How is Telehealth Used to Increase Access to Specialty Palliative Care? A Systematic Review

Context: Specialty palliative care remains inaccessible for many with serious illness, especially in rural areas. Telehealth may be one solution.

Objectives: To describe how telehealth increases access to specialty palliative care, describe facilitators and barriers to its use, and summarize evidence of patient benefits.

Methods: We conducted a systematic review using database-specific vocabulary and Boolean logic focusing on concepts "telemedicine," "remote consultation," "palliative medicine," and "hospice care." Included articles described original research evaluating a telehealth intervention addressing ≥ 2 National Consensus Project for Quality Palliative Care domains. Two researchers reviewed and abstracted articles; disagreements were resolved by consensus.

Results: Of 13,928 articles identified, 150 were eligible. Of these, 112 involved telemedicine (direct care from a clinician to a patient); 15 involved telecoaching (connection of non-palliative care clinician with a palliative care specialist to increase primary palliative care skills); 16 involved e-health (an app to monitor symptoms); and 7 involved e-consults (connection to a palliative care clinician to advise on a particular case). About two-thirds (65%) of articles were published since 2020. Common barriers included broadband issues, lack of familiarity with technology, and lack of access to a device. Facilitators included having a technology-skilled assistant and providing a device. Few studies assessed patient outcomes.

Conclusion: While telehealth is widely used to increase access to specialty palliative care, more evidence is needed to evaluate effectiveness. Further research is needed to understand how to overcome barriers prominent in rural settings and to optimize integration of multiple modalities of telehealth in specialty palliative care.