“ Supplementary at Best” —A Mixed Methods Analysis of Palliative Homecare Patients’, Caregivers’, and Clinicians’ Experiences of Virtual Visits Near the End of the Pandemic

Background: The Coronavirus Disease of 2019 (COVID-19) pandemic catalyzed palliative homecare programs’ increased use of virtual care (by phone/video platforms), but uptake was unknown. Aim: To understand clients’ and clinicians’ use and experiences of virtual homecare visits. Design: Mixed-methods, cross-sectional survey, and interview study. Setting/Participants: Clients receiving palliative homecare in regions of four Canadian provinces were mailed paper surveys (December 2022–June 2023) with quantitative and open-text questions. Palliative homecare clinicians received a corresponding survey by e-mail. Clients and clinicians completing the survey were invited to participate in a qualitative interview. Results: Of 378 client respondents to the survey, most had experienced phone virtual care (65%) but only 8% had video visits. Of 265 clinician respondents (53% nurses, 10% allied health, 8% physicians), 70% increased their use of phone and 29% increased video visits during COVID peaks but this was not sustained between waves. Clients favored in-person visits for all activities. Clinicians rated in-person visits more highly for all activities, except for triaging visits (30% perceived virtual modalities better for triaging than in-person, 18% favored in-person, 38% neutral, and 14% had not tried triaging virtually). Qualitative analysis revealed: Factors influencing virtual technology use; Risks and disadvantages of virtual care; Advantages of virtual care; Virtual care’s role; and Adaptations for virtual care. Conclusions: Qualitative and quantitative data were convergent, describing virtual visits as beneficial for limited aspects of palliative homecare, with significant utilization challenges. Client and provider barriers must be systematically addressed, if sustained use of virtual technology is to supplement in-person palliative homecare.