgroup (17.2% [307/1784]) and then the post-COVID-19 subgroup (11.4% [42/367]) (P=0.0001). For in-person visits, challenges related to absent patients' family members occurred most often in the post-COVID-19 subgroup (6.2% [16/259]) followed by the pre/post-COVID-19 subgroup (3.6% [50/1374]) and then the pre-COVID-19 subgroup (2.2% [12/543]) (P=0.02).

CONCLUSION: Technical difficulties related to PC video visits improved, whereas in-person visit challenges related to absent patients' family members worsened during the pandemic.

PMID:35985551 | DOI:10.1016/j.jpainsymman.2022.08.005