Telemedicine May Help Advance Care Planning in Vulnerable Patients

The rates of advance care planning were no different for patients with cancer who were seen in-person or via telemedicine, posing virtual visits as a viable option for vulnerable populations, according to recent research.

“Telemedicine may help physicians overcome physical and logistical barriers to timely advance care planning,” the researchers wrote in their study, which was published in the journal, Cancer.

Advanced care planning includes discussions about prognosis, goals of care and end-of-life priorities and, according to the researchers, “has become a quality standard in oncology care.” Prior research published in JADPRO has shown that advance care planning can decrease unwanted aggressive treatments at the end of life, thereby improving patients’ quality of life in their final days.

READ MORE:Advanced Care Planning Gives Patients ‘Control of Their Care When They Are Most Vulnerable’

The researchers analyzed data from 3,178 with cancer with a high six-month risk for mortality who were treated within the University of Pennsylvania health system. A total of 2,430 were seen in person, and 748 were seen via telemedicine for their first oncology visit.

“We focused on this population because of the high potential impact, and likely differential effect of telemedicine on clinical and patient outcomes compared to a less vulnerable population,” the researchers wrote.

Patients seen in person were more likely to have advanced disease than those seen virtually (53% versus 44%, respectively) and were also more likely to receive care from a general oncologist (41% versus 24%). While most telemedicine appointments were conducted via video call, Black and lower income patients more frequently used the phone.

Findings showed that within a three-month follow-up period, 6.8% of patients in the in-person group had advance care planning discussions, compared with 6% of patients in the telemedicine group. The difference between these two outcomes was not statistically significant, meaning that the researchers could not be sure that there is definitely a difference between the two.

“The ability to virtually meet patients and their family within the comfort of their home may facilitate advance care planning,” the researchers wrote. “Likewise, telemedicine may increase access for vulnerable patients who are too frail to travel to the clinic.”

Additionally, there was no statistically significant difference between the two groups when it came to unplanned hospitalizations, either, which occurred at 20% and 18% in the in-person and telemedicine groups, respectively.

The researchers did find, however, that the method by which patients took their telemedicine visits did seem to have an impact on advance care planning. Advanced care planning discussions were similar between the in-person and phone-based telemedicine groups, but were actually higher in the group of patients who spoke with their clinicians via video call.

“Although this work is exploratory, it suggests the importance of video-enabled telemedicine among racial and ethnic minorities and those with lower income,” the researchers wrote. “Successful implementation of telemedicine in this setting will require efforts to achieve equitable access to high-quality video-based telemedicine platforms.”

Method of telemedicine did not impact unplanned hospitalizations.

“Overall, our findings suggest that vulnerable patients can be managed safely by telemedicine without negatively affecting key components of their care such as advance care planning and acute care utilization,” the researchers wrote.
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