Remote and rural communities face inequalities in access to specialist palliative care, could telemedicine enhance care? A qualitative study of patient, carer and healthcare professionals' experiences of video consultation.

Abstract

Background: Living in remote and rural areas is associated with worse health outcomes and poorer end-of-life care. Inequality in access to high-quality palliative care due to rurality is a worldwide problem. There is a need to evaluate potential ways, such as using telemedicine, to enhance palliative care and support patients to remain within their communities.

Objective: To understand the experiences of patients, carers and specialist palliative care professionals to receive/deliver video consultations in a rural setting.

Design: Qualitative semi-structured interviews with reflective thematic analysis.

Methods: Patients, their informal carers (family/friend) and members of the community specialist palliative care team were invited to qualitative interview to explore their experience of using video consultations.

Results: Four themes were generated including: (1) interpersonal communication, (2) enhanced provision with subthemes: physical distance and reducing travel and quick and convenient access to care, (3) flexible blended models of care and (4) organisational and practical barriers.

Conclusion: In many situations, video consultations were felt to be beneficial to enable convenient and reliable access to specialist palliative care for patients living remotely. They are feasible, acceptable and practical for patients, their families and healthcare professionals. However, video consultations must be offered as an option to enhance care rather than replace in-person home visits, which are required in some situations. Further research is needed to explore how to ensure this increased accessibility is inclusive and supports disadvantaged older patients and those of lower socio-economic position.