# Extending the reach of palliative care–a double–edged sword: a qualitative study of clinicians’ experiences of delivering telehealth in Australia and Aotearoa New Zealand

## TL;DR

This study explores how telehealth can both expand and limit access to palliative care, based on clinicians' experiences in Australia and New Zealand.

## Contribution

The study provides new insights into the equity implications of telehealth in palliative care through clinicians' perspectives.

## Key findings

- Telehealth can extend palliative care reach but risks marginalizing underserved groups.
- Clinicians need support and education to ensure safe and high-quality telehealth care.
- Organizational guidelines are essential for optimizing telehealth use in palliative care.

## Abstract

Telehealth palliative care delivery has been shown to be feasible and acceptable for patients, families and clinicians across a number of contexts. However, the rapid implementation of telehealth during the pandemic exposed both challenges and opportunities for optimising telehealth integration in palliative care. This study capitalised on clinicians' experience to better understand the complexities of telehealth and palliative care with a focus on access and equity.

We deployed a qualitative interview study exploring Australia and Aotearoa New Zealand (NZ) clinicians’ perspectives of telehealth with a focus on underserved palliative care populations. The study was underpinned by applied critical realism evaluation. Data were analysed through an equity lens using Srivastava and Hopwood’s framework, applying critical realist evaluation questions: what are these data telling us about what works, for whom, in which contexts and with what outcomes?

We recruited a total of twenty-two participants [doctors (n = 7) nurses (n = 11) allied health (n = 4)]. Fifteen participants were based in Aotearoa NZ and seven in Australia. Analysis resulted in the following four key themes: Extending the reach of palliative care; Underserved groups – the thin line of equity and access; Patient safety and quality- the complexities of clinical work; Tele-care, connection and creativity.

Our findings show that although the adoption of telehealth can extend the reach of palliative care, there is, at the same time, the potential to further marginalise those for whom palliative care is already inaccessible. Support and education for clinicians are needed to ensure safe and high-quality telehealth, as well as organisational guidelines and structures to optimise the use of telehealth. There is a need for further research using ethnographic, participatory as well as other qualitative and quantitative methods to identify approaches that optimise access to palliative care and telehealth for underserved groups. This should include the perspectives of patients and families themselves.