Patients with serious cancers, such as advanced lung cancer, often experience physical and psychological symptoms that interfere with their ability to enjoy life. These patients must also engage in difficult conversations with clinicians about their wishes for care toward the end of life, such as whether to receive life-prolonging measures and when to stop cancer treatment and enroll in hospice. Involving palliative care clinicians in the care of patients with advanced cancer, beginning at the time of diagnosis and continuing throughout cancer treatment, can help improve patients’ symptoms, quality of life, and the care they receive at the end of life. Studies show that, compared to patients with advanced lung cancer who do not see palliative care clinicians along with their oncology clinicians, those who do receive “early integrated palliative care” have better quality of life and mood, are more likely to engage in conversations about their end-of-life care wishes, and receive hospice services for longer periods. Even the family and friends of these patients have better experiences when their loved ones receive early integrated palliative care. Unfortunately, the number of palliative care clinics in the United States is insufficient for all patients with advanced cancer to receive early integrated palliative care, despite the proven benefits of such services for patients and their family/friends.
To increase patient access to palliative care, this study proposes to use telemedicine, in which palliative care clinicians will use videoconferencing to conduct virtual visits with patients in their homes. Telemedicine will allow patients to see the palliative care clinician without traveling to the cancer clinic, which is especially important when they feel too sick to leave home. Telemedicine will also enable family and friends to participate in visits through videoconferencing, even if they live far away.
This study will compare early integrated palliative care delivered via telemedicine or in person at the clinic to ensure that these delivery methods are equivalent from the perspective of both patients and their family/friends. If telemedicine is an effective way to deliver early integrated palliative care, such videoconferencing will allow greater numbers of patients to access this service. Importantly, even patients with advanced cancer who live in remote areas without available palliative care clinics would be able to receive services through telemedicine from institutions that have palliative care.
The project’s patient and stakeholder partners agreed that increasing access to palliative care services for those with advanced cancer is a key goal for patients, healthcare systems, and insurers, expressing great enthusiasm about using telemedicine to increase delivery of early integrated palliative care. The stakeholders will provide valuable input on designing the study, implementing the trial, and sharing the results in the broader community.
*All proposed projects, including requested budgets and project periods, are approved subject to a programmatic and budget review by PCORI staff and the negotiation of a formal award contract.