Katharine L Cheung1, Manjula Kurella Tamura2, Renee D Stapleton3, Terry Rabinowitz4, Michael A LaMantia5, Robert Gramling6. 1. Division of Nephrology, Department of Medicine, Larner College of Medicine at The University of Vermont, Burlington, Vermont, USA. 2. Division of Nephrology, Geriatric Research, Education, and Clinical Center, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA. 3. Division of Pulmonary and Critical Care, Department of Medicine, Larner College of Medicine at The University of Vermont, Burlington, Vermont, USA. 4. Department of Psychiatry, Larner College of Medicine at The University of Vermont, Burlington, Vermont, USA. 5. Division of Geriatrics, Department of Medicine, Larner College of Medicine at The University of Vermont, Burlington, Vermont, USA. 6. Division of Palliative Medicine, Department of Family Medicine, Larner College of Medicine at The University of Vermont, Burlington, Vermont, USA.
Abstract
Background: Patients receiving dialysis have unmet palliative care needs. Limited access to palliative care is a key barrier to its integration into routine dialysis care. Objective: To determine the feasibility and acceptability of telepalliative care in rural dialysis units. Methods: This was a single-arm pilot clinical trial. The target population was patients with kidney failure receiving outpatient dialysis in a rural U.S. state. Feasibility was measured by one-month completion rate. Acceptability was measured using an adapted telemedicine questionnaire. Results: We recruited 39 patients with mean age 71.2 years to undergo a telepalliative care consultation while receiving dialysis. Four specialty palliative care clinicians (three physicians and one nurse practitioner) conducted the visits. The recruitment rate was 40% (39/96), scheduling rate was 100% (39/39), and one-month completion rate was 77% (30/39). Thirty-six patient participants (14 women and 22 men) completed the baseline survey. Audiovisual aspects of the visit were rated highly. More than 80% reported the visit being at least as good as an in-person visit and 41% felt the teleconsult was better. Eighty-one percent of patients felt the appointment was relevant to them, 58% felt they learned new things about their condition, and 27% reported the appointment changed the way they think about dialysis. Discussion: Telepalliative care is acceptable to patients receiving dialysis and is a feasible approach to integrating palliative care in rural dialysis units. The study was registered with Clinicaltrials.gov (NCT03744117).
Background: Patients receiving dialysis have unmet palliative care needs. Limited access to palliative care is a key barrier to its integration into routine dialysis care. Objective: To determine the feasibility and acceptability of telepalliative care in rural dialysis units. Methods: This was a single-arm pilot clinical trial. The target population was patients with kidney failure receiving outpatient dialysis in a rural U.S. state. Feasibility was measured by one-month completion rate. Acceptability was measured using an adapted telemedicine questionnaire. Results: We recruited 39 patients with mean age 71.2 years to undergo a telepalliative care consultation while receiving dialysis. Four specialty palliative care clinicians (three physicians and one nurse practitioner) conducted the visits. The recruitment rate was 40% (39/96), scheduling rate was 100% (39/39), and one-month completion rate was 77% (30/39). Thirty-six patient participants (14 women and 22 men) completed the baseline survey. Audiovisual aspects of the visit were rated highly. More than 80% reported the visit being at least as good as an in-person visit and 41% felt the teleconsult was better. Eighty-one percent of patients felt the appointment was relevant to them, 58% felt they learned new things about their condition, and 27% reported the appointment changed the way they think about dialysis. Discussion: Telepalliative care is acceptable to patients receiving dialysis and is a feasible approach to integrating palliative care in rural dialysis units. The study was registered with Clinicaltrials.gov (NCT03744117).
Authors: Katharine L Cheung; Samantha Smoger; Manjula Kurella Tamura; Renee D Stapleton; Terry Rabinowitz; Michael A LaMantia; Robert Gramling Journal: J Palliat Med Date: 2022-03-04 Impact factor: 2.947
Authors: Rebecca N Hutchinson; Eric C Anderson; Mollie A Ruben; Noah Manning; Liam John; Ava Daruvala; Donna M Rizzo; Margaret J Eppstein; Robert Gramling; Paul K J Han Journal: J Palliat Med Date: 2022-04-12 Impact factor: 2.947