“We really need to do our best to reach people who don’t have access to palliative care in their communities, and this is an innovative way for us to do that,” Carey Ramirez, ANP-C, ACHPN, nurse practitioner and manager of advanced practice and supportive care medicine at the City of Hope National Medical Center in Duarte, CA, told Lenise Taylor, MN, RN, AOCNS®, BMTCN®, oncology clinical specialist at ONS, during a discussion about how telehealth is overcoming barriers and disparities that previously limited patients’ access to timely oncology palliative care. 

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Music Credit: “Fireflies and Stardust” by Kevin MacLeod 

Licensed under Creative Commons by Attribution 3.0 

The planners and faculty for this episode have no relevant financial relationships with ineligible companies to disclose. ONS is accredited as a provider of NCPD by the American Nurses Credentialing Center’s Commission on Accreditation.

Learning outcome: The learner will report an increase in knowledge related to telehealth-based oncology palliative care. 

Episode Notes 

• The NCPD activity for this episode has expired, but you can still earn NCPD through many other ONS Podcast episodes. Find a full list of opportunities.

• Oncology Nursing Podcast: 

• • Episode 251: Palliative Care Programs for Patients With Cancer 

  • Episode 135: ELNEC Has Trained More Than One Million Nurses in End-of-Life Care 

  • Episode 41: Advocating for Palliative Care and Hospice Education 

• ONS Voice articles: 

• • Bipartisan PCHETA Legislation Reintroduced in U.S. Senate 

  • U.S. Senators Introduce Legislation for Earlier Palliative Care 

  • Help Your Patients Prepare for the End From the Beginning 

  • APRNs Can Lead by Example When Integrating Palliative Care in Practice 

• Clinical Journal of Oncology Nursing articles: 

• • Palliative Care: Oncology Nurses’ Confidence in Provision to Patients With Cancer 

  • Telehealth in Palliative Care: Communication Strategies From the COVID-19 Pandemic 

  • Clinical Oncology Nurse Best Practices: Palliative Care and End-of-Life Conversations  

  • Integrating Palliative Care in Hematopoietic Stem Cell Transplantation: A Qualitative Study Exploring Patient, Caregiver, and Clinician Perspectives  

• ONS Palliative Care Huddle Card 

• ONS clinical practice resource: Palliative Care Communication Strategies 

• ONS book: Integration of Palliative Care in Chronic Conditions: An Interdisciplinary Approach 

• Center to Advance Palliative Care (CAPC) 

• Hospice and Palliative Nurses Association (HPNA) 

• National Hospice and Palliative Care Organization (NHPCO) 

 

To discuss the information in this episode with other oncology nurses, visit the ONS Communities.   

To find resources for creating an ONS Podcast Club in your chapter or nursing community, visit the ONS Podcast Library. 

To provide feedback or otherwise reach ONS about the podcast, email [email protected]. 

Highlights From Today’s Episode 

“If a person is uncertain of their prognosis or if a provider is uncertain of the goals that the patient has for themselves, that might be an appropriate time to consider palliative consultation. These are all important considerations for triggers that might make palliative a possibility for patients in those scenarios. The take-home message, though, is that the sooner that palliative care is involved, the more likely the patient and family are to benefit.” TS 2:51 

“From a patient and family perspective, we frequently find that there are misperceptions regarding palliative care. Oftentimes, they'll conflate the word palliative with either hospice or end-of-life care. They unfortunately sometimes believe that they’re one and the same. They demonstrate a lack of knowledge regarding the benefits, including the fact that palliative care can and should be provided alongside life-prolonging care.” TS 3:53 

“Palliative providers do their best to help patients maintain hope throughout their disease trajectory, regardless of how well or how poorly things are going. I tend to view things in terms of climbing a sand dune: Living with cancer can sometimes feel like you’re walking up a sand dune, either at the beach or at the desert, and there will be days where you take two steps forward and you might slide only one step back. There may also be days where you take two steps forward and slide three steps back. And you find, for example, that if you keep trudging toward the top, that because the winds are constantly blowing those dunes, the top you eventually reach might be different than the one you initially set out to reach. And I think that speaks to the changing nature of hope.” TS 6:08 

“It’s important to ensure that providers are aware of the local services available to them in their respective communities. [And] we often find that from an organizational or a structural barrier perspective, there are lack of access to palliative care in the community. We often find that outpatient programs may not be as robust, or you may find that there is great variation between outpatient programs with regard to quality.” TS 10:10 

“We have multiple patient populations who unfortunately do not have equal access to palliative care. They include rural populations, those who come from low socioeconomic backgrounds. We find that male patients and/or patients who are older adults have lower access to palliative care. We find that those who might be either single or live alone, those who might have an immigrant status, those who don’t speak English, those who might have certain cancer diagnoses. It may surprise some of you to know that those with hematologic malignancies actually have much lower rates of palliative referral than those with solid tumors.” TS 11:23 

“There’s a maldistribution of palliative care resources nationwide. We tend to see that many of the resources are in urban areas, and as a result, we find that a great many rural areas are left untouched. I think it’s important for us to recognize that these social determinants of health exist. It’s important for us to look intentionally at them and whether they affect some of our patient populations and to work together to overcome them.” TS 14:03 

“Anecdotally, I’ve been doing telehealth for about five years and it’s been quite well received. It decreases my no-show rates. It improves my ability to monitor patients over time, and it can be carried out safely.” TS 16:12 

“It’s important to recognize that telehealth can be utilized not only for a planned appointment that might be scheduled to surveil someone every two weeks or every month from a pain and symptom management perspective, it can also be utilized as a same-day possibility. So if, for example, we have a patient who’s due to have an MRI tomorrow and their last MRI was stopped in part because they couldn’t tolerate it due to pain or symptoms, we might have a primary team reach out to us and ask whether we can see that patient the day prior to their MRI and devise a plan with that patient so that they can tolerate the MRI more easily the next day.” TS 22:26 

“Many of our patients no longer have the ability to get to and from their place of worship, and we can sometimes bring their clergy people to them via telehealth video. We also offer psychology services, psychiatry services, child life services, all via telehealth. And I think it’s important to recognize that palliative care is actually made up of an interdisciplinary team, including all of the aforementioned specialists who can basically work together to improve the experience of the patient who is living with cancer and being treated for it.” TS 26:41 

“Accept the inevitability of ups and downs. Learn from the downs and persevere. The outcomes are definitely worth it.” TS 28:11