Assessing Rural Disparities in Telemedicine Palliative Care Delivery for Patients with Cancer

Outcomes 1. Learners will describe how demographics are associated with the mode of clinical care delivery (in-person, virtual, or audio) for patients with advanced cancer receiving outpatient palliative care. 2. Learners will describe how clinical outcomes for patients with advanced cancer receiving outpatient palliative care are associated with the mode of clinical care delivery (in-person, virtual, or audio). Key Message Limited data exist evaluating the potential disparities in telehealth use for patients with advanced cancer receiving outpatient palliative care (PC) across rural settings. Our study aims to assess the associations between patient demographics, mode of care received (in-person, video, audio-only care), and clinical outcomes. Introduction Early integration of palliative care in patients with advanced cancer improves patient outcomes and aligns with national guidelines. (Ferrell et al, 2017) Yet, patients living in rural/frontier areas may have limited access to outpatient palliative care services and clinicians, as well as hospice services at the end of life. Despite a 63-fold increase in telehealth services after the COVID-19 pandemic, limited data exist evaluating its efficacy in palliative care delivery. (HHS, 2022) While data exist describing disparities in care for patients with advanced cancer receiving telehealth palliative care in urban populations, we lack data on their rural counterparts. (Frydman et al, 2022) Methods We will retrospectively evaluate all patients with solid tumors or hematologic malignancies receiving palliative care at Oregon Health & Science University (OHSU) between June 2020 and June 2023. Our primary aim is to compare patient demographics and cancer stage at palliative care referral between patients receiving outpatient palliative care with audio-only clinical visits and those without audio-only visits. We hypothesize that patients with any audio-only clinical visit will more likely be underserved (rural/frontier, non-white, low socioeconomic status, >65 years of age) at the time of palliative care referral. Our secondary aim is to compare differences in clinical outcomes (interval from initial outpatient palliative care consultation to POLST completion, hospice referral, date of death). Our exploratory aim is to assess patient electronic medical record engagement (MyChart activation, number of logins, mean number of messages) for patients with any audio-only palliative care visits compared to those without any audio-only visits. We will use descriptive statistics to summarize primary, secondary, and exploratory endpoints. To examine the demographic and cancer variables associated with the mode of palliative care delivery, we will employ a series of bivariate analyses using a chi-square test for categorical variables and a t-test for continuous variables. Keywords Models of Palliative Care Delivery / Diversity, Equity, Inclusion, Belonging, Justice