Enhancing palliative care for chronic diseases through telemedicine
An article written by Sim Xiang Rong, Monash Health, Supportive and Palliative Care Unit, Victoria
Introduction
Palliative care (PC) for patients with end-stage chronic diseases is gaining recognition globally. Conditions like Ischaemic Heart Disease (IHD) and chronic lung disease pose significant challenges, necessitating outpatient PC services for quality home-based care (1). Recognizing this need, the Supportive Care Clinic (SCC) was established in an Australian metropolitan health service, focusing on non-malignant chronic disease PC.
In response to COVID-19 lockdowns in Melbourne from 2020 to 2022, the SCC swiftly adopted telemedicine, offering both telephone and video consultations. A survey was opportunistically conducted for both quality assurance and to gauge satisfaction of the telemedicine modality, over a period of six months.
Results
Of 95 patients, 49 were identified as eligible to participate. Reasons for ineligibility included being non-English speaking (n=13; 30.95%) or attendance of less than two appointments (n=10; 23.81%). Patients and their caregivers were invited to participate with consent. From 82 distributed surveys (49 patients and 33 caregivers), 35 surveys were returned (21 patients and 14 caregivers). The eligible cohort had a median age of 82 years (range 39 to 94 years). All patients had non-malignant disease, most commonly renal failure (41.51%).
Participants rated telemedicine as easier to access than face-to-face appointments. Video-consultation was rated ‘just as good as face-to-face’ or ‘better than face-to-face’ by 87.50% of participants that had utilised both appointment modalities. Additionally, there was greater satisfaction for telephone appointments when compared with face-to-face appointments (n=15; 66.67%). Participants also responded overwhelmingly well (almost 100% positive) towards the clinic, both in addressing their needs and to the utility of the clinic in complementing other healthcare services.
Telemedicine was rated highly when it came to future utility. When comparing the two telemedicine modalities, participants indicated that video-consultation had greater utility than telephone consultations, with a greater proportion indicating video-consultation as very useful (65%) compared to telephone (40%).
Discussion
Our findings demonstrate high levels of satisfaction for the SCC model and for telemedicine. This is likely because telemedicine offers the convenience of being at home while still receiving care, particularly during the restricted movement of people during the COVID-19 pandemic (2).
The greater proportion of attended appointments via telephone could be attributed to patients’ limited technological knowledge or access to connect successfully to video-conference platforms. These logistical challenges cannot be disregarded; in future service planning, it will remain important to offer patients a suite of available modalities through which they can engage with healthcare. Our findings suggest that a hybrid model that offers telemedicine in addition to physical appointments, would meet most patients’ preferences.
We hypothesize that telemedicine will become increasingly important and favourable as patients deteriorate and become less mobile – a phase that, pre-telemedicine, may have seen a patient disengage with outpatient clinic services. Telemedicine allows for the reach of outpatient specialist care through to the terminal phase without a patient needing to be physically present at a clinic. More research will be required to develop guidelines for triaging patients for telemedicine versus a face-to-face consultation, and to explore sentiment towards telemedicine platforms alongside patient deterioration.
Conclusion
This study highlights the effectiveness of a chronic disease-focused PC clinic and underscores the potential of telemedicine for PC service access. These findings will inform future healthcare planning for chronic diseases, emphasizing the value of integrating telemedicine into existing care models.
Author
Sim Xiang Rong, MD, BMedSc
Monash Health
Supportive and Palliative Care Unit, Victoria, Australia
References
- Ritchie H, Spooner F, Roser M. Causes of death [Internet]. OurWorldInData.org; 2018 [cited 2018 Jan 12]. Available from: https://ourworldindata.org/causes-of-death.
- Haleem A, Javaid M, Singh RP, et al. Telemedicine for healthcare: Capabilities, features, barriers, and applications. Sens Int. 2021; 2: 100117.