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J Pain Symptom Manage · Jan 2025
Quality of Virtual versus In-Person Outpatient Palliative Care: Disparities by Language and Race.
- Sarah Nouri, Steven Z Pantilat, Christine S Ritchie, Courtney R Lyles, Ying Shi, David O'Riordan, John Boscardin, and Rebecca L Sudore.
- Division of Palliative Medicine, Department of Medicine, University of California San Francisco, San Francisco, California. Electronic address: sarah.nouri@ucsf.edu.
- J Pain Symptom Manage. 2025 Jan 3.
ContextVirtual visits have increased in outpatient, clinic-based palliative care (OPC). The association between virtual visits and OPC outcomes is largely unknown.Objectives(1) Examine the association between visit type (virtual vs. in-person) and screening (yes/no) for psychosocial, spiritual, and goals of care needs. (2) Assess effect modification by language.MethodsWe used data from the Palliative Care Quality Network (01/2017-03/2021). We conducted multivariable analyses adjusting for age, sex, diagnosis, self-reported race-ethnicity, and language, clustered by site, and included an interaction term to assess effect modification by language.ResultsAmong 2,684 patients, 29% had a virtual visit; 50% were ≥65 years old, 24% non-English preferred languages; 18% identified as Hispanic, 9% Black, 17% Asian, 6% Native Hawaiian/Pacific Islander. There were no differences by visit type in screening for psychosocial (aOR 0.87 vs. in-person visits, 95%-CI 0.60-1.25), spiritual (aOR 0.81, 95%-CI 0.57-1.15), or goals of care needs (aOR 1.05, 95%-CI 0.85-1.31). Patients with non-English preferred languages (vs. English-speaking) had significantly lower odds of screening regardless of visit type. Patients identifying as Black (vs. White) also had significantly lower odds of screening.ConclusionsThere were no differences by visit type in screening for psychosocial, spiritual, and goals of care needs. Patients with preferred languages other than English were significantly less likely to be screened than English speakers, though there was no further difference by visit type. Patients identifying as Black were also significantly less likely to be screened. Addressing these disparities in core OPC elements is essential in providing equitable, high-quality OPC.Copyright © 2025. Published by Elsevier Inc.
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