New Frontier for Hospice Care?
Telehealth and End of Life Care – A Doctor’s StoryRobert | Family Medicine Apr 30, 2020
Dr. Sean Oser is an associate professor in the Department of Family Medicine and the medical director at UCHealth Primary Care in Lone Tree.
Like his colleagues he is adapting to caring for patients in the age of COVID-19. Telehealth visits have become more routine – but, recently, an experience with one patient touched his heart and opened his eyes to how telehealth could enhance the end of life experience for patients in hospice care.
Dr. Oser’s story begins late last year when he started providing hospice care for an 88-year-old woman with lung cancer who had decided not to attempt more treatment for her condition. She was living with her daughter in Centennial and simply wanted to be able to enjoy whatever time she had left.
Prior to the pandemic, Oser saw the woman in-person in the clinic on a regular basis. But, as COVID-19 concerns grew, they switched to technology to continue care.
That was the beginning of an unforgettable experience for both doctor and patient.
How did the hospice care telehealth visits differ from a routine visit with a patient online?
Dr. Oser: I was unprepared for how profoundly richer and more meaningful the home hospice telehealth visits became for me.
I knew that home telehealth visits were helpful, and almost as useful as in-office visits, so I was expecting home telehealth hospice visits to be the same. However, I had forgotten how helpful it can be to see a patient in their home environment, especially at the end of life.
The freedom to be able to care for her frequently, while she stayed at home, and while I got a highly informative window into her and her environment, was unexpected.
How did she respond to the virtual visits versus seeing you in person?
Dr. Oser: She responded very well to the virtual visits.
One thing that didn’t change is how much her daughters told me she perked up after visits with me. Left on her own to contemplate her impending death left her very scared and full of questions.
When seeing me in the office, every two weeks, or four, she felt like she had fewer opportunities to ask me her newest questions. With the ability to check in more frequently, with less effort for her and her family to do so, she brought me her questions more frequently, and had less time to sit alone with them. Even once she stopped speaking and opening her eyes, her daughters told me she smiled as soon as she heard my voice through the tablet.
It brought them great comfort to be able to see her comforted. It brought me comfort too.
How has this particular patient experience influenced your view of the value of telehealth visits?
Dr. Oser: Home telehealth for hospice care brings numerous advantages, from my perspective, that I hadn’t anticipated.
It feels like it should have been obvious now, in hindsight, but it is something so far out of the usual wheelhouse for most of us that it was still a surprise.
Especially as she got weaker, it would have been increasingly hard for her and her family to come to the office, but it was immeasurably easier on them for me to check in by video instead. Also, home nursing visits, including hospice, can’t happen at the same time as an office visit for obvious reasons, but they can happen at the same time as telehealth visits.
The ability to speak with the home hospice nurse while he was at the home was incredibly helpful for me and for the nurse, as he told me. It was also virtually unprecedented for both of us, which is a shame.
In this way, telehealth greatly improved everyone’s ability to deliver truly coordinated and patient-centered care at a time when that is usually hardest to do but most needed.
I hope I remember this and make much more use of this modality of care going forward, especially for end of life care. I’m sure there are other applications of telehealth that we haven’t thought of yet that might also seem like they should have been obvious when we do; I’m looking forward to learning together what they are.