Results Summary

What was the project about?

Palliative care focuses on improving quality of life by preventing and treating suffering. Patients may find it hard to travel to a clinic for palliative care. In home-based palliative care, or HBPC, healthcare teams visit patients at home. Another way to provide HBPC is through telehealth. Telehealth provides care to patients remotely using phone, video, or other devices that can help manage care.

In this study, the research team first wanted to compare video visits and home visits for HBPC. But in this study, few patients and clinicians, such as doctors and nurses, used video visits for HBPC. The team then focused on learning about barriers to using video visits for HBPC.

What did the research team do?

The research team surveyed and interviewed 66 patients and 32 caregivers by phone one to two months after they signed up for the original study and again six months later. Eight months after the initial study started, the team surveyed 84 HBPC clinicians and interviewed 14 of these clinicians to get feedback about video visits. All surveys and interviews took place in the year before January 2020.

To collect more information about video visits, the research team looked at health records and held weekly meetings with patients, doctors, nurses, and health system senior staff. The team observed video visits and took notes. They also visited clinics.

The study took place at 14 Kaiser Permanente clinics in Southern California, Oregon, and Washington State.

Patients, caregivers, clinicians, and clinic staff helped design the study.

What were the results?

Of the patients and caregivers who took surveys about their care, 49 percent of patients and 38 percent of caregivers were very satisfied with video visits. Patients and caregivers stated that video visits offered an easy way to talk with doctors more frequently.

Patients preferred to first have an in-person visit with doctors. Having the first visit with their doctors in person made patients feel better about later video visits.

Barriers to using video visits included the following:

  • Patients with limited hearing or vision who used video visits couldn't see the screen or hear the doctor well.
  • The video didn't always work, which made meeting urgent, complex, or sensitive HBPC needs hard.
  • Aligning nurses' and doctors' schedules to have video visits was hard.

What were the limits of the project?

The study took place in one health system. Results may differ in other health systems.

Future research could look for ways to address the barriers described in this study.

How can people use the results?

Researchers and hospitals can use these results when considering ways to use video visits for HBPC.

How this project fits under PCORI’s Research Priorities
PCORI identified planning and delivery of care for patients with advanced illness and their caregivers as an important research topic. Patients, clinicians, and others wanted to know:  How can we identify care needs and address them effectively in real-life community settings? To address this issue, PCORI launched an initiative in 2016 on Community-Based Palliative Care Delivery for Adult Patients with Advanced Illnesses and their Caregivers. The initiative funded this research project and others.

Final Research Report

View this project's final research report.

Journal Citations

Related Journal Citations

Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments. 

Peer reviewers commented and the researchers made changes or provided responses. Those comments and responses included the following:

  • The reviewers were impressed with the researchers’ transparency regarding the problems they faced implementing this study and their willingness to discuss the lessons learned.
  • One reviewer questioned the impetus for this research, questioning the need to conduct a large randomized controlled trial comparing physician palliative care home visits to physicians meeting with patients using telehealth with registered nurses conducting home visits. The researchers acknowledged that in the postpandemic environment it may not seem as necessary to test whether patient outcomes are the same with in-person and telehealth care, but when the study was initially devised and conducted this was the major question in the field.
  • The reviewers suggested that many of the problems the researchers faced could have been uncovered using a different study design instead of implementing a full-scale randomized controlled trial. The researchers agreed that in hindsight, a stepped wedge research design could have given them more warning about some of the obstacles they would face in implementing the study. However, the researchers noted that such a design would be less appropriate to evaluate comparative effectiveness and more appropriate to evaluate how the telehealth intervention could be integrated in a palliative care practice. The stepped wedge design would also not have solved some of the challenges they faced with this study, including technological challenges and workforce shortages.

Conflict of Interest Disclosures

Project Information

Huong Q. Nguyen, PhD, RN
Richard Mularski, MD, MSHS
Kaiser Foundation Research Institute, a Division of Kaiser Foundation Hospitals
$5,382,127
10.25302/02.2022.PLC.160936108
A Non-Inferiority Comparative Effectiveness Trial of Home Based Palliative Care in Older Adults (HomePal)

Key Dates

September 2017
December 2021
2017
2021

Study Registration Information

Tags

Has Results
Health Conditions Health Conditions These are the broad terms we use to categorize our funded research studies; specific diseases or conditions are included within the appropriate larger category. Note: not all of our funded projects focus on a single disease or condition; some touch on multiple diseases or conditions, research methods, or broader health system interventions. Such projects won’t be listed by a primary disease/condition and so won’t appear if you use this filter tool to find them. View Glossary
Populations Populations PCORI is interested in research that seeks to better understand how different clinical and health system options work for different people. These populations are frequently studied in our portfolio or identified as being of interest by our stakeholders. View Glossary
Intervention Strategy Intervention Strategies PCORI funds comparative clinical effectiveness research (CER) studies that compare two or more options or approaches to health care, or that compare different ways of delivering or receiving care. View Glossary
State State The state where the project originates, or where the primary institution or organization is located. View Glossary
Last updated: October 18, 2023