After-hours telehealth delivers effective palliative care - but context matters
An article written by Dr. Pathma Namasivayam
For people living in rural and remote areas in Australia, accessing timely palliative care after-hours can be challenging due to factors such as geographical location, absence of specialised palliative care services, poor transportation to name a few. The lack of support services and advice available after-hours can make managing complex symptoms challenging. When patient symptoms are not adequately managed in a timely manner, this can lead to patient distress and unnecessary hospital transfer. The use of technology has been proven to be effective in overcoming these challenges and enabling equitable access to appropriate care. However, using technologies to support communities in rural and remote areas has its own challenges. To further explore this, a scoping review on the use of telehealth in providing after-hours palliative care services in rural and remote Australia was recently conducted and published in Plos One by our research team. 
Our review revealed that stakeholders were generally satisfied with the use of telehealth in after-hours palliative care. This service enabled timely access to care and reduced feelings of isolation for patients and carers, especially at night. Patients living in rural and remote areas had equitable access to specialist health care support and were able to connect with health professionals quickly. Other benefits reported by the studies were early patient management, decrease in unnecessary ambulance callouts and ED presentations, allowing patients to be cared for at home. Nevertheless, improved communication and coordination between services are required in ensuring patients received continuity of care.
Network and connectivity can be an issue when using telehealth services in remote areas. Additionally, technology usability can be challenging for some users, especially in older and digitally inexperienced people. Therefore, the software used to deliver this service needs to be simple, effective, reliable, and safe. Preparation and continuous support are required in building user confidence and helping them to engage with telehealth services.
Protocols, comprehensive policy documents, and standardised operating procedures are useful in guiding telehealth staff to provide patients and their carers with appropriate advice. There is a great need for ongoing staff education on managing patients’ complex symptoms. Nevertheless, the availability of palliative care specialists after-hours is important in supporting telehealth staff to manage complex patient symptoms. Existing service gaps require further exploration and alternative models of after-hours palliative care are needed.
In conclusion, after-hours telehealth service is effective in managing patients’ symptoms in rural and remote communities as well as promoting patient autonomy in managing their symptoms. However, there were issues such as connectivity, improved communication, and service coordination that needs to be overcome for the service to be implemented successfully. Furthermore, telehealth services may not be effective in managing higher symptom burden experienced by some palliative patients and may be less appropriate for discussing serious diagnosis or end-of-life issues.
- Namasivayam, P., Bui, D. T., Low, C., Barnett, T., Bridgman, H., Marsh, P., & Lee, S. (2022). The use of telehealth in the provision of after-hours palliative care services in rural and remote Australia: A scoping review. PLOS ONE, 17(9), e0274861. https://doi.org/10.1371/journal.pone.0274861
Pathma Namasivayam RN PhD
Lecturer in Nursing
College of Health and Medicine
University of Tasmania