{"id":27180,"date":"2019-10-24T13:35:51","date_gmt":"2019-10-24T19:35:51","guid":{"rendered":"https:\/\/www.uchealth.org\/today\/?p=27180"},"modified":"2024-02-22T06:35:44","modified_gmt":"2024-02-22T13:35:44","slug":"palliative-care-telehealth","status":"publish","type":"post","link":"https:\/\/www.uchealth.org\/today\/palliative-care-telehealth\/","title":{"rendered":"Palliative care telehealth"},"content":{"rendered":"
<\/div>

Once a month, Al Hall takes out an iPad, fires it up and gets ready for a half-hour conversation. It\u2019s a routine familiar to many who use a tablet or computer to connect with friends and loved ones miles away. Hall, though, reaches out for a different purpose: palliative care.<\/p>\n

Hall, 70, has stage 4 non-small cell lung cancer. The discovery came after trips to UCHealth University of Colorado Hospital<\/a> on the Anschutz Medical Campus<\/a> to treat a sore back he thought he\u2019d injured when he tried to lift his stuck garage door. When his providers gave him the bad news, he wondered how he\u2019d progressed to the most serious stage of the disease, although he readily admits he smoked for many years.<\/p>\n

\"A
The University of Colorado Cancer Center is conducting a clinical trial to determine whether palliative care telehealth helps patients who have cancer. Photo: Getty Images.<\/figcaption><\/figure>\n

\u201cI figured there was no use in jumping up and down, screaming and yelling or anything like that,\u201d Hall said. \u201cI said, I got it so let me go ahead and deal with it. And that\u2019s what I\u2019ve been doing.\u201d<\/p>\n

He\u2019s fighting the disease with Keytruda, an immunotherapy treatment he receives at UCHealth University of Colorado Cancer Center<\/a>. But he gets additional support through the iPad, which he uses to speak with Dr. Jennifer Seibert, a palliative care<\/a> specialist and board-certified family medicine physician<\/a>. Seibert helps Hall and other patients with serious illnesses cope with the physical, emotional and spiritual challenges of disease and identify the goals and values that are most important to maintaining their quality of life.<\/p>\n

Palliative care telehealth<\/strong><\/h3>\n

Most often, Seibert meets with patients and their caregivers face-to-face at the Cancer Center. Now she is lead clinical provider for a study<\/a> examining if palliative care visits conducted remotely with patients can be just as effective in improving quality of life, managing symptoms and increasing satisfaction for patients with newly diagnosed advanced lung cancer and their caregivers. The University of Colorado<\/a> is one of 21 sites for the study, which is sponsored by Massachusetts General Hospital through funding from the Patient Centered Outcomes Research Institute. The Colorado-based Palliative Care Research Cooperative Group <\/a>is helping to coordinate the trial.<\/p>\n

\"Dr.
Dr. Stacy Fischer is principal investigator at CU for the palliative care telehealth trial. Photo by UCHealth.<\/figcaption><\/figure>\n

The approach also includes initiating palliative care soon after the diagnosis and building close communication between palliative care specialists and thoracic oncologists. It\u2019s a model that has shown promising results<\/a> in bolstering coping skills in patients with advanced cancer and improving their quality of life.<\/p>\n

A big problem, though, is that palliative care services aren\u2019t easy to get for many patients, especially in Colorado and surrounding states with large rural populations, said Dr. Stacy Fischer<\/a>, a palliative care and geriatric medicine specialist who is principal investigator for the study at CU.<\/p>\n

\u201cPalliative care is one of those specialties where the need far exceeds the supply,\u201d Fischer said. \u201cFinding innovative and successful ways of being able to spread that reach is really important.\u201d<\/p>\n

Fischer added that while the study isn\u2019t analyzing the cost-effectiveness of palliative care telemedicine, \u201cworkforce realities are in play. We\u2019re not going to have palliative care specialty clinicians in every small town. The issue is really about access for patients.\u201d<\/p>\n

Breaking down barriers<\/strong><\/h3>\n

The study randomizes patients referred by their oncologists to either in-person meetings or the telehealth sessions. All patients who participate have an initial two-hour meeting with the palliative care team. Seibert said the discussion can help allay a frequent fear of many: that palliative care means hospice and end-of-life care.<\/p>\n

Seibert said she and her team dispel the misunderstanding in positive terms. \u201cI\u2019ll say things like, \u2018We\u2019re the quality-of-life and whole-person team.\u2019 That helps them to understand what our focus is.\u201d<\/p>\n

The focus, she added, is on providers listening to patients, not the other way around.<\/p>\n

