“It took away and stripped a part of myself”: Clinician distress and recommendations for future telepalliative care delivery in the cancer context Journal Article


Authors: Rosa, W. E.; Lynch, K. A.; Hadler, R. A.; Mahoney, C.; Parker, P. A.
Article Title: “It took away and stripped a part of myself”: Clinician distress and recommendations for future telepalliative care delivery in the cancer context
Abstract: Background: The COVID-19 pandemic has led to the rapid expansion of telehealth service delivery. We explored the experiences of a multidisciplinary palliative care team delivering telepalliative care for oncology inpatients during a 10-weeks COVID-19 surge in New York City. Methods/Participants: We conducted semi-structured qualitative interviews with a targeted sample, employing a phenomenological approach with applied thematic text analysis. An interdisciplinary coding team iteratively coded data using a mix of a priori and inductive codes. Team members first independently reviewed each category, then met to reach consensus on recurring themes. The sample (n = 11) included a chaplain (n = 1), social worker (n = 1), pharmacist (n = 1), physicians (n = 3), physician assistant (n = 1), and nurse practitioners (n = 4). Results: Participants described multidimensional clinician distress as a primary experience in delivering telepalliative care during the COVD-19 surge, characterized by competing loyalties (e.g., institutional obligations, ethical obligations to patients, resentment and distrust of leadership) and feelings of disempowerment (e.g., guilt in providing subpar support, decisional regret, loss of identity as a provider). Participants provided explicit recommendations to improve telepalliative care delivery for acute oncology inpatients in the future. Conclusion: Palliative care clinicians experienced personal and professional distress providing inpatient telepalliative care during this COVID-19 surge. Clinician strain providing telehealth services must be explored further as the pandemic and utilization of telehealth evolves. Telepalliative care planning must include attention to clinician wellbeing to sustain the workforce and promote team cohesion, and a focus on infrastructure needed to deliver high-quality, holistic care for oncology patients and their families when in-person consultation is impossible. © The Author(s) 2022.
Keywords: neoplasm; neoplasms; palliative care; palliative therapy; oncology; communication; health care delivery; delivery of health care; telemedicine; pandemic; multidisciplinary; procedures; telehealth; humans; human; pandemics; covid-19
Journal Title: American Journal of Hospice & Palliative Medicine
Volume: 40
Issue: 2
ISSN: 1049-9091
Publisher: Sage Publications  
Date Published: 2023-01-01
Start Page: 235
End Page: 243
Language: English
DOI: 10.1177/10499091221101883
PUBMED: 35574961
PROVIDER: scopus
PMCID: PMC9663759
DOI/URL:
Notes: Article -- MSK Cancer Center Support Grant (P30 CA008748) acknowledged in PubMed and PDF -- MSK corresponding author is William Rosa -- Export Date: 1 February 2023 -- Source: Scopus
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MSK Authors
  1. Patricia Ann Parker
    91 Parker
  2. William   Rosa
    220 Rosa
  3. Kathleen A Lynch
    72 Lynch