Video and In-Person Palliative Care Delivery Challenges before and during the COVID-19 Pandemic.

Autor: Chua IS; Division of General Internal Medicine and Primary Care, Department of Medicine (I.S.C.), Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (I.S.C.), Boston, Massachusetts, USA; Harvard Medical School (I.S.C., S.R., M.K., V.A.J., A.E.J., J.S.T., J.A.G.), Boston, Massachusetts, USA. Electronic address: ichua@bwh.harvard.edu., Olmsted M; University of Massachusetts Medical School (M.O.), Worcester, Massachusetts, USA., Plotke R; Massachusetts General Hospital (R.P., Y.T., C.T., S.R., M.K., V.A.J., E.R.G.M., A.E.J., J.S.T., J.A.G.), Boston, Massachusetts, USA., Turk Y; Massachusetts General Hospital (R.P., Y.T., C.T., S.R., M.K., V.A.J., E.R.G.M., A.E.J., J.S.T., J.A.G.), Boston, Massachusetts, USA., Trotter C; Massachusetts General Hospital (R.P., Y.T., C.T., S.R., M.K., V.A.J., E.R.G.M., A.E.J., J.S.T., J.A.G.), Boston, Massachusetts, USA., Rinaldi S; Harvard Medical School (I.S.C., S.R., M.K., V.A.J., A.E.J., J.S.T., J.A.G.), Boston, Massachusetts, USA; Massachusetts General Hospital (R.P., Y.T., C.T., S.R., M.K., V.A.J., E.R.G.M., A.E.J., J.S.T., J.A.G.), Boston, Massachusetts, USA., Kamdar M; Harvard Medical School (I.S.C., S.R., M.K., V.A.J., A.E.J., J.S.T., J.A.G.), Boston, Massachusetts, USA; Massachusetts General Hospital (R.P., Y.T., C.T., S.R., M.K., V.A.J., E.R.G.M., A.E.J., J.S.T., J.A.G.), Boston, Massachusetts, USA., Jackson VA; Harvard Medical School (I.S.C., S.R., M.K., V.A.J., A.E.J., J.S.T., J.A.G.), Boston, Massachusetts, USA; Massachusetts General Hospital (R.P., Y.T., C.T., S.R., M.K., V.A.J., E.R.G.M., A.E.J., J.S.T., J.A.G.), Boston, Massachusetts, USA., Gallagher-Medeiros ER; Massachusetts General Hospital (R.P., Y.T., C.T., S.R., M.K., V.A.J., E.R.G.M., A.E.J., J.S.T., J.A.G.), Boston, Massachusetts, USA., El-Jawahri A; Harvard Medical School (I.S.C., S.R., M.K., V.A.J., A.E.J., J.S.T., J.A.G.), Boston, Massachusetts, USA; Massachusetts General Hospital (R.P., Y.T., C.T., S.R., M.K., V.A.J., E.R.G.M., A.E.J., J.S.T., J.A.G.), Boston, Massachusetts, USA., Temel JS; Harvard Medical School (I.S.C., S.R., M.K., V.A.J., A.E.J., J.S.T., J.A.G.), Boston, Massachusetts, USA; Massachusetts General Hospital (R.P., Y.T., C.T., S.R., M.K., V.A.J., E.R.G.M., A.E.J., J.S.T., J.A.G.), Boston, Massachusetts, USA., Greer JA; Harvard Medical School (I.S.C., S.R., M.K., V.A.J., A.E.J., J.S.T., J.A.G.), Boston, Massachusetts, USA; Massachusetts General Hospital (R.P., Y.T., C.T., S.R., M.K., V.A.J., E.R.G.M., A.E.J., J.S.T., J.A.G.), Boston, Massachusetts, USA.
Jazyk: angličtina
Zdroj: Journal of pain and symptom management [J Pain Symptom Manage] 2022 Dec; Vol. 64 (6), pp. 577-587. Date of Electronic Publication: 2022 Aug 17.
DOI: 10.1016/j.jpainsymman.2022.08.005
Abstrakt: Context: Palliative care (PC) clinicians faced many challenges delivering outpatient care during the coronavirus-19 (COVID-19) pandemic.
Objectives: We described trends for in-person and video visit PC delivery challenges before and during the COVID-19 pandemic in the U.S.
Methods: We performed a secondary data analysis of patient characteristics and PC clinician surveys from a multisite randomized controlled trial at 20 academic cancer centers. Patients newly diagnosed with advanced lung cancer (N = 653) were randomly assigned to receive either early in-person or telehealth PC and had at least monthly PC clinician visits. PC clinicians completed surveys documenting PC delivery challenges after each encounter. We categorized patients into 3 subgroups according to their PC visit dates relative to the onset of the COVID-19 pandemic in the U.S.-pre-COVID-19 (all visits before March 1, 2020), pre/post-COVID-19 (≥1 visit before and after March 1, 2020), and post-COVID-19 (all visits after March 1, 2020). We performed Pearson's chi-squared, Fisher's exact, and Kruskal-Wallis tests to examine associations.
Results: We analyzed 2329 surveys for video visits and 2176 surveys for in-person visits. For video visits, the pre-COVID-19 subgroup (25.8% [46/178]) had the most technical difficulties followed by the pre/post-COVID-19 subgroup (17.2% [307/1784]) and then the post-COVID-19 subgroup (11.4% [42/367]) (P = 0.0001). For in-person visits, challenges related to absent patients' family members occurred most often in the post-COVID-19 subgroup (6.2% [16/259]) followed by the pre/post-COVID-19 subgroup (3.6% [50/1374]) and then the pre-COVID-19 subgroup (2.2% [12/543]) (P = 0.02).
Conclusion: Technical difficulties related to PC video visits improved, whereas in-person visit challenges related to absent patients' family members worsened during the pandemic.
Competing Interests: Disclosures and Acknowledgments Research reported in this publication was funded through the Patient-Centered Outcomes Research Institute (PCORI) Award (PLC-1609-35995) and was supported by the Palliative Care Research Cooperative Group, which is funded by the National Institute of Nursing Research of the National Institutes of Health under award number U2CNR014637. All statements in this publication are solely the responsibility of the authors and do not necessarily represent the views of the Patient-Centered Outcomes Research Institute (PCORI), its Board of Governors, or Methodology Committee. No competing financial interests exist.
(Copyright © 2022 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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