Monica Bason-Flaquer is a project manager at Marie Curie, a leading end-of-life charity that provides frontline nursing and hospice care in the United Kingdom. With a specific interest in improvement and inclusion in health and social care, Monica recently conducted a review of the charity’s shift to telehealth during periods of lockdown, which can benefit other providers who are considering, or expanding, the use of telehealth in palliative care.
Coverage of the pandemic’s impact on palliative care has focused on PPE shortages, visiting restrictions, and funding challenges. Less has been said of the changes to outpatient services to minimise risks of COVID transmission.
In March 2020, Marie Curie’s nine hospices stopped in-person outpatient and day services in response to the national lockdown in the United Kingdom. Outpatient consultations initially transitioned to telephone, coupled with some face-to-face community visits where clinically required. Telephone consultations represented 77 per cent of all outpatient consultations in 2020/2021, 53 per cent greater than the previous year.
By May, video consultations had scaled up, representing 3 per cent of 1:1 outpatient consultations in 2020/21. This increase on the previous year was implemented with data security, a primary concern. We required a platform (AccuRx was chosen) that needed to integrate with clinical records EMIS and SystmOne (which are shared electronic patient notes that can be accessed by healthcare providers), required no installation by patients, and one that would provide an audit trail within the system, which all needed to be documented automatically into the patient’s notes.
The benefits of video included reducing geographic barriers, enabling healthcare teams’ and families’ involvement, and supporting clinical assessments through better visibility of patient’s physical condition, home environment, and non-verbal cues.
Marie Curie staff reported similar experiences and saw video as the next best option to face-to-face for clinical consultations. Staff were surprised at how effective and therapeutic telehealth appeared to be. In one example, a group session became very emotional, and one attendee said to another “I may not be with you, but I’m holding your hand.”
Colleagues reported seeing significant potential benefits to maintaining blended models of face-to-face and telehealth services and our experience suggests there can be a place for both telephone and video consultations within palliative care.
Telehealth, however, can shift significant administrative burden to patients in navigating new, unfamiliar systems to access care, a particular issue in palliative care due to the population’s age profile and severity of illness. Telephone consultations can provide a more familiar and accessible method of service delivery for people facing such barriers.
Social deprivation is inversely correlated with use of telemedicine services and evidence is showing that the pandemic has not reduced socioeconomic barriers to healthcare access.
These are greater for those from marginalised groups, many of whom already face barriers to accessing end of life care. We are now exploring opportunities for using volunteers to support people at home in establishing access to virtual consultations where this is identified as being best route to access for a patient.
There is a strong appetite from frontline staff to continue developing blended virtual and face-to-face services, alongside a recognition of the need for robust policies and protocols to support informed decisions of when telehealth is the right choice to meet a person’s needs. And while face-to-face consultations open up, it is likely that the virtual consultations will continue for people that would prefer this as an option.
- Marie Curie Palliative Care Knowledge Zone. Read more expert information, knowledge and support to help you deliver the best possible care for people living with a terminal illness.
- Follow Monica Bason-Flaquer on Twitter @wordbursts
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