\u201cI tell patients that \u2018we are going to start with you. Tell me your story of who you are, who is your family, what matters to you,\u2019\u201d Seibert said. \u201cSitting down, taking a deep breath and focusing on the person outside of the illness is one of the most important things because who we are as a person and who we are as a family are the parts we are trying to connect with, and that often get lost in medicine.\u201d<\/p>\n

Quality counts<\/strong><\/h3>\n
\"Dr.
Dr. Jennifer Seibert, lead clinical provider for palliative care telehealth trial, meets with Al Hall and other trial patients via computer or tablet. Photo courtesy of Jennifer Seibert.<\/figcaption><\/figure>\n

Following the initial meeting, patients meet with the palliative care team monthly, either in the same room or from their homes. The approach is the same: an emphasis on helping patients achieve \u201cvalue-based goals\u201d that provide purpose and satisfaction, Seibert said. Those could range from spending time with grandkids to walking to fishing to managing pain or anything in between.<\/p>\n

\u201cThat\u2019s the philosophic center of palliative care,\u201d she said, \u201cbecause it\u2019s not enough to just get your body better if you can\u2019t get back to the things you love. Those are the things that help people get through illness.\u201d<\/p>\n

Fischer emphasized that a must for the study team was building support for the early-intervention palliative care model among their colleagues in thoracic oncology.<\/p>\n

\u201cWe wanted to ensure that they felt that it\u2019s important not to wait until people have symptoms that are detrimental to their quality of life. Let\u2019s start the process upstream, early on, when maybe things are going great,\u201d she said. \u201cAllow us the chance to build rapport early on.\u201d<\/p>\n

The response from oncologists was positive and borne out by the enrollment numbers, Fischer added. As of August the CU site had enrolled 23 patients and was on track to reach its three-year total goal of 60.<\/p>\n

Long-distance calls<\/strong><\/p>\n

But does distance make it harder for provider and patient to develop the sense of trust that is fundamental to patient care? Seibert acknowledged that some patients in the videoconference group have told her that they initially found the remote encounters more difficult and \u201cfelt the distance,\u201d while another is so comfortable that she considers them in-person visits.<\/p>\n

Al Hall said conversing via the iPad \u201cfelt funny\u201d at first. \u201cWhen you see people in person, you can see their nonverbal communication and can see if they\u2019re really interested in helping you or just going through the motions.\u201d He\u2019s gotten used to using the tablet, though, and the distance isn\u2019t an issue anymore. Talking with Seibert, though, was another matter \u2013 at least at first.<\/p>\n

Hall is a plain-spoken man who enlisted in the military at age 19 and served 24 years before returning to civilian life. He worked as a manager at Colorado Lace laundry in the Denver area, but left after it was bought out by another company. Hall also battled prostate cancer, as have two of his surviving brothers.<\/p>\n

He knows the survival statistics for stage 4 lung cancer aren\u2019t good. \u201cEvery once in a while I think about it, but I don\u2019t linger on stuff like that,\u201d he said. \u201cThat\u2019s depression. Miracles happen but this [disease] right here, there ain\u2019t no cure for what I got. Eventually something is going to take place.\u201d<\/p>\n

Hall has a wife and son, but he sees his struggle with cancer as an individual battle and one to be faced stoically. Talking about his lung cancer and the emotions that come with his diagnosis isn\u2019t easy.<\/p>\n

\u201cI\u2019m a closed-in person,\u201d he said. \u201cI don\u2019t like to put my business in the street. You\u2019ll never see me cry. I\u2019ll go into a room and cry.\u201d<\/p>\n

It\u2019s probably not surprising, then, that he approached the sessions with Seibert guardedly.<\/p>\n

\u201cThe doctor, she tried to get me to open up, and I admit she worked pretty hard at it, too,\u201d Hall said. \u201cBut I couldn\u2019t tell nobody what I was going through. When we first started, she was doing all the talking and she would try to get me involved, but my answers were short and blunt. I didn\u2019t want to do it.\u201d<\/p>\n

Closing the space<\/strong><\/p>\n

With time, Hall said he became more and more comfortable with talking to Seibert. She began to break down the barriers with a seemingly simple offer, he said.<\/p>\n

\u201cOne thing she told me, and I\u2019ll never forget it, is that if I ever needed anything, contact her,\u201d Hall recalled. \u201cAin\u2019t nobody ever told me anything like that.\u201d He now looks forward to his time with Seibert. \u201cJust to see her and remember what she told me lifts my spirits,\u201d Hall said.<\/p>\n

He admitted he still has trouble fully opening up about his feelings, but the conversations with Seibert encourage him to think about how the disease affects his life.<\/p>\n

\u201cBeing with family and friends is a goal,\u201d he said. \u201cBut what\u2019s going to happen to my family? That was the first thing that hit me upside the head. What\u2019s going to happen to my wife, how is she going to carry on, financially and emotionally? I still think about that now.\u201d<\/p>\n

