Improving Serious Illness Care for Underserved Populations: Patient and Caregiver Experience with Tele-Palliative Care

项目摘要 在重病患者中有大量未得到满足的需求，与健康的沟通质量存在差距 护理提供者，这在历史上未得到充分服务的人群中尤为明显，包括 少数族裔、社会经济地位低、英语水平有限的患者，以及 那些生活在农村地区的人，他们的医疗保健服务不足。对于身患重病的患者， 姑息治疗提供专业的疼痛和症状管理以及临终关怀计划。特别是， 通过远程医疗提供的姑息治疗可能会改善获得门诊姑息治疗服务的机会，这是 主要在大都市地区的大型学术医疗中心提供。尽管增加了 远程医疗用于门诊姑息治疗自新冠肺炎大流行以来，人们对此知之甚少 历史上未得到充分服务的患者对姑息治疗方式和沟通方式的看法 可能会受到虚拟分娩模式的影响，这些患者已经在接受 目标一致的护理。在这项前瞻性队列研究中，我们将招募一组成年患者。 SES低、非白人、LEP或乡村居住社区的门诊姑息治疗患者进行比较 为既往服务不足的患者提供的面对面与远程姑息治疗访问的护理体验 并了解他们对护理方式的需求和偏好的细微差别。vbl.使用 混合方法我们将1)通过面对面和远程评估患者和照顾者报告的体验 使用针对患者和照顾者的调查以及对患者和 护理人员；2)比较以下人员之间的沟通质量和推荐沟通流程的使用 通过对记录的面对面和远程医疗访问的分析，进行个人和远程姑息治疗；以及3)检查 面对面访问与远程姑息治疗的视角，包括感知到的障碍和促进者 采用与姑息治疗提供者的定性访谈的分娩方式。拟议的研究将 增进对历史上服务不足的患者及其家庭照顾者的经历的理解，以 解决有关提供姑息治疗的方式的问题。研究结果将为卫生系统提供路线图，以 改善患者与提供者的沟通，并确定促进文化能力的策略，以提高 亲身和通过远程医疗提供的姑息治疗的体验和整体质量。

Project Abstract There is significant unmet need among seriously ill patients and gaps in quality of communication with health care providers, which are particularly pronounced among historically underserved populations, including patients of racial/ethnic minorities, low socioeconomic status (SES), limited English proficiency (LEP), and those who live in rural areas who are underserved in health care. For patients suffering from serious illness, palliative care provides expert pain and symptom management and planning for end-of-life care. In particular, palliative care offered via telehealth may improve access to outpatient palliative care services, which are predominantly offered in large academic medical centers in metropolitan areas. Despite an increase in telehealth for outpatient palliative care since the beginning of the COVID-19 pandemic, little is known about the perspectives of historically underserved patients on modality of palliative care and how communication may be impacted by a virtual mode of delivery for these patients who already experience inequities in receipt of goal-concordant care. In this prospective cohort study, we will enroll a cohort of adult patients referred to outpatient palliative care who are of low SES, non-White, LEP, or rurally-residing communities to compare care experiences of in-person versus tele-palliative care visits provided to historically underserved patients and their caregivers and understand the nuances around their needs and preferences for modality of care. Using mixed methods we will 1) evaluate both patient- and caregiver-reported experience with in-person and tele- palliative care over time using patient and caregiver-specific surveys and in-depth interviews with patients and caregivers; 2) compare communication quality and use of recommended communication processes between in- person and tele-palliative care using an analysis of recorded in-person and telehealth visits; and 3) examine perspectives of in-person visits versus tele-palliative care including perceived barriers and facilitators to both modes of delivery using qualitative interviews with palliative care providers. The proposed research will improve understanding of the experiences of historically underserved patients and their family caregivers to address issues around mode of delivery of palliative care. Findings will provide a roadmap for health systems to improve patient-provider communication and identify strategies to promote cultural competence to improve experience and overall quality of palliative care delivered both in person and via telehealth.