Clinician Perceptions of Barriers and Facilitators for Delivering Early Integrated Palliative Care via Telehealth

SIMPLE SUMMARY: For patients with a life-limiting illness like advanced cancer, early engagement with palliative care services in the ambulatory care setting can provide several benefits, including improved symptom management and quality of life. Telehealth may be a viable way to deliver these services, especially for populations with limited access to palliative care in a traditional outpatient clinic. We surveyed clinicians who provide palliative care services to patients with advanced lung cancer regarding the barriers, facilitators, and benefits of using telehealth for delivering early integrated palliative care. Our findings show that policies and interventions targeting patient-, organizational-, and systems-based levels are needed to support the use of telehealth for palliative care. ABSTRACT: Early integrated palliative care (EIPC) significantly improves clinical outcomes for patients with advanced cancer. Telehealth may be a useful tool to deliver EIPC sustainably and equitably. Palliative care clinicians completed a survey regarding their perceptions of the barriers, facilitators, and benefits of using telehealth video visits for delivering EIPC for patients with advanced lung cancer. Forty-eight clinicians across 22 cancer centers completed the survey between May and July 2022. Most (91.7%) agreed that telehealth increases access to EIPC and simplifies the process for patients to receive EIPC (79.2%). Clinicians noted that the elderly, those in rural areas, and those with less-resourced backgrounds have greater difficulty using telehealth. Perceived barriers were largely patient-based factors, including technological literacy, internet and device availability, and patient preferences. Clinicians agreed that several organizational factors facilitated telehealth EIPC delivery, including technological infrastructure (85.4%), training (83.3%), and support from study coordinators (81.3%). Other barriers included systems-based factors, such as insurance reimbursement and out-of-state coverage restrictions. Patient-, organization-, and systems-based factors are all important to providing and improving access to telehealth EIPC services. Further research is needed to investigate the efficacy of telehealth EIPC and how policies and interventions may improve access to and dissemination of this care modality.