Palliative Care via Audio-Only Telehealth Boosts Quality of Life  

January 19, 2024 - A team providing palliative care via audio-only telehealth helped improve the quality of life for adults with chronic conditions like chronic obstructive pulmonary disease (COPD), heart failure, and interstitial lung disease (ILD), according to a study published in JAMA.

Quality of life for COPD, heart failure, and ILD patients worsens as the diseases progress, and symptoms, such as breathlessness and pain, persist over time, the study noted. Thus, these patients are ideal candidates for early palliative care along with disease-specific treatments. However, access to palliative care is limited in the United States, partly due to the lack of palliative care specialists.

“While we do a great job caring for these patients’ illnesses, we can do more for quality of life. Many have persistent symptoms, such as depression, anxiety, shortness of breath, and sleep problems that can make living with these illnesses very difficult and have been associated with earlier death,” said study lead author David Bekelman, MD, a professor at the University of Colorado School of Medicine, in a news release. “Palliative care can help. However, access to outpatient palliative care specialists is limited to non-existent, and new, scalable ways to provide early palliative care are needed.”

In the new study, researchers examined the effectiveness of an audio-only telehealth intervention in improving quality of life for COPD, heart failure, and ILD patients at high risk of hospitalization and death.

The team-based Advancing Symptom Alleviation With Palliative Treatment (ADAPT) intervention includes a registered nurse helping address chronic condition symptoms and a social worker providing structured counseling. Patients receive six phone calls each from the nurse and social worker. The nurse and social worker meet weekly with a primary care and palliative care physician and a pulmonologist and cardiologist when needed.

Of 306 patients in the study, 154 received the ADAPT intervention, and 152 received usual care, which included an educational handout that outlined self-care for COPD, ILD, or heart failure.

About 58 percent of the study participants had COPD only, 22 percent had heart failure only, 16 percent had COPD and heart failure, and 4 percent had ILD. Almost half had been hospitalized in the prior year, and 21 percent had two or more hospitalizations.

At baseline, patients reported poor disease-specific health status and poor overall quality of life, as measured by Functional Assessment of Chronic Illness Therapy-General (FACT-G) scores. At six months, the mean FACT-G score improved 6.0 points in the intervention group and 1.4 points in the usual care arm.

“This suggests that the intervention improved quality of life, in part, by helping patients cope with the limitations and symptoms of illness,” the researchers wrote.

Additionally, the intervention improved COPD health status, heart failure health status, depression, and anxiety symptoms at six months. The intervention was not associated with adverse events or patient harm.

“This intervention presents opportunities for health systems and payors in context of value-based care…The virtual and population approach of this intervention lends itself to a hub and spoke model that can improve the reach of palliative care services to areas that may be traditionally underresourced,” they concluded.

This is the latest example of how telehealth can support team-based care.

Research published last March detailed a virtual care team strategy that successfully guided treatment strategies and boosted therapy uptake among heart failure patients at three Massachusetts hospitals.

The researchers assessed the Implementation of Medical Therapy in Hospitalized Patients with Heart Failure with Reduced Ejection Fraction (IMPLEMENT-HF) intervention, which included a centralized physician, study staff, and a local pharmacist at each care site. The healthcare professionals evaluated patient cases daily, providing 187 recommendations for enhancing guideline-directed medical therapy (GDMT).

Researchers found that these suggestions increased the number of patients engaging in new treatments and led to improvements in GDMT dosing.