Community Tele-pal: A community-developed, culturally based palliative care tele-consult randomized controlled trial for African American and White Rural southern elders with a life-limiting illness

Abstract

Background: Patients living in rural areas experience a variety of unmet needs that result in healthcare disparities. The triple threat of rural geography, racial inequities, and older age hinders access to high-quality palliative care (PC) for a significant proportion of Americans. Rural patients with life-limiting illness are at risk of not receiving appropriate palliative care due to a limited specialty workforce, long distances to treatment centers, and limited PC clinical expertise. Although culture strongly influences people's response to diagnosis, illness, and treatment preferences, culturally based care models are not currently available for most seriously ill rural patients and their family caregivers. The purpose of this randomized clinical trial (RCT) is to compare a culturally based tele-consult program (that was developed by and for the rural southern African American (AA) and White (W) population) to usual hospital care to determine the impact on symptom burden (primary outcome) and patient and care partner quality of life (QOL), care partner burden, and resource use postdischarge (secondary outcomes) in hospitalized AA and White older adults with a life-limiting illness. Methods: Community Tele-pal is a three-site RCT that will test the efficacy of a community-developed, culturally based PC teleconsult program for hospitalized rural AA and W older adults with life-limiting illnesses (n = 352) and a care partner. Half of the participants (n = 176) and a care partner (n = 176) will be randomized to receive the culturally based palliative care consult. The other half of the patient participants (n = 176) and care partners (n = 176) will receive usual hospital care appropriate to their illness. Discussion: This is the first community-developed, culturally based PC tele-consult program for rural southern AA and W populations. If effective, the tele-consult palliative program and methods will serve as a model for future culturally based PC programs that can reduce patients' symptoms and care partner burden.

Can you hear me now?: Improving palliative care access through telehealth

“…The RCT (Community Tele‐Pal, R01NR017181) is now underway using recommendations outlined in the protocol of the previous study (Watts et al, 2020). The RCT is testing the efficacy of the community‐developed, culturally based PC tele‐consult program in hospitalized AA and White older adult patients with life‐limiting illnesses, and their caregiver, in three rural hospitals without PC services located in Alabama, Mississippi, and South Carolina.…”

“…However, the most commonly cited benefit is the alleviation of geographical barriers, especially for persons living in rural areas or low-and middle-income countries (LMICs; Bean, 2015). Because most PC telehealth studies are conducted in rural or underserved areas, telehealth increased PC specialist access which, in turn, improved the ability to treat health conditions and provide better overall patient care (Watts et al, 2020). While early in evidence gathering, larger societal and environmental benefits may ultimately include reducing patient travel time on the roads, decreasing fuel emissions, and increasing provider and clinic efficiency with decreased wait times while the patient is triaged for visit.…”

Telehealth Strategies to Support Patients and Families Across the Cancer Trajectory

“…Hence, a study of video consultation is underway to provide this care via video visit. 48 However, the University of Alabama at Birmingham Community-based (Virtual) Access to Palliative Expertises program has a clinical video-visit program that enables patients to have this consultation in the comfort of their homes, though prior to relaxation of telehealth regulations, these visits were only possible to conduct at local area health departments where there was a clinician present at the originating site. Hence, patients like James are now able to get high-quality palliative care in their rural local community, where this care does not often exist.…”

Participation of rural patients in clinical trials at a multisite academic medical center

“…40,41 Cultural differences between patients and health care providers, which can lead to miscommunication and mistrust and reduce the willingness of rural residents to participate in clinical trials, were also not assessed. 42 Selected chronic conditions (eg, hypertension, obesity, heart and cerebrovascular disease, chronic obstructive pulmonary disease) are more common in rural than urban residents. 8 Since these conditions are often exclusion criteria in clinical trials, they may limit the enrollment of rural residents in trials.…”

“…The socioeconomic status can be evaluated with the Housing-based Socioeconomic Status index, which is derived from the home address, and predicts self-rated health, advanced care planning, nursing home utilization, and other indices [40,41]. Cultural differences between patients and health care providers, which can lead to miscommunication and mistrust and reduce the willingness of rural residents to participate in clinical trials, were also not assessed [42]. Selected chronic conditions (e.g., hypertension, obesity, heart and cerebrovascular disease, chronic obstructive pulmonary disease) are more common in rural than urban residents [8].…”