• Isaac S Chua, Molly Olmsted, Rachel Plotke, Yael Turk, Chardria Trotter, Simone Rinaldi, Mihir Kamdar, Vicki A Jackson, Emily R Gallagher-Medeiros, Areej El-Jawahri, Jennifer S Temel, and Joseph A Greer.
• Division of General Internal Medicine and Primary Care, Department of Medicine (I.S.C.), Brigham and Women's Hospital, Boston, Massachusetts, USA; Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute (I.S.C.), Boston, Massachusetts, USA; Harvard Medical School (I.S.C., S.R., M.K., V.A.J., A.E.J., J.S.T., J.A.G.), Boston, Massachusetts, USA. Electronic address: ichua@bwh.harvard.edu.
• J Pain Symptom Manage. 2022 Dec 1; 64 (6): 577587577-587.

ContextPalliative care (PC) clinicians faced many challenges delivering outpatient care during the coronavirus-19 (COVID-19) pandemic.ObjectivesWe described trends for in-person and video visit PC delivery challenges before and during the COVID-19 pandemic in the U.S.MethodsWe performed a secondary data analysis of patient characteristics and PC clinician surveys from a multisite randomized controlled trial at 20 academic cancer centers. Patients newly diagnosed with advanced lung cancer (N = 653) were randomly assigned to receive either early in-person or telehealth PC and had at least monthly PC clinician visits. PC clinicians completed surveys documenting PC delivery challenges after each encounter. We categorized patients into 3 subgroups according to their PC visit dates relative to the onset of the COVID-19 pandemic in the U.S.-pre-COVID-19 (all visits before March 1, 2020), pre/post-COVID-19 (≥1 visit before and after March 1, 2020), and post-COVID-19 (all visits after March 1, 2020). We performed Pearson's chi-squared, Fisher's exact, and Kruskal-Wallis tests to examine associations.ResultsWe analyzed 2329 surveys for video visits and 2176 surveys for in-person visits. For video visits, the pre-COVID-19 subgroup (25.8% [46/178]) had the most technical difficulties followed by the pre/post-COVID-19 subgroup (17.2% [307/1784]) and then the post-COVID-19 subgroup (11.4% [42/367]) (P = 0.0001). For in-person visits, challenges related to absent patients' family members occurred most often in the post-COVID-19 subgroup (6.2% [16/259]) followed by the pre/post-COVID-19 subgroup (3.6% [50/1374]) and then the pre-COVID-19 subgroup (2.2% [12/543]) (P = 0.02).ConclusionTechnical difficulties related to PC video visits improved, whereas in-person visit challenges related to absent patients' family members worsened during the pandemic.Copyright © 2022 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.

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