Telehealth utilization for palliative care during the last decade has been associated with improved quality of life, patient satisfaction and symptom management. But geographic and regulatory barriers pose hurdles to further evaluation of telehealth’s efficacy.

This is according to a recent study analysis published in Cureus found. Researchers included palliative care professionals and educators at medical colleges and hospitals in India. The analysis spanned various clinical trials and studies published between 2014 and 2024 that examined telehealth use within palliative care settings across the world.

Telehealth has consistently demonstrated improvements in symptom management and quality of life, particularly in home-based settings, the analysis found. These services have also been associated with reduced caregiver burden and better care coordination, particularly for patients in rural, remote and underserved communities, according to the research.

“Telehealth is a promising advancement in palliative care, offering improved access to specialized services and better symptom management for patients,” researchers stated in the study. “It enhances communication, reduces the financial burden of travel and increases patient and caregiver satisfaction. Telehealth’s ability to improve communication and provide support remotely contributes to a more favorable experience for both patients and caregivers.”

The effectiveness of telehealth can be difficult to determine, largely due to the varied ways these services can be delivered and methodologies for patient data collection and quality requirements, the researchers stated. Challenges also include limitations in technical and financial infrastructures, internet and phone service bandwidth issues and effective staff training.

The analysis comes at a time when current U.S. telehealth rules are likely to soon change. This could have potentially disastrous impacts for palliative care providers and patients alike, according to some providers. Some of the telehealth flexibilities implemented during the COVID-19 public health emergency are set to expire on Dec. 31 while others are becoming permanent.

Among the temporary flexibilities set to end includes the ability for all Medicare patients to receive telehealth services in their home, as well as the waiver of geographic restrictions around where and how non-behavioral health services can be delivered.

Much of the permanent Medicare changes to telehealth regulations are tied to behavioral and mental health services. These include:

• The ability for Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) to serve as a distant site provider for behavioral/ mental telehealth services
• Medicare patients receiving telehealth services for behavioral/mental health care in their home
• No geographic restrictions for originating site for behavioral/mental telehealth services
• The delivery of behavioral/mental telehealth services using audio-only communication platforms
• Allowing Rural Emergency Hospitals (REHs) to be eligible as originating sites for telehealth

Congress is currently weighing a bill, the Preserving Telehealth, Hospital, and Ambulance Access Act, that proposes to extend the expiration of regulatory telehealth flexibilities through 2026. The bill’s introduction follows legislation floated last year that proposed to expand Medicare coverage of telehealth and make permanent some of the flexibilities implemented during the pandemic.

Future telehealth rules should be carefully implemented with attention to technology, integration and user-centered design, the researchers stated. Current regulations could potentially put seriously ill patients in rural and remote areas at high risk of losing out on important resources and support, they added.

Telehealth services have also been associated with improved cost-efficiency of palliative care delivery, the analysis found. Utilization of telehealth was found to reduce overall health care spending and expensive emergency care visits while also minimizing travel and out-of-pocket costs for in-person patient visits. These trends led to improved clinical capacity and case management while reducing operational costs.

Expanded palliative telehealth care delivery could go a long way toward reducing health disparities among some of the most vulnerable and underserved communities, the researchers stated.

“Telehealth has the potential to improve access to palliative care, particularly in remote or underserved areas, by improving service reach and reducing disparities,” the researchers stated. “Telehealth is a viable option for expanding access to palliative care in areas with financial and logistical barriers. Telehealth in rural and underserved areas holds significant promise for enhancing access to palliative care, improving quality of life and managing symptoms.”