Telehealth and cancer treatment
Many cancer care services can be performed without an in-person visit.
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Distress screening via telehealth
The standard of care for all cancer programs includes a method to screen all newly diagnosed patients for their level of distress, and based on the results, offer appropriate levels of psychosocial care. Like many other forms of behavioral health care, these distress screenings and follow-ups can be conducted through telehealth. Follow these steps to ensure that your cancer patients are receiving the mental health support that they need.
Select a distress screening team lead
This person or persons can be an oncology social worker, clinical psychologist, or other licensed mental health professional trained in the psychosocial aspects of cancer care.
If your practice cannot accommodate this type of staffing, work with community organizations and other specialty providers to develop a virtual distress screening care network.
Create a standardized protocol
Having a protocol ensures that screenings are completed and distress can be addressed in a timely and organized fashion. Protocol considerations include the telehealth platform that screenings will be conducted on, how to determine the need for a follow-up clinical assessment, and developing a referral plan.
Choose a screening tool
Three distress screening measurement tools are commonly used in the United States. Each has unique metrics, and the tool that you select should be based on individual patient needs.
- The Psychosocial Screen for Cancer (PSCAN) measures general distress
- Patient Health Questionnaire-4 (PHQ-4) measures anxiety and depression
- The Edmonton Symptom Assessment System (ESAS-r) assesses 9 common symptoms in cancer patients, such as anxiety, depression, nausea, and fatigue
Chemotherapy and telehealth
Intravenous chemotherapy requires an in-person visit and health care provider supervision. Telehealth visits can be used to assess treatment requirements and potential side effects of chemotherapy before each cycle of treatment. You can also use telehealth to review patient progress and determine if dosing adjustments are needed.
As oral chemotherapy becomes more widely adopted, your telehealth cancer practice may consider including it as part of a patient’s care plan when appropriate.
Both oral and intravenous chemotherapy require strong health IT and remote patient monitoring (RPM) infrastructure to track patient progress and side effects as well as keep them connected with their care team. RPM allows you to respond to a patient’s symptoms in a timely manner with evidence-based care recommendations.
Ongoing monitoring and clinical response to patient feedback can be assessed during scheduled telehealth follow-ups, which can ensure the appropriate use of the monitoring tools.
Palliative care with telehealth
Tele-palliative care, or palliative care conducted primarily through telehealth, has the potential to provide a variety of benefits to palliative and hospice care patients, especially those who are susceptible to infection and/or rely upon interdisciplinary care. These patients can receive care with minimal disruption to their daily lives, from the comfort of their homes—which is particularly valuable to those living in remote or rural areas.
Cancer patients in palliative care benefit from continuous monitoring and symptom management, both of which can be completed through either videoconferencing or audio-only telehealth services.
Periodic virtual visits can help providers address additional care needs and assess symptoms that may require hospitalization. RPM can be used to manage and treat symptoms, such as pain and respiratory distress. Outpatient services or hospitalizations can be coordinated earlier to address symptoms such as pain control or fluid needs to prevent emergency visits.
Implementation considerations for tele-palliative care
Tele-palliative care requires careful planning for successful implementation. As you consider integrating tele-palliative care into your practice, be sure to keep the following in mind:
Take advantage of the relationship consistency telehealth can provide. Tele-palliative visits can be scheduled around chemotherapy infusions to promote better continuity of care
Designate one or more members of your staff to review virtual login instructions with patients ahead of a scheduled call to prevent delays that can impact your care schedule. To address potential audio delays that can happen with video visits, allow for deliberate pauses in speech.
Keep in mind that video-based tele-palliative care may not be an option for many patients due to a lack of technological access. In these cases, work closely with patients to determine alternative approaches, such as in-person visits and audio-only care.
Tele-palliative care in practice
When symptom reports reach predetermined thresholds, notify the patient’s palliative care team for further treatment and symptom management. In response to these notifications, the patient could participate in video conferences with their nurse as an alternative to an in-person office visit, when medically appropriate to do so.
Family Health Centers & Okanogan Palliative Care Consortium
The Okanogan Palliative Care Consortium (OPCC) used funding from Health Resources and Services Administration (HRSA) to develop a partnership of community agencies to realize palliative care services in Okanogan County, Washington. The Consortium has partnered with Honoring Choices Pacific Northwest to train community facilitators to offer advance care planning workshops, with a special focus on culturally appropriate outreach to Latin communities. The Washington State Aging and Long-Term Support Administration partners to provide resources for patient and community needs, evaluations for support services, and community education.
To better serve historically marginalized communities in the county, OPCC is assisting with training community health workers at Family Health Centers in palliative care principles and is also assisting in advancing a community health representative program within the Colville Confederated Tribes. Telehealth and follow-up telephone and electronic communication will ensure efficient and timely communication and more access to providers by clients and families. The Consortium also provides ongoing palliative care education to health care providers and community members through classes, on-site education, and a bi-monthly email.
Learn more about Family Health Centers & Okanogan Palliative Care Consortium here.