On first consideration, the idea of providing palliative care via video chat seems counterintuitive or even insensitive. Palliative care focuses on improving quality of life for individuals with serious illnesses. At such a delicate time, would a computer screen between patients and their doctors really suffice?
Yet tele-palliative care—palliative care via telehealth— is emerging as a promising option. It offers access to care for those who might otherwise go without and has surprising advantages over traditional, in-person care.
How Does Tele-Palliative Care Work?
Instead of scheduling appointments weeks in advance, driving hours to a hospital (or being driven for those unable to drive), paying for parking, and enduring the fatigue of travel, patients and their families can log on to a video visit from home. During these virtual sessions, providers can discuss goals of care, offer social and emotional support, and manage pain and symptoms—all without requiring patients to leave the comfort of their homes. Through tele-palliative care, symptom management and advance care planning become accessible in ways they never were before.
Through tele-palliative care, symptom management and advance care planning become accessible in ways they never were before.
The COVID-19 pandemic accelerated the adoption and acceptance of telehealth, but some patients and providers remain hesitant—especially when dealing with sensitive, deeply personal matters like palliative care. For that reason, RAND researchers spoke with palliative care providers and clinic staff, uncovering key insights from these experts. They highlighted some advantages of virtual palliative care over in-person care as well as some challenges.
Advantages of Tele-Palliative Care
Perhaps surprisingly, virtual care can be more patient-centered in some ways than traditional care. For example, eliminating the need for transportation reduces the stress and fatigue of travel, particularly for individuals with disabilities or mobility challenges. Virtual visits also accommodate patients and caregivers juggling work, childcare, or other obligations, allowing them to participate without sacrificing other responsibilities. For patients feeling unwell, the convenience of a virtual visit means they’re far less likely to cancel or miss appointments. In fact, providers reported lower no-show rates after introducing telehealth.
Another advantage is the ability to assess a patient’s home environment. Via video, providers can evaluate safety risks, review medications in real time, and recommend adjustments to the physical environment—tasks often impossible during office visits. Patients also tend to feel more comfortable in their own surroundings.
Communication gains are also noteworthy. Virtual platforms can integrate interpreters for patients with limited English proficiency, enhancing understanding and care quality. Closed captioning and volume adjustment can also support access.
Perhaps most tellingly, patients themselves often prefer telehealth. As one provider shared, “I would venture to say like 70 percent of our patients would prefer to do telehealth appointments…I think patients really enjoy being able to sit in their home and have their loved one next to them and be on the couch and talk about distressing things that are sort of going on.”
Challenges to Address
Tele-palliative care is not without its hurdles. Technology access remains a barrier, especially for older adults or rural populations. Poor internet connectivity and difficulty navigating virtual platforms can prevent some patients from participating. Addressing these challenges is critical for equitable access.
Another limitation involves prescribing controlled substances, such as opioids, which are often essential for pain management in palliative care. Regulatory restrictions sometimes require in-person visits for these prescriptions, providing protection from misuse but also creating obstacles for patients who struggle to travel.
Providers did not identify the virtual format itself as a limitation. Many felt that they could build rapport just as effectively over telehealth as in-person.
Interestingly, providers did not identify the virtual format itself as a limitation. Many felt that they could build rapport just as effectively over telehealth as in-person. As one provider noted, when people feel comfortable, have privacy, and have a trusting relationship with their care team, “Communication is still very effective over telehealth, just like in-person.”
Looking Ahead
Patients and providers are more comfortable with telehealth due to increased exposure since the pandemic. But tele-palliative care is not merely a technological innovation—it’s a potentially transformative way to improve access to critical medical services. For vulnerable populations, it offers a lifeline to comfort and support during life’s most challenging moments. With thoughtful solutions to its limitations, tele-palliative care could redefine how compassionate care is delivered when it’s needed most.
Shira H. Fischer, Jordan M. Harrison, Julia Bandini
source: RAND
