Wider utilization of telepalliative services could help ease family caregiver burdens and improve quality among seriously ill patient populations, research has found.

Researchers have increasingly dug into the quality impacts of virtual palliative care delivery and how telehealth outcomes compare to in-person care. Telepalliative care models helped to improve experiences among lung cancer patients’ family caregivers in similar ways to in-person services, according to a recent study published by the Journal of the American Medical Association (JAMA) Network.

The study found no differences in caregiver satisfaction when receiving virtual versus in-person palliative services. The findings could indicate that telepalliative care could be an effective avenue for caregiver support, according to researcher Joseph Greer, psychologist and associate professor of psychology at Massachusetts General Hospital (MGH), an affiliate of Harvard Medical School.

“We measure outcomes from the caregiver perspective … their quality of life and we did measure their coping and distress,” Greer said in a recent GeriPal podcast. “Their outcomes were not different across the two groups with respect to their own quality of life and distress. There were no differences between groups in terms of their knowledge and understanding. Satisfaction with care for the caregivers and for the patients [showed] no differences.”

The JAMA study examined outcomes of 1,250 adults with advanced lung cancer receiving palliative care across 22 health care organizations in the United States from June 14, 2018 to May 4, 2023. The clinical trial study compared the outcomes of patients receiving in-person palliative services with those utilizing video visits, as well as the experiences of their caregivers.

A large aim of the research was to examine the potential scalability and impact of early telepalliative care integration during a time of growing demand and clinical workforce shortages, Greer said.

Many palliative care programs across the nation have expanded telehealth utilization, a trend that gained momentum as regulatory flexibilities expanded during the pandemic. With some of the waivers set to expire March 31, some providers and stakeholders have become increasingly concerned at the potential detrimental effects on access and quality.

Among the challenges of telepalliative models is the vastly diverse scope of services and care delivery approaches that they can encompass, though a few common threads exist, Greer stated.

“The scalability question is really what was driving us to think creatively about improving access and efficiency in delivery of this model of care, and that’s how we landed on telehealth,” Greer said.

Telepalliative care can be as effective as in-person services, the JAMA study found. Quality-of-life scores were equivalent among patients and family caregivers between the virtual care and in-person groups, the study found. The groups also did not differ in patient coping, mood, symptoms or prognostic perceptions.

Caregivers attended fewer video visits compared to in-person palliative care services, the JAMA study found. On one hand, a decreased presence could have negative impacts on caregivers’ ability to understand goals of palliative treatments and awareness of the patients’ overall trajectory, according to Greer. On the other hand, a lack of caregiver presence could increase patient autonomy, among other benefits, he stated.

Telepalliative models can in some ways help to improve communications between patients and clinicians, according to JAMA researcher Simone Rinaldi, palliative care nurse practitioner and director of nursing for MGH’s division of palliative care and geriatric medicine. Rinaldi is also co-director of Mass General’s palliative care clinic.

“It does give the opportunity for patients to be able to have meetings with their palliative care clinician privately in a way that is often not possible when they are in person,” Rinaldi said during the podcast. “It’s hard to find privacy, but also just to have that private space to be with your clinician. That really matters, for folks to be able to talk about their experience sometimes without having to worry about the impact on the family member that’s standing next to them. That is one of the benefits.”

Virtual palliative care delivery allowed caregivers more time for respite breaks and reprieve, easing transportation challenges associated with in-person visits, said researcher Dr. Lynn Flint, outpatient palliative care physician and clinical professor at University of California San Francisco’s (UCSF) division of geriatrics.

An important consideration when shaping telepalliative models is having a balance of both in-person and virtual services, Flint stated.

“For some patients, it has to do with the respite that video visits provide,” Flint said. “They’re not driving. It’s also the portability of video visits. You can get [to someone if] there’s a snowstorm. We need an in-person presence … even if we’re doing video visits. We need to be here at the table.”