There are no easy answers to those questions, but he\u2019s not going at them alone.<\/p>\n

\u201cI would suggest that they continue [palliative care] because it does help, just to have a conversation that you can talk about anything,\u201d Hall said. \u201c[Dr. Seibert] brings it right back to the disease because she\u2019s really trying to know how I feel about certain things.\u201d<\/p>\n

Al Hall and other patients in the telehealth study will help to shape the future of palliative care, Seibert said.<\/p>\n

\u201cWe have to prove to payers that telehealth works, that connecting to people can work across a computer or a tablet screen,\u201d she said. If that proves successful, she added, \u201cthat will mean that resources are available to more patients. That\u2019s how we\u2019re to change palliative medicine. This will grow because the need is so great.\u201d<\/p>\n

For more information about the study, contact Dr. Stacy Fischer at <\/em>migration-stacy.fischer@cu-anschutz.edu<\/em> or Mary Mancuso at <\/em>mary.mancuso@cuanschutz.edu<\/em> (email), 303-724-5729 (phone).<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

Once a month, Al Hall takes out an iPad, fires it up and gets ready for a half-hour conversation. It\u2019s a routine familiar to many who use a tablet or computer to connect with friends and loved ones miles away. Hall, though, reaches out for a different purpose: palliative care. Hall, 70, has stage 4 […]<\/p>\n","protected":false},"author":2143,"featured_media":27182,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_relevanssi_hide_post":"","_relevanssi_hide_content":"","_relevanssi_pin_for_all":"","_relevanssi_pin_keywords":"","_relevanssi_unpin_keywords":"","_relevanssi_related_keywords":"","_relevanssi_related_include_ids":"","_relevanssi_related_exclude_ids":"","_relevanssi_related_no_append":"","_relevanssi_related_not_related":"","_relevanssi_related_posts":"","_relevanssi_noindex_reason":"","footnotes":""},"categories":[5],"tags":[28,154],"class_list":["post-27180","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-innovative-care","tag-cancer-care-oncology","tag-palliative-care"],"acf":[],"yoast_head":"\nPalliative care telehealth - UCHealth Today<\/title>\n<meta name=\"description\" content=\"The University of Colorado participates in a trial that tests the effectiveness of palliative care delivered to patients via secure videoconference.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.uchealth.org\/today\/palliative-care-telehealth\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Palliative care telehealth\" \/>\n<meta property=\"og:description\" content=\"The University of Colorado participates in a trial that tests the effectiveness of palliative care delivered to patients via secure videoconference.\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.uchealth.org\/today\/palliative-care-telehealth\/\" \/>\n<meta property=\"og:site_name\" content=\"UCHealth Today\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/uchealthorg\/\" \/>\n<meta property=\"article:published_time\" content=\"2019-10-24T19:35:51+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2024-02-22T13:35:44+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/uchealth-wp-uploads.s3.amazonaws.com\/wp-content\/uploads\/sites\/6\/2019\/10\/24131148\/Palliative-Care-Telehealth-1-Getty-Image.jpg\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"Tyler Smith\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@uchealth\" \/>\n<meta name=\"twitter:site\" content=\"@uchealth\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"Tyler Smith\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"9 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/www.uchealth.org\\\/today\\\/palliative-care-telehealth\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/www.uchealth.org\\\/today\\\/palliative-care-telehealth\\\/\"},\"author\":{\"name\":\"Tyler Smith\",\"@id\":\"https:\\\/\\\/www.uchealth.org\\\/today\\\/#\\\/schema\\\/person\\\/98c85c0e40c4933eedcec2cd054f349d\"},\"headline\":\"Palliative care telehealth\",\"datePublished\":\"2019-10-24T19:35:51+00:00\",\"dateModified\":\"2024-02-22T13:35:44+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/www.uchealth.org\\\/today\\\/palliative-care-telehealth\\\/\"},\"wordCount\":1730,\"publisher\":{\"@id\":\"https:\\\/\\\/www.uchealth.org\\\/today\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/www.uchealth.org\\\/today\\\/palliative-care-telehealth\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/uchealth-wp-uploads.s3.amazonaws.com\\\/wp-content\\\/uploads\\\/sites\\\/6\\\/2019\\\/10\\\/24131148\\\/Palliative-Care-Telehealth-1-Getty-Image.webp\",\"keywords\":[\"Cancer care\",\"Palliative care\"],\"articleSection\":[\"Innovative care\"],\"inLanguage\":\"en-US\"},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/www.uchealth.org\\\/today\\\/palliative-care-telehealth\\\/\",\"url\":\"https:\\\/\\\/www.uchealth.org\\\/today\\\/palliative-care-telehealth\\\/\",\"name\":\"Palliative care telehealth - 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