What Models Exist to Deliver Palliative Care via 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. Telemedicine may be particularly helpful for patients with serious illness who often have unmet palliative care needs. In particular, due to significant functional impairment or inability to carry out daily activities, this patient population faces challenges in leaving home. Furthermore, dynamic changes in clinical status, such as worsening pain or confusion, require timely and frequent reassessment by clinicians. In addition, given the workforce shortage of palliative care clinicians, telemedicine may provide access to palliative care for patients with serious illness who do not live near specialty providers. Telemedicine models exist for the delivery of palliative care and hospice across inpatient, ambulatory, and community-based settings. However, there is an urgent need to expand the evidence base and evaluate the impact of such models of care on meaningful outcomes for patients with serious illness, their caregivers, health care providers, and payors. In addition, given the rapid expansion of telemedicine, it is crucial to ensure equitable access for patients with serious illness. If rigorously studied and implemented, telemedicine offers an opportunity to enhance the accessibility, quality, and cost-effectiveness of palliative care and hospice.