Travel burden and telemedicine in home-based palliative care: potential and limitations - prospective analysis
Clinical Snapshot
PICO Framework
| P — Population | Adult oncology patients receiving home-based palliative care, assessed across multiple centres in Italy (July 2025) |
| I — Intervention | Telemedicine (TM) as a substitute for in-person home visits by palliative care clinicians |
| C — Comparator | Standard in-person home visits by palliative care clinicians |
| O — Outcomes | Primary: clinician travel burden (time, distance); Secondary: concordance between clinician and patient perceptions of TM feasibility; predictors of TM practicability; visit duration by visit type and clinical complexity |
Bottom Line
This prospective Italian multicentre study quantifies the substantial travel burden imposed on palliative care clinicians delivering home-based oncology care — over 7,000 minutes of travel time and more than 4,400 km across just 311 visits in a single month. The study demonstrates moderate clinician-patient concordance (κ=0.55) on telemedicine feasibility, with potential savings of nearly 1,500 minutes of travel time if TM were applied where both parties agreed it was appropriate. Key predictors of TM practicability included low clinical complexity, follow-up (rather than first or unscheduled) visit type, controlled symptoms, and absence of significant therapeutic changes. These findings are clinically intuitive and provide a useful framework for patient stratification. However, the study has important limitations: a single-month observation window, no confidence intervals, incomplete confounder reporting, and restriction to oncology patients in an Italian healthcare context. Critically, TM feasibility was assessed perceptually — no actual TM encounters were evaluated for safety or quality outcomes. For Australian clinicians and health service planners, this study supports the principle of selective TM use in established, low-complexity palliative care patients, consistent with existing RACGP and Palliative Care Australia guidance, but stronger evidence from longer-duration, outcome-focused trials is needed before broader implementation.
Key Findings
P Value: First-time/unscheduled vs follow-up visit duration: p<0.001; visit duration with uncontrolled symptoms: p=0.0419; visit duration with higher PERSONS score or significant therapeutic changes: p<0.001
Effect Size: Concordance between clinician and patient TM feasibility assessments: 76.20% agreement rate. First-time and unscheduled visits were significantly longer than follow-up visits. Visit duration was significantly longer with uncontrolled symptoms, higher PERSONS scores, and significant therapeutic changes.
Primary Outcome: Total clinician travel time for 311 home visits was 7,071 minutes; total visit time was 14,177 minutes; total distance travelled was 4,411.85 km. Where TM was deemed feasible by both parties, potential savings were 1,493 minutes of travel time, 2,353 minutes of visit time, and 984.6 km.
Nnt Or Sensitivity: Cohen's kappa for clinician-patient TM feasibility concordance: κ=0.55 (moderate agreement). No NNT, sensitivity/specificity, or hazard ratio data reported.
Confidence Interval: Not reported for any outcome measure
Clinical Application
TM substitution for in-person visits is feasible in a selected subgroup only. The study identifies clinical complexity, visit type, symptom burden, and target symptom as key determinants. Implementation requires digital infrastructure, patient and carer digital literacy, and robust clinical triage protocols to identify appropriate candidates. Safety monitoring frameworks for remote palliative care delivery would be essential prior to scale-up. In Australia, home-based palliative care is delivered through a mix of state-funded community palliative care services, Medicare-subsidised GP home visits, and specialist outreach programs. Telehealth in palliative care has been supported under MBS telehealth item numbers expanded post-COVID-19 (e.g., MBS items 92024, 92025 for specialist telehealth). The RACGP and Palliative Care Australia have both endorsed telehealth as a complement to in-person care in appropriate circumstances. This study's findings are directionally consistent with Australian policy direction but cannot be directly applied given the Italian context, oncology-only population, and absence of cost-effectiveness data relevant to the Australian healthcare funding model. PBS implications are indirect — TM does not alter medication prescribing pathways but may affect medication review frequency and opioid titration safety in remote settings. TGA-approved remote monitoring devices could enhance the safety of TM-based palliative care in Australia. Rural and remote Australian populations may derive particular benefit, given the substantial travel burden documented in this study, though digital connectivity remains a barrier in many such communities. Adult oncology patients receiving home-based palliative care who are established (non-first-visit), have controlled symptoms, low clinical complexity (low PERSONS score), and no anticipated significant therapeutic changes. Clinicians and patients must both perceive TM as feasible.
Abstract
OBJECTIVES: To assess clinicians' travel burden in home-based palliative care (PC), identify factors improving the telemedicine (TM) applicability and assess its perceived feasibility. METHODS: This prospective, multicentre, real-world study analysed outpatient visits with oncological patients. It assessed travel and time burden, patient and visit characteristics, perception of both patients and clinicians regarding TM. Statistical analyses were performed to describe the data and evaluate associations between variables. RESULTS: Based on 311 recorded visits in July 2025, travel time reaching patients' home was 7071 min, visit time was 14 177 min, distance travelled was 4411.85 km. The agreement between clinicians and patients on TM feasibility had a concordance rate of 76.20% (κ=0.55). In these cases, the potential savings were 1493 min on travel time, 2353 min of visit time and 984.6 km in distance. First-time and unscheduled visits were significantly longer than follow-up (p<0.001). Visit time was also significantly longer with uncontrolled symptoms (p=0.0419), higher median PERSONS score or significant therapeutic changes (p<0.001). Multivariate analysis confirmed that expected clinical complexity, type of visit, presence of significant symptoms and target symptom (only for clinicians) were the strongest predictors of TM practicability. CONCLUSIONS: TM could reduce travel burden, but it is feasible in selected cases. Future efforts should focus on identifying patient subgroups for whom TM could safely and effectively replace in-person home visits. Stratifying patients may help optimise resource allocation and guide personalised care models in home-based PC.
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